What to exclude first
- Testicular tumor is a mandatory examination for any pain in the scrotum, even if it is chronic
- Testicular torsion and intermittent torsion - during episodes of acute pain
- Epididymitis and orchitis, including chronic
- Varicocele
- Large hydrocele and spermatocele
- Chronic prostatitis and chronic pelvic pain syndrome
- Stone in the lower third of the ureter - pain radiates to the testicle
- Inguinal hernia, including small and unobvious ones
- Pathology of the spine and pinched nerve roots
- Consequences of operations: hernia repair, vasectomy, scrotal surgery
- Tuberculosis of the genitourinary system with a long course
Отдельно отметим: боль в яичке нередко оказывается отражённой. Источником могут быть мочеточник, тазобедренный сустав, позвоночник или передняя брюшная стенка. Поэтому обследование не ограничивается мошонкой, а при нормальном УЗИ поиск продолжают за её пределами.
Reasons that are often not thought about
- Post-vasectomy pain syndrome - pain after sterilization surgery
- Pain after hernia repair due to nerve damage or involvement in the scar, especially when using mesh
- Ilioinguinal or genital femoral nerve entrapment
- Myofascial syndrome of the pelvic floor and anterior abdominal wall muscles
- Pathology of the lumbar spine
- Neuropathic pain after injury or inflammation, when the original cause has already been eliminated, but the pain persists
- Psychological factors: anxiety, depression, catastrophizing of sensations - not a “fiction”, but a real mechanism for increasing pain
Diagnostics
- Detailed conversation: the nature of the pain, what intensifies and what alleviates, connection with load, body position, urination, ejaculation
- Examination of the scrotum, groin areas, abdomen; scrotal lift test
- Ultrasound of the scrotum with Doppler sonography is a mandatory study
- General analysis and urine culture
- Screening for sexually transmitted infections
- TRUS of the prostate and assessment of prostatic secretions for suspected prostatitis
- Ultrasound of the kidneys and ureters - stone exclusion
- Ultrasound of the groin areas - search for a hernia
- Spermogram when planning pregnancy
- MRI of the lumbar spine if a neurological cause is suspected
- Tumor markers for a suspicious ultrasound picture
- Assessing anxiety, depression and sleep quality
Treatment: What Really Works
The approach is always stepwise: they start with the least traumatic methods and move on to more serious ones only if they are ineffective.
- Elimination of the identified cause: treatment of varicocele, hydrocele, infection, stone, hernia
- Short course non-steroidal anti-inflammatory drugs
- Wearing supportive underwear, limiting provoking loads
- Thermal procedures outside the period of acute inflammation
- Working with the pelvic floor muscles: relaxation techniques, physiotherapy, manual techniques
- Drugs that affect the neuropathic component of pain - as prescribed by a doctor
- Spermatic cord blocks are both diagnostic and therapeutic: relief after block indicates a neural component
- Microsurgical denervation of the spermatic cord - with a confirmed effect of blockades
- Epididymectomy for pain clearly localized in the appendage
- Psychotherapy and work with chronic pain
- Orchiectomy is a last resort, rarely discussed and after other options have been exhausted.
О чём стоит сказать прямо: повторные курсы антибиотиков при хронической боли в мошонке без доказанной инфекции неэффективны. Первый курс при подозрении на воспаление оправдан, но третий и четвёртый — уже нет: они не снимают боль, зато формируют устойчивость флоры и затягивают поиск истинной причины.
What you can do yourself
- Wear supportive underwear, especially during physical activity
- Avoid long-term cycling on a hard saddle and other provoking loads.
- Take breaks during sedentary work
- Establish regular bowel movements
- Master techniques for relaxing the pelvic floor muscles - in this condition, it is relaxation rather than strengthening that is useful
- Normalize sleep: lack of sleep significantly increases the perception of pain
- Keep a pain diary: what makes it worse, what makes it easier - it really helps the doctor
- Do not self-prescribe antibiotics
- Do not delay treatment if a lump appears in the testicle
Realistic Expectations
It is important to say this honestly: with chronic pain in the scrotum, it is not always possible to find a specific cause and completely eliminate the pain.
- A realistic goal is a significant reduction in pain intensity and a return to normal life, not necessarily its complete disappearance
- Treatment often takes months and requires patience
- A combination of methods helps, rather than searching for one “right” remedy.
- Changing doctors in search of a quick solution usually lengthens the journey
- Chronic pain changes the functioning of the nervous system, so working with pain perception is a full-fledged part of treatment, and not a sign that “the pain is made up”
Where to get examined in Tashkent
An appointment with a urologist, ultrasound of the scrotum with Doppler sonography, laboratory examination and, if necessary, assessment of the prostate and spine are necessary.
In Tashkent, such examination and treatment, including surgical correction of identified causes, are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Bring to your appointment all previous examinations and a list of completed courses of treatment: this will save you from repeating what has not helped and will speed up the search for the cause. Clinic contacts are below.
