Orchialgia, commonly known as testicular pain, is a frustrating condition for both patients and urologists.  Present in all age groups, this condition can be quite limiting and can lower one's quality of life.

Common causes of this discomfort including recurrent urinary tract infections, epididymitis, and varicoceles.

An initial evaluation should include a urine culture and a scrotal ultrasound to rule out other pathology.  In an infection is present, several weeks of antibiotics may be required to penetrate the tissue of the epididymis to cure infection.  Further therapy via conservative methods with sitz baths, scrotal support,  and nonsteroidal anti-inflammatory agents (ibuprofen, Aleve) are typically employed with success.

With post-vasectomy pain, orchialgia can be common.  This occurs in approximately 1 in 1000 men and is linked to pressure build up in the epididymis as sperm continues to be produced.  This pain can be dull with exacerbation from ejaculation.  The first treat should be the above conservative measures for 3 months.  Should these fail, vasectomy reversal or removal of the epididymis (epididymectomy) are considerations.

In men with pain post-hernia, the treatment can be more difficult.  Many times the ileoinguinal nerve will be entrapped post-hernia repair.  In this condition, conservative methods will allow for resolution.  If not, exploration and removal of any material may offer relief.

Finally, the most frustrating orchialgia is that of unknown etiology.  Without a specific cause, treatment can be quite difficult.  Again, conservative measures should be introduced for 3 months.  At the same time, consideration of alternative sources of discomfort (irritable bowel, ureteral stones, etc.) should be explored.  In these conditions, I have found success with addition of pelvic muscle physical therapy.  Finally, should all other measures fail, use of nerve blocks and microsurgical denervation of the genitofemoral nerve is considered.