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Orchialgia

Orchialgia is a topic covered in the 5-Minute Clinical Consult.

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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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Citation

Stephens, Mark B., et al., editors. "Orchialgia." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. 5minute, www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816860/all/Orchialgia.
Orchialgia. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816860/all/Orchialgia. Accessed April 20, 2019.
Orchialgia. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816860/all/Orchialgia
Orchialgia [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 20]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816860/all/Orchialgia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Orchialgia ID - 816860 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816860/all/Orchialgia PB - Wolters Kluwer ET - 27 DB - 5minute DP - Unbound Medicine ER -