Right Groin Discomfort: Seeking the Right Medical Advice

Right groin?

Since last summer, I've been experiencing discomfort on the right side of my body, starting with pain that is hard to describe.
The uncomfortable area is located to the right of my right testicle, in the perineum, and the upper right side of my anus (initially, it felt tight and swollen).
Up to now, I have visited: Yang Ming Hospital's Family Medicine Department, Urology Department (where I underwent physical examination, urinalysis, and blood tests), and the doctors all said everything was normal (the pain started to increase).
I also went to Yang Ming Hospital's Rehabilitation Department and Orthopedics (where I had X-rays taken), and the doctors said the X-ray results looked normal (by this point, I had taken countless muscle relaxants but still felt very uncomfortable).
Additionally, I sought acupuncture from Dr.
Zhuo Qingfeng in Chiayi City, who believed it was related to my lower back (after this treatment, the pain diminished).
A general surgeon at St.
Martin's Hospital also thought it was a muscle issue, while a neurologist there suspected it was an internal hemorrhoid (after taking the medication prescribed by this doctor, the pain subsided).
When I returned to the general surgeon at St.
Martin's, he stated it was not hemorrhoids and prescribed anti-inflammatory pain medication related to the muscles along with Vitamin C.
As of now, I still feel a sense of swelling, especially after exercising, and the discomfort in that area feels like muscle tightness, but only on the right side; the left side does not have this issue.

Doctor, which specialty should I consult? I have already taken many muscle relaxants, and I truly believe this is not a muscle problem.
The discomfort in that area feels swollen after exercising, similar to the feeling of holding back ejaculation during masturbation, but this sensation only occurs on the right side, not the left.
Please, I would appreciate any advice, as I am really confused, especially since I will be enlisting in the military after graduation.

stu10123, 20~29 year old female. Ask Date: 2012/05/06

Dr. Wu Jiyu reply Internal Medicine

First, let's clarify a few points that may not seem related to nephrology (I am a nephrologist).

1.
Where exactly do you feel discomfort? Is it in the scrotum, inner thigh, perineum, or near the anus? A physician examining you in person would have a better understanding of the location, as different areas have different differential diagnoses and considerations.
You mentioned, "The uncomfortable area feels swollen after exercising, similar to the feeling of holding back ejaculation during masturbation." Did you explain this to the urologist? If the discomfort is in the scrotum, it may indicate a urological issue (though if the physician performed a physical examination, it likely wouldn't be a scrotal problem).
2.
You mentioned "St.
Martin's neurology" and that "the pain has stopped since taking the medication prescribed by this doctor." If your discomfort is near the anus or in the perineum, it could be related to an anal issue (not necessarily hemorrhoids).
Although general surgery may not consider it hemorrhoids, it might be worth consulting a neurologist or a general surgeon (or in some medical facilities, a colorectal surgeon) to see if they can address your concerns.

Lastly, this area contains many muscles, ligaments, and nerves.
If your discomfort is in the inner thigh or deeper in the buttocks, it could be due to these tissues being "pinched." In that case, you might need to see a rehabilitation specialist (for example, piriformis syndrome can cause deep buttock pain).

Reply Date: 2012/05/06

More Info

Understanding right groin discomfort can be quite complex, especially when the symptoms are vague and the discomfort persists despite multiple consultations with various specialists. Based on your description, it seems you have already seen a range of healthcare providers, including family medicine, urology, rehabilitation, orthopedics, and even traditional Chinese medicine, without a definitive diagnosis or relief from your symptoms.

The term "nosological entity" refers to a specific disease or condition that can be classified and diagnosed based on established medical criteria. In your case, the discomfort you are experiencing in the right groin area could stem from various underlying issues, including muscular, neurological, or even vascular problems. The fact that you have undergone multiple tests, including blood tests, urinalysis, X-rays, and physical examinations, suggests that the more common causes of groin pain have been ruled out.

Given that you have described a sensation of tightness or discomfort that worsens with physical activity, it may be beneficial to consider a few potential avenues for further investigation:
1. Musculoskeletal Issues: While you mentioned that you feel it may not be a muscular issue, it is still worth considering that there could be a strain or a minor injury that has not been adequately addressed. A referral to a sports medicine specialist might provide a more focused approach to diagnosing and treating any potential soft tissue injuries.

2. Neurological Evaluation: Since one of the doctors suggested that it might be related to internal hemorrhoids, it could be beneficial to have a thorough neurological evaluation. Conditions such as nerve entrapment or referred pain from the lumbar spine could manifest as groin discomfort. A neurologist may conduct further imaging studies, such as an MRI of the lumbar spine, to rule out any nerve-related issues.

3. Urological Assessment: Given the location of your discomfort, a follow-up with a urologist might be warranted, especially since you have experienced discomfort around the testicular area. Conditions such as epididymitis or testicular torsion (though less likely given your description) should be ruled out.

4. Pelvic Floor Dysfunction: Sometimes, groin discomfort can be attributed to pelvic floor dysfunction, which can cause a range of symptoms, including pain and discomfort in the pelvic region. A pelvic floor physical therapist could provide specialized treatment and exercises to help alleviate your symptoms.

5. Psychosomatic Factors: Lastly, it is essential to consider that chronic pain can sometimes have a psychosomatic component. Stress and anxiety can exacerbate physical symptoms, and addressing these factors through counseling or therapy may also be beneficial.

In conclusion, while it can be frustrating to navigate through various medical opinions without a clear diagnosis, it is crucial to advocate for yourself and seek further evaluation if your symptoms persist. A multidisciplinary approach involving specialists in musculoskeletal medicine, neurology, urology, and pelvic health may provide a more comprehensive understanding of your condition. Additionally, keeping a detailed symptom diary that tracks your discomfort in relation to activities, medications, and other factors could help your healthcare providers identify patterns and potential triggers. Remember, it is essential to communicate openly with your healthcare team about your concerns and the impact of these symptoms on your daily life, especially as you prepare for your upcoming military service.

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