What to Do When Testicle Pain Won’t Go Away

African American doctor talking to patient in office
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Men might not talk about it, but it’s quite common to have pain in your testicles or scrotum at some point in your life. It’s why many men see a urologist.

Called “orchialgia” (pronounced or-kee-ALL-jee-ah), long-term testicle pain can affect men of any age, from adolescents to the elderly.

In some men, the pain is sudden and severe. In others, the pain worsens gradually over several months. Some men have constant pain, requiring daily medication. Others can go days without pain, only to have it aggravated by certain activities.

You may have orchialgia if testicle pain disrupts your life and has lasted more than three months.

What Makes It Hurt?

Orchialgia can develop due to:

Diagnosing and treating the root cause of your pain is the first step. Your doctor will do a physical exam and recommend tests, as necessary.

  • Screenings can detect sexually transmitted infections.
  • A urine test can detect a urinary tract infection or urethritis.
  • An ultrasound can detect inflammation or another abnormality in the testicle, such as testicular cancer.

These conditions can be treated with antibiotics, surgery or other therapies. If the pain is from a pulled groin muscle or pelvic floor spasm, physical therapy can help.

However, approximately half of men with orchialgia have pain for no apparent reason.

Try These Treatments First

For men with unexplained orchialgia, testicle pain can be due to irritated nerves or muscles. These easy, at-home treatments may bring relief:

  • Rest. Don’t lift heavy objects or do strenuous exercise. Avoid aggravating sore muscles.
  • Heat. Using a heating pad or sitting in a hot bath can stimulate blood flow and soothe muscle aches.
  • Anti-inflammatories. Medications like ibuprofen can reduce pain.
  • Tight-fitting underwear. Wearing it helps restrain movement and the pain it can cause.

It may take three months or more for you to notice an improvement.

The Next Step: Nerve Block

If at-home treatments don’t work, the next step is finding out if your pain is coming from the testicle or somewhere else. To do that, urologists can perform a temporary nerve block.

We inject an anesthetic into the spermatic cord, the structure that carries nerves to the testicle.

If the anesthetic does not relieve pain, we can deduce that the cause of pain is not in the testicle. It’s best to see a pain management specialist for further treatment.

However, if the anesthetic does take away the pain, we can deduce that the cause of pain is in the testicle. A urologist can continue to help and may suggest a procedure called “cord denervation.”

Is Cord Denervation Right for You?

Anesthesia will wear off in a few hours, but cord denervation can make pain relief permanent.

In this outpatient surgery, a urologist will cut nerves to the testicle. Roughly 75 percent of patients who’ve had cord denervation are cured of orchialgia.

Cord denervation may be right for you if:

  • Pain has been interfering with your life for three or more months
  • Other pain treatments haven’t worked
  • Your pain was completely resolved with the nerve block

You must be honest with yourself and your doctor about how much the nerve block helped. Surgery won’t help more than the nerve block, just longer term. Of the men who don’t get better with cord denervation, many admit that the nerve block didn’t really resolve their pain either.

Orchialgia isn’t widely discussed—even by urologists. There’s still a lot we don’t understand that needs to be studied. Rest assured, the condition is common and can be treated.

Dr. Shoskes is a urologist at Cleveland Clinic Glickman Urological & Kidney Institute and is Director of the institute’s Novick Center for Clinical and Translational Research.

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