Scrotal and Testicular Pain (Orchialgia)

Conditions

Understanding Scrotal and Testicular Pain

Scrotal and testicular pain, also known as orchialgia, refers to discomfort or pain felt in one or both testicles, or more diffusely within the scrotum, groin, or perineum. While it may be acute (after infection or injury), in many patients it becomes chronic, persisting for three months or more even after initial causes have resolved.

The pain may arise from nerve irritation, inflammation, previous surgery, or referred pain from the spine, pelvis, or abdomen. Because of the sensitivity and functional importance of this area, it can cause significant distress and affect mobility, sleep, and sexual function.

Typical symptoms include:

  • Dull, aching, or sharp pain in one or both testicles
  • Pain radiating to the groin, perineum, or inner thigh
  • Heaviness or pulling sensation in the scrotum
  • Discomfort during sitting, walking, or sexual activity
  • Intermittent or constant pain that may worsen with physical activity or prolonged sitting

Common causes include:

  • Nerve irritation (ilioinguinal, genitofemoral, or pudendal nerves)
  • Post-surgical pain (after hernia repair, vasectomy, or varicocele surgery)
  • Epididymitis or infection (current or previous)
  • Varicocele or hydrocele
  • Referred pain from the lower spine, pelvis, or hip
  • Pelvic floor muscle tension

Chronic testicular pain is complex and often involves multiple overlapping factors — requiring careful, specialist evaluation and an integrated treatment approach.

Wessex Pain Clinic

How We Diagnose

At Wessex Pain Clinic, diagnosis begins with a detailed clinical history and examination, focusing on pain characteristics, prior operations, infections, and associated urinary or pelvic symptoms.

Our consultants work closely with urologists and pelvic pain specialists to ensure thorough assessment and exclusion of serious causes.
We may recommend:

  • Imaging such as ultrasound
  • Diagnostic nerve blocks (ilioinguinal, genitofemoral, or pudendal) to identify neuropathic sources of pain

Spermatic cord blocks, targeting the pain carrying fibres of the painful testicle.

Wessex Pain Clinic
Lifestyle and Complementary Therapies

Our specialist physiotherapists and pelvic health partners play a key role in rehabilitation, focusing on:

  • Pelvic floor relaxation and desensitisation
  • Gentle stretching and breathing techniques to reduce muscular tension
  • Postural correction and ergonomic adjustments to reduce nerve compression

Our pain psychology partners provide essential emotional and cognitive support, using CBT, mindfulness, and ACT to help manage the distress, fatigue, and anxiety often associated with chronic genital pain.

At Wessex Pain Clinic, this consultant-led, multidisciplinary approach ensures that both the physical and psychological components of scrotal and testicular pain are addressed comprehensively and compassionately. We work as a team and meet regularly to discuss complex, treatment resistant or unusual cases. As such you will often receive the expertise of several pain consultants. We believe that we are one of very few pain clinics to offer this.

Medications

We may prescribe:

  • Anti-inflammatory medicines (NSAIDs) to reduce local inflammation and pain
  • Neuropathic pain medications (e.g. amitriptyline, pregabalin, duloxetine, gabapentin) to calm irritated sensory nerves

All medication plans are tailored individually for safety and effectiveness.

Interventional Procedures

Our consultants offer targeted image-guided nerve and joint interventions, including:

  • Ilioinguinal and genitofemoral nerve blocks for nerve entrapment or post-surgical pain
  • Pudendal nerve blocks for deeper pelvic or perineal pain radiating into the scrotum
  • Spermatic cord block to target the sensory nerves directly supplying the testicle
  • Pulsed radiofrequency (PRF) for longer-term relief in chronic neuropathic cases
  • Lidocaine infusions to calm widespread nerve sensitisation
Our approach to scrotal and testicular pain is comprehensive and multidisciplinary, targeting nerve irritation, inflammation, and muscular tension through a combination of medical, interventional, and rehabilitative treatments.

Treatment at Wessex Pain Clinic

Treatments