The Scourge of Chronic Scrotal Content Pain

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In some cases, a knock to the groin can result in pain that doesn't go away.

At any given time, an estimated 100,000 American men suffer from chronic scrotal content pain (CSCP), defined by at least three months of chronic or intermittent pain with severity that interferes with daily activities. The condition accounts for roughly 2.5% of urology visits each year.

While CSCP sometimes results from a tumor, infection, or some other kind of readily correctable trauma, in as many as half of cases, the pain is idiopathic, meaning that it doesn't have a clear cause. In many instances, sufferers associate their condition with an initial strike to the groin where the pain was excruciating at first, went away, then returned with a recurring throb.

Nerve sensitization could account for this type of CSCP. A tangled web of nerves runs throughout the scrotum. Occasionally, a harsh stimuli can alter their activity, resulting in persistent hypersensitivity and spontaneous firing.

Maddeningly, pain in the hip or lower back can also radiate to the scrotum, as nerves in those locations share the same innervation as nerves in the scrotum. Scrotal nerves are even linked to nerves in the intestines, which may explain why some men can suddenly feel sick to their stomach after suffering an acute testicular injury.

Even worse, for idiopathic CSCP affecting the nerves, there are no easy fixes. Nonsteroidal anti-inflammatory drugs like Ibuprofen have often been prescribed. For good reason, opioids are no longer recommended.

"The treatment of idiopathic CSCP remains a therapeutic dilemma, as there are no published data providing good evidence regarding reliable non-surgical interventions. Diagnostic and treatment recommendations are currently based on expert opinion derived from small cohort studies," Rush University Medical Center urologists Wei Phin Tan and Laurence A Levine wrote in the World Journal of Men's Health.

"The pathophysiology of chronic scrotal pain is complicated, multifactorial, and not well understood," Ohio Urologist Abhishek P. Patel noted in an article published to Translational Andrology and Urology.

But treatments are progressing. Recently outlining new ways to manage CSCP in the journal Current Urology Reports, five urologists report that low doses of certain antidepressants have been surprisingly effective at reducing pain. Applying low voltage electrical current to the region can also prove beneficial. Surgical options are still considered a last resort, but are advancing.

What's sorely needed, urologists insist, are large-scale, multicenter randomized trials for CSCP treatments to give this frustrating condition the attention that it deserves.

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