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

• 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