TENDER TESTICLE:
Dear Sumner:
I am sending you a 45 year old Silicone Valley executive for a second opinion. He has been bothered by a painful right testicle for about 4 months. Craig did see another urologist a few weeks ago, who reputedly rushed him through an abbreviated exam and failed to address all of his concerns. No obvious abnormalities were found on either physical exam or urinalysis. However, he is still worried that he has a serious underlying condition. I would be most grateful if you would see him.
Dear Ken:
You were certainly correct in your appraisal of Craig’s degree of anxiety. I spent the bulk of our time together trying to address his concerns. Craig admitted he was worried about an unrecognized infection--or even a tumor! We discussed the differential diagnosis of tender scrotal contents, namely inflammatory or infectious processes of the testis, epididymis or spermatic cord structures, as well as testicular torsion. Other entities, which could, though do not ordinarily, produce discomfort include inguinal hernia, hydrocele, varicocele, spermatocele (AKA epididymal cyst) or a testicular tumor. Primary disorders of the back, or pressure secondary to a ureteral stone, can also cause radiating pain to the testicle.
I went ahead with Doppler testicular ultrasonography which showed good blood flow to the testes and no testicular masses. An abdominal ultrasound revealed no gross obstruction of the renal collecting system. Given these findings, I was able to assure Craig that we had ruled out any obvious condition that required interventional therapy. We discussed the fact that the genital structures have more nerves than many other parts of the body, and may, therefore, be more sensitive to any underlying irritative or inflammatory processes (which can cause secondary spasm of the perineal muscles, with resultant pressure on the surrounding nerves, causing more muscle spasms, etc., etc.) I am hoping (and I’m actually optimistic) that a trial of anti-inflammatory meds (e.g. ibuprofen) along with relaxing in warm tub baths (possibly with a friend), combined with a good dose of reassurance, will result in a cure!
