Common Causes of Chronic Testicular Pain and How They’re Treated

Posted on May 10, 2025 by root

Chronic testicular pain, medically referred to as chronic orchialgia, can be a debilitating condition that affects men’s quality of life. Defined by persistent discomfort lasting longer than three months, this condition often leaves patients searching for answers and solutions. It is the cause of about 2.5% to 5% of all urology consultations and currently affects about 100,000 men in the United States each year.

Dr. Justin Houman, a leading urologist in Los Angeles, wants men to understand the underlying causes of chronic testicular pain and how he provides effective treatment and recovery. We asked him to explore the most common causes of this condition and how he can help diagnose and resolve these issues.

What Makes Testicular Pain Chronic?

Chronic testicular pain is not merely about the physical sensations in the testicles; it encompasses a range of emotional and psychological experiences. A January 16, 2024, article in Men’s Health magazine reveals that acute testicular pain is “so common… that every guy, at some point in his life, will have experience with it.”

Unlike acute pain that might arise from an injury or infection, chronic pain persists over time and can become harder to manage. Most experts agree that chronic testicular pain generally lasts for three months or more. The pain may not have a clear cause, and while some men may experience intermittent discomfort, others may suffer from persistent aching or stabbing sensations.

Common Causes of Chronic Testicular Pain

The Fall 2010 Therapeutic Advances in Urology journal lists a broad range of possible causes for chronic orchialgia, and these include:

Varicocele

A varicocele is an enlargement of veins within the scrotum, similar to varicose veins in the legs. This condition can lead to testicular pain due to increased blood flow and pressure within the scrotal veins. Up to 15% of men may have a varicocele, which is often discovered incidentally during examinations. Dr. Houman specializes in microsurgical varicocelectomy, a minimally invasive technique to alleviate pain and restore normal blood flow.

Infections

Infections of the testicles or epididymis, known as epididymo-orchitis, can cause significant discomfort. These infections may arise from sexually transmitted infections (STIs) or other bacterial infections. Symptoms often include swelling, redness and tenderness in the affected area. Prompt diagnosis and treatment, often involving antibiotics, can alleviate symptoms and prevent further complications.

Trauma

Physical trauma to the testicles can lead to unexplained chronic pain. Even minor injuries can result in long-term discomfort. It’s essential to evaluate the specific nature of the trauma to determine if further treatment, such as medication or surgical intervention, is necessary.

Nerve Issues

Nerve compression or injury can lead to chronic pain in the testicles. Conditions like neuropathy or referred pain from other regions of the body may contribute to the sensation of discomfort in the testes. Understanding the nerve pathways and how they relate to pelvic pain is critical in diagnosing these issues effectively.

Pelvic Floor Dysfunction

Pelvic floor dysfunction in men can manifest in various ways, including difficulty with urinary control, painful urination and discomfort in the pelvic area. Some men may experience pain that radiates to the genitals, lower back or thighs, which can sometimes be related to muscle tension or spasms.

Post-Vasectomy Pain Syndrome (PVPS)

Post-Vasectomy Pain Syndrome (PVPS) can produce persistent scrotal pain following a vasectomy for weeks, months or even years after the procedure. The 2017 Translational Andrology and Urology medical journal states, “With approximately 500,000 vasectomies performed each year in the United States, 1–2% of these patients will experience chronic testicular pain for greater than three months after the procedure.” The exact cause of PVPS is not fully understood, but it may involve factors such as nerve damage, scar tissue formation or ongoing pressure in the testicular area.

Testicular Torsion or Other Conditions

While acute testicular torsion typically presents as sudden, severe pain and requires immediate medical attention, some men may experience chronic pain afterwards. Similarly, conditions like hernias or tumors, although less common, can also lead to long-term discomfort. It’s important to rule out serious underlying conditions through thorough examinations and imaging tests.

Idiopathic Causes

The May 2017 Translational Andrology and Urology journal claims that approximately 25–50% of chronic orchialgia is idiopathic in nature. In such cases, it is reasonable to consider psychological and psychosocial factors that may be contributing to chronic pain.

How Dr. Justin Houman Can Help

As a board-certified urologist and fellowship-trained specialist in Men’s Sexual and Reproductive Health, Dr. Justin Houman brings a wealth of expertise to men experiencing chronic testicular pain. With a focus on minimally invasive surgical techniques, Dr. Houman is particularly adept at diagnosing and treating varicoceles and other conditions contributing to orchialgia.

Dr. Houman’s practice is rooted in enhancing men’s quality of life—whether through hormone management, improving sexual function or achieving reproductive goals. His training at Cedars-Sinai Medical Center and his role as a clinical instructor in the Department of Urology underscore his commitment to cutting-edge techniques and personalized care.

Diagnosis and Treatment

Dr. Houman emphasizes a comprehensive approach to diagnosing chronic testicular pain. This begins with a thorough medical history and physical examination, followed by any necessary imaging studies or lab tests. Treatment options can vary significantly based on the identified cause of pain:

1. Medications: Depending on the severity and underlying cause, medications may include anti-inflammatory drugs, pain relievers or antibiotics if an infection is present.
2. Surgical Interventions: For structural issues like varicoceles or certain tumors, surgical options may be necessary. Dr. Houman utilizes the latest minimally invasive techniques to minimize recovery time and pain.
3. Physical Therapy: Physical therapy may provide relief by addressing muscle tension and dysfunction in cases involving nerve pain or pelvic floor issues.
4. Lifestyle Changes: Encouraging patients to adopt healthy habits, such as regular exercise, stress management and maintaining a healthy weight, can also help reduce pain.

Los Angeles Chronic Testicular Pain Treatment

Chronic testicular pain is a complex condition with various causes, requiring a nuanced approach to diagnosis and treatment. I can sometimes go away on its own with rest, anti-inflammatory medications and lifestyle changes, but any persistent discomfort should be evaluated by a specialist. Dr. Justin Houman, located in Los Angeles, is committed to providing tailored care that addresses both the physical and emotional aspects of this challenging issue. If you’re experiencing persistent testicular pain, don’t hesitate to reach out for an evaluation. With expert guidance, you can find relief and improve your quality of life.

Posted on behalf of Justin Houman MD