Testicular Pain: What Causes it 2.0
Updated: Aug 25
Chronic scrotal pain can arise out of a variety of etiologies, and while many cases have unknown root causes, the location, duration, and referred pain can offer insight into what physiological systems or body parts are contributing.  The most obvious causes of testicular pain are injury and infection and should be ruled out by a urologist before taking further action.  If there are no clear explanations for the cause of testicular pain, an assessment of the spine and pelvic floor muscles can help develop a treatment plan and a return to a better quality of life. Simple changes in posture, joint treatment and soft tissue work can easily be done to help improve forces on the nerve that will eliminate pain.
The genitofemoral nerve runs from the spine and innervates part of the abdomen and branches off to the anterior (front) of the scrotum as well as the top and side of the thigh. This nerve can become irritated near the upper portion of the lumbar spine, or by an overactive psoas muscle at the front of the hip. In either case, the nerve irritation can present as pain in the scrotum and/or thigh. If genitofemoral nerve entrapment and/or irritation is suspected, physical therapy treatments that stretch the psoas and assesses the biomechanics of the spinal segment is in order, as well as exercises that support spine stability have been shown to be successful.
Similarly, the pudendal nerve can be an irritant for testicular pain. The pudendal nerve is the main nerve of the perineum and in patients with sacroiliac joint pain, the possibility for co-occurring testicular pain increases.  The joint itself has no direct impact on the nerve, but the pudendal nerve passes through associated ligaments in this anatomical region and can be affected by sacroiliac joint dysfunction. Treatment for testicular pain and sacroiliac joint discomfort includes a variety of manual therapies, like myofascial release, nerve glides and dry needling. 
The testes and surrounding tissues descend from the inner layers of the abdominal wall. Any irritation to these abdominal muscle layers can translate to testicular pain.  If a patient is most comfortable in a slouching position and/or has increased pain during contraction of the abdominal muscles, the abdominal tissues need to be thoroughly assessed.  Should abdominal etiology be suspected, manual therapy, soft tissue release along with myofascial lengthening along with postural re-education are all recommended forms of treatment.
Being such a sensitive topic for many men, testicular pain can greatly affect patients’ quality of life; therefore, it is recommended to approach treatment from a holistic, multi-disciplinary approach.
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Ziegelmann, M. J., Farrell, M. R., & Levine, L. A. (2019). Evaluation and Management of Chronic Scrotal Content Pain-A Common Yet Poorly Understood Condition. Reviews in urology, 21(2-3), 74–84.
Chu, E. C. (2020). Taming of the Testicular Pain Complicating Lumbar Disc Herniation With Spinal Manipulation. American Journal of Men's Health, 14(4), 155798832094935. https://doi.org/10.1177/1557988320949358
Pisio, L., & Linc Pisio PT. (n.d.). An Orthopedic PT's Guide to Treating Testicular Pain Part 2: The Pelvis - ignitephysio. Ignite Physio. https://ignitephysio.ca/blog/an-orthopedic-pts-guide-to-treating-testicular-pain-part-2-thoracolumbar-spine-and-abdomen/.
Pisio, L., & Linc Pisio PT. (n.d.). An Orthopedic PT's Guide to Treating Testicular Pain - Part 1: Thoracolumbar Spine & Abdomen - ignitephysio. Ignite Physio. https://ignitephysio.ca/blog/an-orthopedic-pts-guide-to-treating-testicular-pain-part-1-thoracolumbar-spine-abdomen/.