Causes of Testicular Pain
Many men deal with testicular pain at some point in their lives. For some, the pain is mild and disappears on its own, while others experience persistent, severe pain. The causes of testicular pain are treatable and can include:
- trauma,
- infection,
- prior testicular surgery,
- testicular torsion,
- post-vasectomy pain,
- pelvic floor dysfunction, and
- neurologic disease.
Testicular Pain Diagnosis
At your appointment, we ask you questions about the pain you're experiencing and examine your testicles for any abnormalities, such as swelling or lumps. We may even run a urine test, scrotal ultrasound, or blood test to confirm the cause of your testicular pain. Before we choose a treatment plan, we need to determine if the pain is local (in the testicles) or central (from something affecting your whole body). Since pain can exist in any body part for a long time, your brain may misinterpret any stimulation or feeling in that area as pain. This type of miscommunication is often a result of old trauma, an infection, or neurologic problems like diabetic neuropathy (nerve damage caused by diabetes). Pain can still continue even if the infection or painful part is gone. To determine where your pain is coming from, we inject a local anesthetic and steroid into the spermatic cord (a collection of blood vessels in the scrotum that supplies blood to the testicles) in the area of the groin where you feel pain. We use this technique to see if the pain is in your testicle or is affected by your brain and nervous system. If the anesthetic temporarily relieves your testicular pain, then the pain is probably in your testicle and not your brain.
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Testicular Pain Treatment
We treat testicular pain by treating each of the causes for the condition.
Testicular torsion: We use surgery to untwist the testicle in an attempt to save it. Any prolonged delay could cause the death of the testicle.
Trauma: We either allow it to heal or operate on it to fix a ruptured testicle. Our treatment depends on the severity of the trauma.
Post-vasectomy pain: We may prescribe you pain medication, operate to remove the nerves from the spermatic cord, or reverse the vasectomy.
Neurologic disease: We treat the neurologic condition.
In some men, medications or other interventions do not work. For these cases, we perform a spermatic cord block. A spermatic cord block is a two-minute procedure where we grasp the spermatic cord through the skin and insert a small needle with local anesthesia into it.
If the anesthesia makes the testicular pain better, we recommend proceeding with a microscopic denervation of the spermatic cord.
Microsurgical Denervation of the Spermatic Cord
For this procedure, we dissect the nerve inside the spermatic cord because it supplies the testicle with nerves. Cutting this nerve can successfully reduce the pain by 50 percent or greater. In fact, more than 90 percent of our patients have seen a 70 to 100 percent reduction in their pain.
Most insurance plans will cover this procedure. However, check with your insurance company before scheduling the surgery.
Preparation for Surgery
Make sure you follow these rules before undergoing surgery:
- Eat like you normally would the evening before your surgery.
- Do NOT eat or drink anything after midnight, including the morning of surgery.
- If you have medication you need to take the morning before your surgery, only take them with a small sip of water.
- Wear loose, comfortable clothing.
Procedure
We perform this surgery in the operating room and make a small incision in the groin, similar to where a hernia repair is done. If a hernia repair was already done, we go through the previous scar. You can opt for local or general anesthesia before the surgery.
The spermatic cord contains arteries, nerves, the vas deferens, and lymphatic vessels. We cut the nerves under an operating microscope and keep the testicular arteries, lymphatics, and vas deferens intact. This method preserves the testicle’s blood supply and blocks the nerve transmission from the testicle. We finish up by using dissolvable stitches and tissue glue to close the incision.
The entire surgery takes only one hour, which means you can go home the same day.
As with any procedure, there are risks to a spermatic cord denervation, such as:
- no pain relief,
- hydrocele formation (fluid accumulation in the testicles),
- loss or compromise of the testis, and
- numbness of the scrotum and inner thigh on the operated side.
After-Surgery Care & Recovery
For the first 24 hours after your surgery, do not:
- drive,
- use machinery,
- eat any heavy or large meals,
- drink alcohol, or
- make important decisions because the anesthesia can make it hard to think clearly.
Expect bruising, swelling, tenderness, inflammation, and pain after surgery. Many men report an immediate change in the type of pain, from deep neuropathic pain to superficial inflammatory pain. This postoperative pain will fade over time.
Make sure you take the following steps for a speedy recovery:
- For the first three days, take 800mg of Ibuprofen every eight hours and 650mg of Tylenol every six hours around the clock. Use narcotic pain medication only if needed.
- Ice the area for 20 minutes out of every hour to relieve pain.
- No sex, masturbation, or lifting heavy objects more than 25 pounds for a week.
- You may shower the day after surgery, but baths are not allowed for one week.
Pain Management for Chronic Scrotal and Testicular Pain
For men who do not respond to therapies such as local injection or microscopic denervation of the spermatic cord, we will need a different approach to manage the pain. Chronic pain management is best left to doctors who specialize in treating pain.
Our treatment policy is as follows:
- We do not prescribe any narcotic pain medications, except in the immediate postoperative period.
- All patients being evaluated for pain must have a backup plan that includes a physician or provider in their local area who is willing to provide long-term pain management in the event this is required. It is the patient's responsibility to arrange this with the physician or clinic of their choice.
- Under no conditions will we manage pain before surgery or provide prescriptions for controlled substances after the immediate post-surgery recovery period (two weeks). This is done for your safety.
If you need clarification, please do not hesitate to discuss this issue with us. Contact our office at 801-587-1454 with any questions or concerns.
Next Steps
If you would like to see a specialist for testicular pain, you can call our office at 801-587-1454 to make an appointment.
