Resolving Chronic Scrotal Pain: A Comprehensive, Non-Surgical Strategy

Scrotal pain, also known as orchialgia, is a distressing and often misunderstood condition that affects men of all ages. While acute causes such as testicular torsion or infection require urgent evaluation, many men suffer from chronic or intermittent scrotal pain that has no clear surgical target. In these cases, the pain may persist for months or even years, impacting physical comfort, emotional well-being, and sexual function.

At the Performance Medicine Institute, we specialize in identifying the true source of scrotal pain—whether it’s nerve entrapment, pelvic floor dysfunction, referred pain, or residual inflammation—and use an integrative, non-surgical approach to relieve symptoms and restore quality of life. Symptom relief is often times very fast, with most patients reporting an 80% or more reduction in pain after the first session.

A Complex Pain Problem

Chronic scrotal pain is rarely confined to the testicle alone. The nerves that supply the scrotum originate from the lumbar spine and sacral plexus, and pain may be referred from the ilioinguinal, genitofemoral, or pudendal nerves. Pelvic floor muscle dysfunction, particularly hypertonicity or trigger points, can also contribute to localized pain.

Other contributors include post-surgical nerve injury, varicocele, epididymitis, or scar tissue following vasectomy. In some cases, no pathology is seen on imaging, yet the patient remains symptomatic.

Unfortunately, these patients are often told there is nothing wrong or are referred for orchiectomy when conservative options have not even been explored.

How We Evaluate Scrotal Pain

Our approach begins with a detailed history and physical exam, including functional assessment of the pelvic floor, abdominal wall, spine, and groin. We look for trigger points, nerve entrapment patterns, or mechanical contributors such as postural imbalances or hip dysfunction. A scrotal ultrasound may be reviewed if one has been done, but a normal result does not rule out neuropathic or musculoskeletal causes.

We also screen for systemic factors that may increase pain sensitivity or reduce healing, such as low testosterone, elevated inflammatory markers, or unresolved trauma.

Our Treatment Protocol

The treatment of chronic scrotal pain requires a multifaceted strategy, targeting both the symptomatic area and upstream causes. Our protocol may include:

• Pelvic floor physiotherapy is a cornerstone of treatment. Many patients present with a hypertonic pelvic floor or active trigger points in the bulbospongiosus, obturator internus, or levator ani muscles. Targeted myofascial release, neuromuscular retraining, and breathing strategies are used to normalize tone and reduce nerve irritation.
• Neuromodulation techniques, including the Neubie device, are used to downregulate overactive pain pathways and promote nerve desensitization. Patients often report reduced pain and improved mobility within a few sessions.
• Class IV laser and shockwave therapy may be used to improve microvascular flow, break up fibrosis, and accelerate healing in the spermatic cord or surrounding tissues.
• Manual therapy and dry needling address musculoskeletal restrictions in the hips, abdomen, and low back, which often contribute to pelvic tension and nerve irritation.
• Pharmacologic support may include topical analgesics, compounded neuropathic pain creams, low-dose naltrexone, or hormone optimization depending on the clinical profile.

Individualized and Restorative

Scrotal pain is highly individualized. One patient may respond to trigger point release in the adductors, while another requires laser therapy to the inguinal canal or neuromodulation of the pelvic nerves. Our goal is not simply to suppress pain, but to restore normal tissue function and allow long-term recovery without surgery.

We also address psychological distress, relationship strain, and fear-avoidance behaviors that commonly develop after months of unresolved pain. In many cases, reducing fear and improving movement patterns are just as important as the physical treatments themselves.

Conclusion

Chronic scrotal pain is rarely just about the testicle. It is a complex neuro-musculoskeletal issue that deserves a careful and integrative approach. If you’re struggling with persistent groin or testicular discomfort and have been told “nothing is wrong,” there is still hope. Contact Us to schedule a comprehensive evaluation with our pelvic health team.

References

Anderson, R. U., et al. (2006). Chronic orchialgia: etiology and management. Journal of Urology, 176(5), 1748–1751.

Hedelin, H., & Jonsson, O. (2007). Chronic scrotal pain: a multidisciplinary approach. British Journal of Urology International, 99(5), 1083–1087.

Levine, L. A., & Hoeh, M. P. (2006). Evaluation and management of chronic scrotal content pain. Journal of Andrology, 27(3), 269–275.

Wright, E. J., et al. (2004). Orchialgia: diagnosis and treatment. Current Urology Reports, 5(4), 296–300.