The Tribune

By GREGGORY PINTO

Chronic scrotal pain is described by sufferers of this affliction as the equivalent of being kicked in the testicles several times a day, often with lingering, long-lasting pain.

Chronic scrotal pain has multiple possible causes and may be related to the condition called chronic pelvic pain syndrome.

The pain may be originating in or confined to one testicle, or it might be bilateral.

These conditions are unfortunately very common and they were recently highlighted and discussed at the 113th Annual Scientific Meeting of the American Urological Association (AUA) in May this year.

Chronic testicular pain, also known as orchialgia, is constant scrotal pain, often without any known cause. The condition, sadly, can have a profound negative effect on a man’s quality of life.

Chronic testicular or scrotal pain is very common and often affects most men at some point in their lives.

Many men when they experience this sometimes debilitating pain often think testicular cancer. Fortunately, this is rarely the case, and men of African ancestry have very low incidences of testicular cancer. Most testicular cancer cases are in fact painless.

Sexually transmitted diseases (STDs) are a potential cause, but if it is, you are also likely to have experienced a penile discharge and pain on urination.

Infection of the testicle(s), or the tail appendage attached to it could lead to unilateral or bilateral scrotal pain.

There is a very long list of possible causes of testicular or scrotal acute and chronic pain, and thankfully most of them are benign in their cause and can be cured. These causes can include:

• Hydroceles, which are very common. They are simply an increase in the accumulation of naturally occurring fluid that bathes the testicles.

• Epididymal cysts and spermatoceles are also relatively common and harmless causes of scrotal pain that many men experience.

• Inguinal scrotal hernias are swellings in the scrotum and groin region associated with the contents of the abdomen protruding through an anatomical defect.

• Varicoceles are an enlargement of the veins of the testicles and often has the appearance of a bag of worms, and sadly it can lead to impaired male fertility.

Scrotal pain can originate elsewhere in the body and the pain can be referred to either or both testicles because of shared nerve supply. Such is sometimes the case with lumbar vertebrae disorders, kidney stones and constipation or bowel and stomach related disorders.

Acute or chronic infection of the prostate known as prostatitis is a common disorder that may lead to acute or chronic scrotal pain. Previous trauma or surgeries may also cause scrotal pain.

Testicular torsion is a surgical emergency that occurs in newborns or prepubertal to young adult age men, whereby the testicle may twist on itself, impairing the blood supply and the testicles’ survival is dependent on the surgeon untwisting the affected testicle and its fixation so that the twisting cannot occur again in either testicle.

As many as one quarter of scrotal pain cases have no known organic identifiable cause and their treatment can provide a challenge to the patient and his urologist.

These cases of orchialgia have been found in many long-term studies to have a psychological component and the pain often aggravated by stress.

Management starts with treatment of the root cause and that often involves medical management with antibiotics and/or analgesics or pelvic floor therapy or minimally invasive surgery as required.

Debilitating chronic scrotal pain that unfortunately affects many men may be effectively treated by microsurgery involving the denervation of the nerves in the spermatic cord.

A 2015 long-term study provided positive evidence that Botox injections can provide relief for chronic scrotal pain.

Chronic scrotal pain can potentially interfere with a man’s social and sexual life. Do not suffer needlessly in silence, as effective treatment is readily available.

• Dr Greggory Pinto is a Bahamian urologist who has trained in South Africa, Germany and France. He is a member of the European Association of Urologists. Dr Pinto can be reached at Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, Collins Avenue and Sixth Terrace. Call 326-1929, e-mail welcome@urologycarebahamas.com, or visit urologycarebahamas.com.