Chronic Testicular Pain: A Review of Aetiology and Management

Abstract

Chronic testicular pain affects a growing number of men worldwide. The approach to diagnosis and treatment is variable, resulting in treatment delays of reversible causes that may increase the probability of progression to chronic pain. A large proportion of men have no reversible cause identified and delayed recognition and management of this issue can cause significant morbidity. In this article, an approach to diagnosis and a review of treatment modalities available to manage chronic testicular pain is presented. Randomised control trials and current protocols for management were reviewed, in addition to case series and single-centre experiences of specialists with an interest in managing this condition. It is evident that chronic testicular pain should be managed with a multidisciplinary approach, to address the complex psychosocial elements often co-presenting with chronic pain. Various treatment options are available including medical therapy, non-invasive physiotherapy techniques and invasive surgical techniques. There is good evidence emerging for microsurgical techniques and nerve blocks. More research is required to determine the most effective duration and repetition of treatments. Chronic scrotal pain is physiologically related to other chronic pain syndromes and more research is required to determine the mechanisms behind this and potentially target chronic pain at a cellular level. In summary, chronic testicular pain affects a large number of men and further investigation into aetiology is important to direct treatment. A range of interventions are available -it is recommended that conservative treatments are trialed first in a multidisciplinary setting.