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Pelvic/groin pain
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Pelvic/groin pain

40 yr old male with pain around scrotum, right side of lower abdomen, groin (both sides) and tail bone (both sides).  Pain is most extreme when sitting.  Up until 3 yrs ago, I had done a lot of jogging, weightlifting, and sit-ups.  Pain began about 3 years ago after case of epididymitis (ep) in left testicle.  Prior to then, both testicles hung rather evenly and freely in the scrotum.  

During the ep episode, I wore a jock strap for several weeks to relieve the pain until the (ep) cleared up.  Since then, the right testicle is now much higher and tighter than it used to be.  In fact, it often feels like the right testicle moves onto it's side, almost upside down, and in all different directions inside the scrotum, especially when the pain is the greatest.

I sleep on my side, and I now need to keep a pillow between my knees when I sleep.  With my legs too close together, I get the painful feeling like I've been punched in the scrotum.

We all know that exposure to cold causes the muscle fibers in the scrotal sac to contract and wrinkle up.  However, since the pain began, my scrotum is in almost constant state of contraction, except after a very hot bath.

Also have some mild lower back pain around L4-L5.

Been to several urologists, who all dismissed the movement of the right testicle as insignificant.  I've been on Doxycycline for about a week now, and I'm just starting some pelvic floor physical therapy, but all doctors I've seen have been stumped as to exactly how to treat?

Could this be a cremaster muscle disorder or neurological condition?  Any thoughts on how to proceed with treatment?
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You can consider things like infection or testicular torsion - can't say for sure without examination.  If you have been to several urologsits, it is less likely that a serious disorder is present.  

A scrotal ultrasound can be considered to evaluate the anatomy of the testicles.  You can also consider analyzing the urine to ensure there is no infection.

If the ultrasound is negative, you can consider a surgical referral to evaluate for the possibility of a hernia.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b
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