Scrotal Pain Syndrome (Post-Vasectomy Pain)
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Background
Scrotal Pain Syndrome includes testicular pain syndrome, post-vasectomy pain syndrome and epididymal pain syndrome. Post vasectomy pain syndrome has a prevanence of 1-15% with severe pain present in 1-5% of pain. Pain is often chronic (lasting > 3 months in duration).
Causes
Causes of Scrotal Pain Syndrom are not well-known. The majority of cases are idiopathic or without known cause.
Post vasectomy pain syndrom has a prevanence of 1-15% with severe pain present in 1-5% of pain. Specifically causes of post-vasectomy pain syndrome have altered or hyperacitve nerves in the scrotum.
Other possible causes of scrotal pain which will be assessed by urologist include symptomatic spermatocoeles, hydrocoeles, varicocoeles, epididymo-orchitis, testicular trauma, hernia or neuropathic pain.
Diagnosis & Evaluation
History and physical examination is part of the evaluation.
Symptoms of Scrotal Pain Syndrome
Symptoms of include:
dull, throbbing unilateral pain in the scrotum that may worsen through the day
stabbing, shock-like pain
radiates to perium or inner thigh
worsened by cycling, sitting, driving or horseback riding
hypersensitivity (clothes or bedclothes can exacerbate problem)
Often digital rectal examination is performed to examine the prostate. As well abdominal, scrotal and digital rectal exam is completed to identify possible trigger points that could cause refering pain to scrotum and testicles.
Treatment
Treatment for Scrotal Pain Syndrome is varied and may include multiple therapies:
+ Multi-Disciplinary Pain Managemen: Biofeedback, Pelvic Floor Physiotherpy
Treatment of Scrotal Pain Syndrome has been most succesful with a mult-disciplinary approach using multiple modalities.
Often techniques employed include biofeedack with pelvic floor physical therapy. The premise being that tension reduction in the pelvic floor will often reduce scrotal pain. Men with scrotal pain sydrome show up to a 60-70% response with multi-modal therapy.
20% of men will have a muscolo-skeletal source for their pain and will respond to physical therapy.
+ Non-Steroid Anti-Inflammatories (NSAIDS)/Neuropathic Pain Agents
Medical therapy is often used to try and diminish the neuropathic up-regulation associated with scrotal pain syndrome.
Non-steroidal anti-inflammatories such as Ibuprofen/Advil can be used. As well, neuropathic pain agents such as Gabapentin (100-300 mg/day) or Lyrica (Pre-gabalin)(100-300mg/day) can also be used.
As all of these medications have side-effects they are used with caution.
+ Antibiotics
Antibiotics can sometimes be used for patients who have had chronic infections in the testicle or scrotum. However antibiotics are not used routinely to manage scrotal pain syndrome.
+ Temporary Nerve Blocks for Scrotal Pain
Nerve blocks for scrotal pain has been used as a temporizing measure for scrotal pain. These blocks can target the ilioinguinal nerve, iliohypogastric nerve or genitofemoral nerve.
+ Surgery
Rarely surgery is used to treat scrotal pain syndrome.
Surgery can be performed for men who have symptomatic varicocoeles, hydrocoeles and spermatocoeles.
Occasionally vasectomy reversal,epi-didymectomy, orchiectomy or denervation of the spermatic cord can be performed for refractory scrotal pain sydrome but is not first line. The success of surgical treatment of scrotal pain syndrome can vary from 30-70%.
On the Web
General Urology Websites
Canadian Urological Association Extensive library of downloadable pamphlets on a wide range of urological conditions
Medline Plus Produced by the US National Institutes of Health with information on virtually every health topic and extensive list of links
UrologyHealth.org The patient information site of the American Urological Association.