What is an Chronic Testicular Pain?

Chronic testicular pain (also known as chronic orchialgia) is defined as persistent or recurrent pain in one or both testicles lasting for more than 3 months, even when there is no obvious infection, tumour, or structural abnormality. It may be constant or intermittent, and
can significantly affect quality of life.

The pain may originate from the testicle itself, or it may be referred pain from surrounding nerves, muscles, or joints — including the lower back, groin, or pelvis.

What are the symptoms?

You may experience:

  • Dull, aching, or sharp pain in one or both testicles
  • Pain that radiates to the groin, inner thigh, perineum, or lower abdomen
  • Increased sensitivity or tenderness in the scrotal area
  • Pain aggravated by sitting, physical activity, or tight clothing
  • In some cases, numbness or tingling, suggesting nerve involvement

How is it diagnosed?

Diagnosis is based on:

  • A comprehensive clinical history and physical examination
  • Identification of pain patterns, nerve involvement, or myofascial triggers
  • Review of any previous scans or urology assessments
  • Diagnostic nerve blocks may be used to confirm the participation of specific nerves

 

What are the common causes we assess?

    Common causes of persistent testicular pain include:

  • Genitofemoral or ilioinguinal neuralgia, caused by irritation, inflammation, or entrapment of these nerves.
  • Obturator or pudendal nerve involvement, which may produce pain in the groin, perineum, or testicle.
  • Myofascial pain syndrome, where painful trigger points in the abdominal wall, groin, pelvic floor, or hip muscles refer pain to the testicle.
  • Central sensitisation (nociplastic pain), where the nervous system becomes overly sensitive, amplifying pain signals. Testicular pain is often accompanied by pain in other parts of the body, fatigue, poor sleep, headaches, or other symptoms associated with pain sensitisation. Testicular pain is often present in male patients with fibromyalgia.
  • Chronic post-surgical pain, which can occur after procedures such as a vasectomy, inguinal hernia repair, hydrocele surgery, or varicocele surgery.
  • Referred pain from the lumbar spine, sacroiliac joints, hip, or pelvic structures, where the source of pain lies outside the scrotum but is perceived in the testicle.

Please note: We do not treat pain caused by testicular torsion, infection, tumours, or other urological emergencies. These conditions require urgent assessment by a GP, emergency department, or urologist.

 

What treatments do we offer?

We offer several targeted treatments, depending on the likely source of pain:
1. Peripheral Nerve Blocks

  • If your neck pain is accompanied by nerve-related testicular pain, we may offer blocks of the:
      o  Genitofemoral nerve
      o  Ilioinguinal nerve
      o  Pudendal nerve (if perineal pain is also present)
  • These are performed using ultrasound or anatomical guidance with local
    anaesthetic, sometimes with steroid

2. Pulsed Radiofrequency Treatment

  • If a nerve block provides temporary relief, we may consider pulsed radiofrequency,
    which modulates the nerve’s pain signals for longer-lasting relief without damaging
    the nerve

3. Trigger Point Injections

  • For myofascial or muscular causes of referred testicular pain (e.g. from abdominal
    wall, pelvic floor, or lower back muscles), we offer trigger point injections

4. Sacroiliac Joint injections or Lumbar Facet Injections

  • If pain is referred from the lower back or pelvis, we may offer image-guided injections to the sacroiliac joints or lumbar facet joints

5. Medication Optimisation

We review your current medications to ensure they are safe and effective.
In line with HSC NI prescribing guidelines, we can not prescribe opioids or pregabalin. These should be managed by your own GP. We can offer recommendations for safer alternatives and support with reducing unnecessary medications.

 

What to expect from treatment

  • Most people experience gradual improvement with the right combination of physical strategies and targeted interventions
  • All procedures are minimally invasive and performed as day-case treatments
  • Our goal is to help you reduce pain, restore function, and reduce reliance on medication

What we do not offer

  • We assess and manage chronic (persistent) testicular pain that is thought to arise from nerve-related pain, referred pain, or chronic pain mechanisms.
  • We do not diagnose or treat acute surgical or urological emergencies such as testicular torsion, acute infection, or suspected testicular cancer. 
  • We do not provide surgical or urological treatments. Patients with conditions requiring surgery or specialist urological management will be referred to the appropriate service.
  • We are not authorised to prescribe controlled (scheduled) pain medications. Where appropriate, we provide evidence-based prescribing recommendations to your GP in accordance with HSC Northern Ireland prescribing guidance.