Orchialgia

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5-Minute Clinical Consult

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Basics

Description

  • Chronic scrotal pain of at least 3 months duration arising from any intrascrotal structure and negatively affecting quality of life
  • Pain may be intermittent or constant, unilateral or bilateral, direct (infection, obstruction, tumor, or trauma) or referred. In many cases, pain is idiopathic.

Epidemiology

Incidence
  • Majority of patients present in mid- to late 30s.
  • Affects up to 6% of postvasectomy patients (1)

Prevalence
Up to 0.4% of men, overall (1)

Etiology and Pathophysiology

  • Trauma
  • Infection
    • Epididymitis
    • Prostatitis
    • Urinary tract infection
  • Postvasectomy
  • Other abdominal, scrotal, or testicular surgery
  • Nerve entrapment
  • Torsion or posttorsion
  • Urethral stricture
  • Hydrocele
  • Testicular tumor
  • Radicular pain
    • Vertebrogenic
    • Ureteric calculi
    • Indirect inguinal hernia
    • Aortic or common iliac artery aneurysm
    • Retroperitoneal tumor
  • Psychological
    • Sexual abuse
    • Stress
    • Depression
  • Vitamin B12 and/or testosterone deficiency
    • A small 2016 study showed that 76% of men with chronic testicular pain were deficient in either vitamin B12 or in testosterone (2).

Pathophysiology

  • Poorly understood
  • Afferent innervation via somatic nerves in the genital branch of the genitofemoral and ilioinguinal nerves implicated in chronic pain
  • Referred pain may be due to entrapment neuropathies involving the pudendal nerve, aneurysms, obstruction of the pelviureteric junction, or other disorders.

Risk Factors

  • Vasectomy
  • Other scrotal or abdominal surgery
  • Bicycle riding
  • Horseback riding
  • Long periods without postural changes
  • Heavy lifting
  • Intercourse

Commonly Associated Conditions

  • Low back pain
  • Clinical depression

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