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QUESTION: I had an ultrasound recently which came back normal. I am still experiencing mild pain and discomfort which is driving me mad. Is it worth having another ultrasound by a different person? I felt that the first one may have been rushed and therefore failed to pick up any abnormalities.

I have read that in some cases the cause can never be identified. Am I just going to have to live with this now for the rest of my life?

ANSWER: If you feel the first ultrasound was not properly done, it probably should be repeated.  The test is not that expensive, has no radiation or x-rays and can identify most testicular problems.  However, the most likely result of the repeated ultrasound would be no abnormalities detected.

It is true that it may not be possible to identify the cause in some cases.  In such situations, your choices are to live with it and deal with the discomfort with pain treatments or have a surgical exploration and possibly a surgical removal of the testicle called an orchiectomy.  It should also be possible to do an anesthetic block to the spermatic cord to verify if the testicle is truly the source of the pain.  If the block works, then the testicle is causing the pain and a surgical approach is reasonable.  If the block doesn't work, then the pain cause could be from a back or nerve issue and any surgery on the testicle is less likely to be helpful.

You should consult a urologist.

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QUESTION: I have also read that the cause of scrotal discomfort can be psychogenic. It is true I have suffered from depression, anxiety and ocd for many years but I am sceptical this could cause such pain. What do you think?

Also 3 years ago I had a similar pain on the right side (the same side as the current pain) in the inguinal area. It wasn't actually in the testicle but it was in the inguinal area. A hernia was suspected and ultrasound was performed but was unremarkable. I cant remember exactly how long that pain lasted but it eventually went away.

The difference this time is that its not only in the inguinal area its inside the scrotum and bilateral. Plus it has gone on for longer. What connection could there be?

ANSWER: It's almost impossible to prove that a pain is psychological.  At this point, it's impossible to determine the cause of your pain from the available information.  You need to consult a urologist.

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QUESTION: The right testicle ( the one which has been causing problems)  feels very hard. what could this mean?

The other indication is that the right testicle is not hanging as low or freely as before. Its consistently hanging closer to the body as if the sperm cord has been shortened.

can you tell me what these symptoms could indicate please.

as I said before an ultrasound did not reveal anything abnormal.

thanks

Answer
A hardened testicle could be scarred over which happens after a trauma or infection; or there could be a tumor involving the entire testis (unlikely with a normal ultrasound).  

The fact that the testicle is not hanging as low as the other means nothing as this is considered normal.  It is extremely unlikely that the spermatic cord has actually been shortened.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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