Tests and Examinations for Chronic Testicular Pain: What to Expect

At The Institute for Advanced Reconstruction, our specialists are leaders in diagnosing and treating chronic testicular pain, a condition that affects about 100,000 men in the United States each year. With our advanced expertise and the guidance of internationally recognized plastic and reconstructive surgeon Dr. Hamid Abdollahi, we have helped countless patients find long-term relief from this often debilitating issue.

If you’ve been told there’s no solution for your testicular pain, you may be overlooking the nerves. At The Institute, we specialize in diagnosing what others miss — and restoring what pain has taken away.

Understanding Chronic Testicular Pain

How Do You Know When Testicular Pain Is Serious?

“Testicular pain that is persistent, severe, or accompanied by other concerning symptoms like swelling, lumps, fever, nausea, vomiting, or difficulty urinating should be taken very seriously,” explains Dr. Abdollahi. “Pain that lasts longer than a few days, worsens over time, or is sharp and sudden in onset may indicate an underlying issue, and warrants a prompt medical evaluation.” 

Additionally, if the pain is interfering with daily activities or doesn't improve with rest or home care, Dr. Abdollahi shares that  it’s important to seek advice from a healthcare professional to prevent potential complications and address the root cause effectively.

Common Causes of Chronic Testicular Pain

Chronic testicular pain can arise from a variety of causes, many of which may not be immediately obvious, so a thorough medical evaluation is necessary to determine the underlying issue. Some of the most common causes of chronic testicular pain include:

• Infections: Sexually transmitted diseases (STDs) or urinary tract infections (UTIs) can cause inflammation and pain in the testicles, as the infection may spread to surrounding tissues in the scrotum.
• Inflammation: Conditions like orchitis (inflammation of the testicles) or epididymitis (inflammation of the epididymis) can cause severe, chronic pain. These conditions are often caused by infections or irritants and can persist if not treated.
• Inguinal Hernia: This occurs when tissue pushes through a weak spot in the abdominal muscles near the groin. The pressure from the hernia can cause testicular pain.
• Low Back Strain and Nerve Irritation: Nerve damage or irritation in the lower back can lead to referred pain in the testicles. This is particularly true for spinal issues, where nerves affecting the groin area become inflamed.
• Previous Surgical Procedures: Surgeries such as vasectomies or hernia repairs may sometimes lead to post-surgical nerve damage or scar tissue, causing long-term testicular pain.
• Testicular Torsion: This is a medical emergency where the testicle twists, cutting off its blood supply. If left untreated, torsion can lead to chronic pain even after the acute event is resolved.
• Trauma: Injuries to the testicles, whether from accidents, sports, or other physical activities, can lead to persistent pain. Even minor trauma can result in lingering discomfort if tissues don’t heal properly.
• Tumors: Though less common, tumors in the testicles or surrounding areas can lead to pain. Tumor growth puts pressure on nearby nerves, resulting in chronic discomfort.
• Varicocele: Enlarged veins within the scrotum, known as varicocele, can lead to chronic testicular pain. The veins dilate, causing increased pressure and discomfort.

Diagnosing Chronic Testicular Pain

Diagnosing chronic testicular pain begins with a thorough physical examination of the scrotum and genital area. During this exam, we will check for any visible signs of swelling, lumps, or abnormalities. We will also review your medical history, including any past infections, surgeries, or injuries, as well as questions about sexual activity, bowel movements, and physical activity levels. This helps us identify potential risk factors or causes, like infections or nerve issues. Your doctor may also ask about the nature, frequency, and severity of the pain to gather a clearer picture of the condition. In addition to a physical exam and medical history review, your medical professional may also order:

• Urinalysis and urine culture
• A scrotal ultrasound or abdominal-pelvic CT scan
• A spermatic block to help determine if the problem is neurological

These tests help pinpoint the specific cause of the pain, allowing our team to craft a targeted treatment plan. If your testicular pain coincides with simultaneous back or hip pain, a spinal MRI may also be recommended for diagnosis. The team at The Institute specializes in advanced diagnostic techniques and will work closely with you to determine the best course of action, whether that involves conservative treatments or more advanced surgical options.

Treatment Options for Chronic Testicular Pain 

In most cases, treatment begins with non-surgical therapies designed to reduce inflammation, calm nerve sensitivity, and support healing. These may include:

• Anti-inflammatory or neuromodulating medications
• Nerve blocks (for both diagnosis and pain relief)
• Physical therapy and scrotal support
• Targeted antibiotics (if infection is suspected)
• Lifestyle and dietary changes (e.g., reducing caffeine, citrus, and prolonged sitting)

If conservative care doesn’t provide lasting relief—or if a spermatic cord block relieves at least 50% of pain—your care team may recommend surgical options for long-term resolution.

Surgical Options for Chronic Testicular Pain

Surgical interventions focus on identifying and addressing the root cause of nerve-related pain. Each of the following procedures is highly specialized and selected based on your specific symptoms, response to prior treatments, and diagnostic testing:

• Microsurgical Denervation of the Spermatic Cord (MDSC)
  This precision procedure disconnects the tiny nerve fibers responsible for chronic pain while preserving function and sensation. It’s the gold standard for men with idiopathic testicular pain or positive response to nerve blocks.
• Peripheral Nerve Decompression
  For patients with confirmed nerve entrapment, this surgery relieves pressure on compressed nerves—similar to how carpal tunnel surgery relieves nerve pain in the wrist.
• Nerve Reconstruction or Grafting
  In rare cases where nerves have been damaged but not severed, surgical reconstruction can restore function and reduce neuropathic pain.
• Vasectomy Reversal (Vasovasostomy)
  For patients whose pain began after a vasectomy, reversing the procedure may help resolve obstruction-related or nerve-irritation pain.
  
  

What to Expect from Surgical Evaluation

Our team specializes in diagnosing and treating complex nerve-related pain—and when surgery is the right next step, you’re in the most capable hands.

We take a precision-based, personalized approach to every surgical plan. If your symptoms, diagnostics, or nerve block response point to a surgical solution, your surgeon will guide you through a tailored plan designed to maximize relief and restore your quality of life.

At every stage, we ensure you fully understand:

• Why surgery is recommended based on your unique case
• What outcomes you can expect based on national benchmarks and our center’s experience
• How our expertise in microsurgical and nerve procedures sets us apart

Many of our patients come to us after years of unresolved pain. Here, they find answers—and a path forward.

Request an Appointment for Testicular Pain Relief

If you or a loved one are seeking treatment for chronic testicular pain, contact Dr. Abdollahi or the team at The Institute for Advanced Reconstruction at 855-980-6981.

Schedule an online consultation with our team here.