Orchialgia refers to pain in the testis….usually pain that has been present for a long time. That is why it is often refried to as chronic testicular pain. The pain might be intermittent or constant and considered by the patient to be a bothersome discomfort. The might also be of such significant intensity that it is disabling. No matter what the presentation, in many cases, it markedly impairs the patient’s quality of life.
There are many potential causes for orchialgia. The most common ones being injury, infection, surgery (post vasectomy pain syndrome especially0, pain from cancer and potentially testicular torsion (although testicular torsion most often is associated with a sudden onset of pain and should be considered a medical emergency).
Diagnosis often entails ruling out significant medical concerns such as cancer and testicular torsion. Evaluation should begin with a thorough history including a description of the type, duration and onset of the pain as well as what makes it worse and what might make it better. A physical examination includes evaluation of the male genitalia as well as unrelated causes that might refer pain to the region. These might include kidney stone disease, diverticulitis as well as bladder and prostate diseases. A urine analysis is essential. Blood testing and imaging studies (in particular scrotal ultrasound) might also be needed.
Treatment depends upon the intensity of the pain, how long the pain has been present as well as whether there is evidence of an infection as the cause. Non steroid anti-inflammatory drugs (NSAID) such as ibuprofen and naproxen either alone or in combination with antibiotics are often first line drugs. I have also been using acupuncture, a painless and minimally invasive treatment is often effective in either controlling, reducing and in some cases, eliminating the pain of orchialgia.
When conservative modalities are not effective surgical approaches are an option. However, they should not be considered as a primary treatment modality. The most common surgery performed is called a microsurgical denervation of the spermatic cord and should be performed by an expert urologic microsurgeon. Prior to this procedure a spermatic cord block is necessary. In this simple office procedure an anesthetic like lidocaine is infiltrated along the spermatic cord. Complete elimination of the patient’s pain should occur within 10 minutes. If pain is not gone or significantly reduced, then it is unlikely that a microsurgical denervation of the spermatic cord will be effective in reducing the patient’s pain.
Please feel free to contact Dr. Gilbert directly for questions.
Bruce R.Gilbert, M.D., Ph.D. at 516-487-2700 or info@BruceGilbertMD.com