Pain in the Pouch- Scrotal Pain May Be Coming From Somewhere Else

By far, most causes of pain in the pouch is from the testicles and the epididymis, the gland behind the testicle where sperm are nurtured and mature. But there are other causes of scrotal pain that must be considered and which have different treatments.

Testicular tumors do not usually cause pain, but it is possible. Since testicular cancer is common in young men (between the ages of 18 and 32) and is often cured if treated early, prompt medical attention to any lump is important. If you feel something down there that is new or is hard, see your doctor right away.

Inguinal hernia—An inguinal hernia is part of the intestines which protrudes through the inguinal canal (passageway connected to the scrotum). Inguinal hernia is suspected if swelling or pain above the scrotum worsens with coughing, sneezing, movement, or lifting. This condition is fairly common, especially in young boys, and it occasionally causes pain in the scrotal area. Premature infant boys have the highest risk for inguinal hernia. This condition usually results from an abdominal wall weakness present at birth, but symptoms may not appear until adulthood.
Hernias do not resolve without treatment and may cause serious complications if not treated. Hernia repair surgery is usually required to treat this condition. Often this surgery can be done through a laparoscope which consists of a several pencil sized openings in the lower abdomen. Most men can go home the same day of the surgery and resume all activities, including heavy lifting in 3-4 weeks after surgery.

Pudendal nerve damage (neuropathy), also called “bicycle seat neuropathy,” may cause numbness or pain. Pudendal nerve damage can result from the pressure of prolonged or excessive bicycle riding (e.g., competitive cycling), especially improper seat position or riding techniques are used. Special bicycle seats have been designed to decrease pressure on the area between the scrotum and the rectum, potentially preventing or resolving this problem. Pudendal neuralgia is the painful type of this nerve damage. Sometimes called “cyclist’s syndrome,” pudendal neuralgia is painful inflammation of the pudendal nerve. The pudendal nerve carries sensations to the genitals, urethra, anus, and perineum (area between the scrotum and anus), so the pain can be felt in any of these areas. Pain can be piercing and is more likely to be noticed while sitting. If untreated, nerve damage can lead to erectile dysfunction or problems with bowel movements or urination, such as involuntary loss of feces or urine (e.g., urinary incontinence).

Pudendal Nerve Damage

Narrow bike seat can cause pudendal nerve injury

Surgery—Temporary testicular pain and swelling can be expected after surgical procedures in the pelvic area, such as hernia repair and vasectomy. Post-surgery pain that lasts longer than expected should be reported to a physician. Chronic or recurring pain may be the result of a surgical complication or an unrelated problem, and may need treatment.
Kidney stones—Stones usually cause abdominal pain, but the pain radiates into the testicular area in some cases. Intense, sudden, and severe pain in the scrotum that cannot be explained by a problem in the scrotum may be caused by kidney stones.

Swelling with mild discomfort—Conditions that cause swelling in the scrotal area also may occasionally result in mild discomfort. These conditions include varicocele, hydrocele, and spermatocele. Many cases are benign (mild and non-threatening), but swelling and discomfort in the scrotal area should be addressed by a doctor. If a hydrocele (an abnormal fluid-filled sac around the testicles) becomes infected, it can lead to epididymitis, which can cause severe pain.
Unrelieved erection—An erection that does not end in ejaculation sometimes can cause a dull ache in the testicles. This minor ache, commonly called “blue balls,” is harmless and usually goes away within a few hours or when ejaculation occurs.

Bottom Line: Scrotal pain is common condition that usually involves the structures in the scrotum. However, there are other conditions that can cause scrotal pain. If your doctor evaluates these other causes of scrotal pain, effective treatment can relieve the discomfort.

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5 Responses to “Pain in the Pouch- Scrotal Pain May Be Coming From Somewhere Else”

  1. Al Campana Says:

    Hi dr. thanks for the article and I have something very strange going on that is baffling drs. I own a construction company and have been healthy all my life, 1 girl, reg sex life, age 42. Had pain before easter 2012 and felt lump on top of testicle..went to er..epididymitis, 2 weeks cipro…nothing….went to gp….naproxen..had ultrasound…normal.. I said having a lump on top of testicle is not mormal? Ok went to uro..rt side varicocele now that wasnt there before and another limp started growing on lefy testicle, was..ooops phone wont let me get back to spot, sorry…..anyways size of almond on left ball and uro said I have possible pinched nerve. Do pinched nervrs cause varicocele or make head of epi swollen? Am currently on second week of doxycycline….11 days …nothing….balls still hurt right on top….gp one week later to figure out whats going on with possible nerve..did xray….coccyx is rubbing a liitle and there id pain above rt buttock, goes around hip…not too bad but when it hits I wince and it has droppefd me a gew few times.. small lile a pea at first now is size of almond, sballs hurt right at those places. Uro put me on methylprefnisolone..nothing….said it may be a pinched nerve…

    • neilbaum Says:

      Very difficult situation. I am going to send you my article about chronic scrotal pain and perhaps you could share it with your urologist to help unravel your problem and relieve your discomfort.

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