Clinical Review

Investigating and managing chronic scrotal pain

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6716 (Published 06 December 2010) Cite this as: BMJ 2010;341:c6716
  1. S R Keoghane, consultant urological surgeon1,
  2. M E Sullivan, consultant urological surgeon2
  1. 1Department of Urology, Portsmouth NHS Trust, Portsmouth PO6 3LY, UK
  2. 2Department of Urology, Churchill Hospital, Oxford, UK
  1. Correspondence to: S R Keoghane srkeo{at}hotmail.com
  • Accepted 10 November 2010

Summary points

  • Chronic scrotal pain is an ill understood symptom complex for which evidence based treatments are lacking

  • Many patients have no identifiable cause to explain their discomfort

  • Pain can be subclassified as testicular pain syndrome, post-vasectomy pain syndrome, and epididymal pain syndrome

  • As many as 16% of men undergoing vasectomy develop a chronic pain syndrome

  • Surgery is a last resort because its efficacy is uncertain, with limited data to support its use

Few data are available on the true incidence of chronic scrotal pain and most figures relate to post-vasectomy pain syndrome. However, a crude incidence of 350-400 cases of chronic scrotal pain per 100 000 men per year has been estimated on the basis of a questionnaire among Swiss urologists.1 Data on the impact of scrotal pain on quality of life are lacking.

These patients are challenging to both the general practitioner and urologist, and a clear understanding of the aetiology and unpredictable course of this common condition is needed when treating them. Chronic scrotal pain refers to an ill understood complex of symptoms. Various terms have been used to describe the condition including orchalgia and orchidynia, which really refer to the testicle itself, and chronic epididymitis.

Both the European Urological Association (EAU) and the International Continence Society have adopted the generic term scrotal pain syndrome to include testicular pain syndrome, post-vasectomy pain syndrome, and epididymal pain syndrome.2 3 4 The condition is defined as persistent or recurrent episodic scrotal pain associated with symptoms suggestive of urinary tract infection or sexual dysfunction without confirmed epididymo-orchitis or other obvious pathology.4

Sources and selection criteria

We searched Medline from 1975 to 2010 using the terms “chronic scrotal pain”, “orchalgia”, “testicular pain”, and “orchidynia”. We found a mixture of retrospective and prospective studies of intermediate quality. We also used the 2009 guidelines from the European …

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