Is Severe Pain in the Spermatic Cord Normal? Causes and Solutions

Q: Is Severe Pain in the Spermatic Cord Normal? Causes and Solutions

Miss Sun： (Please forgive me if I am guessing incorrectly) The pain associated with varicocele is quite distinctive： 1. <br>It typically occurs after prolonged standing, physical activity, in the evening, or at night. <br>It usually affects the left side, with the right side bein

Is it normal to experience severe pain in the spermatic vein area?

Hello Dr.
Hsu, I need your help.
My husband is currently in the United States.
Since July of last year, he has been experiencing significant pain around his testicles, described as a sharp pain.
In September, he was diagnosed with varicocele and prostatitis, but the doctor said it shouldn't be causing him this much pain.
However, he sometimes experiences pain severe enough to break out in a cold sweat, and he is still in pain every day.
He previously had an injury near his penis and testicles, and the doctor is seeking a second opinion from a sports medicine specialist.
I am very anxious and hope he can have surgery soon.
Please help me with the following questions:
1.
Can varicocele cause such severe pain, or could there be other conditions causing this pain?
2.
Can prostatitis cause pain?
3.
After several months of delay, is there a risk that the testicle may have become necrotic? Is there a way to determine this through appearance or other methods?
4.
Would taking a hot bath help alleviate the pain?
5.
Should he have surgery sooner, or should we wait for the sports doctor's advice to address all issues at once? But I am unsure how long that will take, as it takes a long time to see a doctor in the U.S.
It has already been almost six months, and I am really anxious and feel helpless! Would it be better to return to Taiwan for treatment? Dr.
Hsu, please help me, as I am truly at a loss.
Seeing him in pain every day breaks my heart.
Thank you!

Qing bang bang wo!, 30~39 year old female. Ask Date: 2006/02/15

Dr. Xu Weikai reply Urology

Miss Sun: (Please forgive me if I am guessing incorrectly) The pain associated with varicocele is quite distinctive: 1.
It typically occurs after prolonged standing, physical activity, in the evening, or at night.
It usually affects the left side, with the right side being rare.
2.
As American physicians describe, the pain is generally dull and aching, occasionally sharp, and may even radiate to the perineum (the area around the anus).
Regarding prostatitis, the pain can vary significantly in intensity and nature, meaning it differs from person to person.
Sometimes, in cases of chronic prostatitis, symptoms can be quite bizarre, including frequent urination and painful urination.
However, prostatitis mostly occurs in older male patients.
Given your reported age (35), your husband should not be over 40 years old, and even if he experiences prostatitis, it is usually easily treatable and rarely progresses to a chronic condition.
Testicular necrosis is very rare due to epididymitis, varicocele, or prostatitis; it seldom occurs clinically.

When it comes to treatment, approaches vary based on individual differences.
My personal recommendations are as follows, and I hope they are helpful: 1.
If local heat application alleviates the pain, continue doing it daily, but ensure the temperature is not too high, generally around 45-55°C (113-131°F) is appropriate.
If symptoms do not improve or worsen after warm baths or heat application, there may be a concurrent bacterial infection, and it is best to perform a urine/prostate fluid culture and treat based on the culture results.
2.
If there is clinical evidence of a bacterial infection, antibiotics are generally prescribed for at least 6 weeks, and in some cases, treatment may extend up to 12 weeks.
3.
For uncomplicated varicocele, surgical recovery typically takes about 3-6 months, so improvement in pain should be limited.
Personally, I believe that varicocele should not be that painful.
4.
My personal speculations and suggestions: (1) For chronic prostatitis, urine, semen, and prostate massage fluid tests can be conducted to confirm the presence of infection.
If no infection is found, consider physical therapies like heat or cold application to relieve pain.
(2) It could be due to previous injury leading to fibrosis or neuropathic pain, which can sometimes be difficult to diagnose.
(3) Occasionally, urinary tract stones, especially those in the upper ureter, can cause referred pain to the testicles due to nerve pathways.
An abdominal X-ray (KUB, plain abdomen X-ray) or renal ultrasound may be considered for diagnosis.

I have written a lot of information, much of which is speculative, and I hope it helps you.
If you have further test results, feel free to discuss them.

Director of Urology, Taitung Hospital, Department of Health, Executive Yuan, Hsu Wei-Kai.

Reply Date: 2006/02/15

More Info

Severe pain in the spermatic cord and surrounding areas can be concerning, and it’s understandable that you are feeling anxious about your husband’s condition. Let’s break down the potential causes of his pain and discuss possible solutions.

1. Varicocele and Pain: Varicocele, which is an enlargement of the veins within the scrotum, can indeed cause discomfort and pain. While it is often asymptomatic, some individuals experience significant pain, especially if the varicocele is severe. The pain can be exacerbated by prolonged standing, physical activity, or sexual arousal. It’s important to note that while varicocele can cause discomfort, it is not typically associated with severe pain that causes sweating. If the pain is severe, it may indicate other underlying issues.

2. Prostatitis: Prostatitis, or inflammation of the prostate gland, can also lead to pelvic pain, which may radiate to the testicular area. Symptoms can include pain during urination, discomfort in the lower abdomen, and pain during ejaculation. If your husband has been diagnosed with prostatitis, it could certainly contribute to his pain. Treatment typically involves antibiotics and anti-inflammatory medications, and it may take time to see improvement.

3. Other Potential Causes: Given your husband’s history of injury to the area, it’s possible that there could be scar tissue or nerve damage contributing to his pain. Other conditions, such as testicular torsion (which is a medical emergency), hernias, or infections, should also be ruled out. If the pain is persistent and severe, further imaging studies like an ultrasound may be necessary to assess the condition of the testicles and surrounding structures.

4. Concerns About Testicular Viability: Regarding your concern about whether the testicles could be damaged or "dead," it is crucial to understand that testicular torsion can lead to loss of the testicle if not treated promptly. However, if your husband’s pain has been ongoing for several months without acute symptoms (like sudden severe pain, nausea, or vomiting), it is less likely that he is experiencing torsion. An ultrasound can help determine blood flow to the testicles and assess their condition.

5. Hot Baths and Pain Relief: Soaking in warm water may provide temporary relief from pain, as heat can help relax muscles and improve blood flow. However, this is a symptomatic treatment and should not replace medical evaluation and treatment.

6. Surgical Intervention: The decision to proceed with surgery should be made in consultation with a urologist. If the varicocele is confirmed to be the source of significant pain and discomfort, surgical intervention may be warranted. It is also essential to consider the recommendations of the sports doctor, especially if there are concerns about previous injuries. Waiting for a comprehensive evaluation may provide a clearer picture of the best course of action.

7. Seeking Care: If your husband is experiencing significant pain that impacts his daily life, it may be worth seeking care sooner rather than later. If the wait times in the U.S. are long, and you feel that his condition is worsening, returning to Taiwan for a more immediate evaluation could be a viable option.

In conclusion, while varicocele and prostatitis can cause pain, it is essential to rule out other potential causes. A thorough evaluation by a urologist, including imaging studies, may be necessary to determine the best treatment plan. Your husband’s pain is valid, and it’s important to advocate for timely and effective care.

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