Cyclic testicular pain

Specialty: Nephrology and urology.

• cyclic orchialgia
• periodic testicular discomfort

Why it occurs

• Large varicocele (local heat accumulation and venous stasis increase periodically, often coinciding with prolonged physical exertion activities, hot weather, or body fatigue accumulated at the end of the day)
• Intermittent reactive hydrocele (with periodic accumulation of fluid of peritoneal origin that is partially reabsorbed)
• Cyclic referred testicular pain (associated with mechanical problems of the lumbar spine L1-L2 triggered by certain repetitive postures or periodic efforts in the workplace or sports)
• Cyclic psychogenic orchialgia (associated with cyclical periods of stress or anxiety)

Initial workup

Scrotal ultrasound with color Doppler (of choice, performed at rest and standing during a symptomatic period); urinalysis with sediment and urine culture; sperm culture; orthopedic evaluation of the lumbar spine; Scrotal MRI in selected very complex cases.

Standard management

• Ibuprofen or Naproxen — short courses of NSAIDs during days of cyclical pain to mitigate inflammatory congestion
• Mechanical measures such as use of a tight scrotal support during physical exertion activities
• Paracetamol — 500 mg to 1 g every 8 hours orally as a rescue analgesic
• Scheduling surgical varicocelectomy if cyclic pain is refractory and causes significant functional limitations.