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Testicle and groin pain

      Re: Testicle and groin pain

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Posted by HFHS M.D.-MS on March 04, 1998 at 09:20:26:

In Reply to: Testicle and groin pain posted by Jerry on March 02, 1998 at 12:21:39:
  I'm experiencing pain on the top of my right testicle, and it seems to radiate into my groin area.  I've been to a Urologist and he says that the ultra sound tells him there is no cancer; he also did a Cystoscope and said there was no bladder or urethea problems.  He has checked my urine numerous times and says that is all perfectly alright.  He has tried Floxin (200 MG 2X a day for 12 Days) and Doxycycline (100 MG 2X a day for 10 days ) three times and nothing seems to work.  He also says my prostate is a little enlarged, but nothing to be concerned about.  I'm in a quandary, and I have a feeling that my Urologist is also.  I forget the word he used, but he said he could cut this cord or muscle that runs over the top of my right testicle, and he feels that would stop my constant pain and the groin pain also.  I am naturally very concerned about an operation, and more so in this area.  I had a knee injury and had to take Prednisone for 6 days (20 MG 3X a day for 2 days, 2X a day for 2 days, and 1X a day for 2 days), but while I was taking this medicine for my knee I did not have any pain in my testicle or groin.  Could there be a connection??  I really want this problem solved with time or medicines, and put off any kind of surgery if possible.  Your help and guidance would dearly be appreciated.  Thanks!!
Dear Jerry ,
Thanks for your questions.
It seems like you have had a thorough work-up. Chronic pain in the area you describe is not too rare. Several structures in this area can cause pain. Since you have been on antibiotics, this probably rules out any infectious cause.    If you have had a vasectomy, you could be one of the few percent of patients which have chronic  pain after such a procedure.  This can be due to irritation of the nerve, or rupture of the epididymis from back pressure. The epididymis is the tube closest to the testicle which  carries  sperm. An epididymal rupture has an acute onset and usually resolves over a week.  Varicocele can also cause pain, but usually when they are large.  This is a varicose vein of the scrotum.   This maybe what the doctor is describing.   It is diagnosed with a scrotal exam and can be seen on ultrasound if questionable.   Surgery can offer relief from pain but may not.   You could  have a cyst in the epididymis which is benign and rarely needs surgery for pain control.  This would be seen on the ultrasound.   An inguinal hernia would be the other possibility which may also explain your groin discomfort.   A hernia usually presents as a bulge in the groin.  It is recommended that this condition be corrected surgically before it gets larger or causes more problems.
The relief with steroids is an interesting observation.  Most benign pathology in the region that does not require surgery usually responds to  Ibuprofen  or  Tylenol taken on a regular bases.  Tylenol,  ibuprofen and aspirin all work to decrease inflammation like steroids but are much safer.   Remember to stick to Tylenol if you have peptic ulcer disease.  Some patients find relief with supportive underwear or athletic supporter while others get relief from sitting in a warm tub of water once or twice a day.  Injection of a long acting local anesthetic along the spermatic cord leading to the testicle may also break the cycle of pain.  This can be performed by your urologist or an anesthesiologist specializing in chronic pain.
Hope this has helped.
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