I thought I would start a thread (My first I think?) about dealing with Chronic Testicular pain and how it might be resolved. If your here because of this and can share some of your story I know it would be appreciated by a couple of members who are in a semi steath mode. We all know that the forum goes from A to Z with one end being into the more then willing sexual fetish angle and the other being those brought kicking and screaming into surgery for Cancer. Those that are closer to the kicking and screaming but do want to resolve months/years/decades of pain? Please chime in.

This is really about how to deal with chronic pains aka Orchialgia. I've been dealing with that most of my adult life and have been talking to various friends I've met on the forum who have solved this. I've also met a number who still live with it because the Doctors just don't "do" surgery to solve this. Thus they are on drugs or getting TENs (Electric shocks) etc. I've been curious what play book these doctors are going by to get to these points and found a document on the web that pretty much spells out what happens and in what order. I've bumbled through one surgeon who followed the book but also literaly freaked out at the conclusion. His "manhood" was too tied up in my testicles if that makes any sense at all. My MD sent me to her choice surgeon who is clearly not a fan of surgery to solve this but is not saying "No way no how" either.

Anyway I'm sharing (The playbook) here so those of you with Orchialgia can work closely with your doctor to get to a point where the problem is resolved.

I also submit this because I felt pretty embaressed to be asked to talk to a "shrink" about this. Anyway anyone easily embaressed won't want to bring any of this up with the variety of tests done. Ugh! I think the fact that you do suffer though all this crap is one way they gauge how much pain your in.

--------------THE PLAYBOOK--------------------

1. Characteristics of Testicular Pain

1. Duration of pain (chronic defined as >3 months)

2. Location of pain

3. May be unilateral or bilateral

2. Associated urologic symptoms

1. Hematuria “Blood in Urine”

2. Hematospermia “blood in the ejaculate”

3. Dysuria “Painful or difficult urination”

4. Erectile Dysfunction (Impotence)

3. Previous urologic surgery

1. Vasectomy.

2. Genital trauma.

3. Prior Hernia Repair.

4. Comorbid conditions

1. Major Depression.

# Causes

1. Idiopathic in 25% of cases “arising spontaneously or from an obscure or unknown cause”

2. Intermittent Testicular Torsion

3. Post-genitourinary surgery

4. Sperm granuloma (post-Vasectomy)

5. Varicocele *Extra Veins in the scrotum

6. Testicular Cancer (painless in 60% of cases)

7. Genitourinary infection (e.g. STD)

8. Testicular Torsion

9. Torsion of Testicular Appendage

10. Epididymitis

11. Orchitis

12. Traumatic injury to scrotum

13. Strangulated Inguinal Hernia

# Evaluation

1. Assessment for Acute Testicular Pain is critical

2. Assess for referred pain

1. Nephrolithiasis in the mid-ureter (most common) “Kidney Stones etc”

2. Radiculopathy

1. Genitofemoral and ilioinguinal nerves (T10-L1)

2. Causes

1. Inguinal Hernia

2. Radiculitis “swelling in the nerve roots due to local trauma.”

3. Entrapment Neuropathy after Hernia Repair

4. Sperm granuloma

# Signs

1. Complete Male Genital Exam including rectal exam

# Labs

1. Urinalysis

2. Urine Culture

3. Expressed Prostatic Secretions when indicated

4. Gonorrhea and Chlamydia cultures

# Radiology

1. Ultrasound with color flow doppler of scrotum

2. Consider Spiral CT abdomen (CATSCAN) or intravenous pyelogram (XRAY)

# Management

1. Step 1

1. NSAIDs

2. Adjust posture if due to radiculopathy

3. Empiric antibiotics for 2 weeks or more

1. Cover Chlamydia and Ureaplasma

2. Doxycycline

3. Ciprofloxacin

2. Step 2

1. Spermatic cord block at pubic tubercle

1. Bupivicaine (Marcaine) 0.25% 3 ml and

2. Methylprednisolone 40 mg

3. Inject no more often than once monthly

2. Trascutaneous Electrical Nerve Stimulation (TENS)

3. Step 3

1. Multidisciplinary Pain Management

2. Antidepressant medication

3. Psychotherapy

4. Step 4: Urologic Surgery

1. Orchiectomy

2. Surgical denervation Testes along spermatic cord

# References

1. Baum (1995) Postgrad Med 98(4):151-8

That's quite a lengthy and expensive procedure.

I'd guess most doctors and too concerned about enhancing their paycheck and/or their malpractice premiums to go right to the bottom line. Doh!

Kangan (imported) wrote: Mon Apr 09, 2007 10:51 am That's quite a lengthy and expensive procedure.

I'd guess most doctors and too concerned about enhancing their paycheck and/or their malpractice premiums to go right to the bottom line. Doh!

Your correct that lawyers and lawsuits have a large say in why this is complicated. That being those Surgeons who would not perform an orchiectomy for chronic orchialgia.

I understand what your saying but I think some of the logic has merit. Lets say you or I show up and say "My balls hurt give me an orchiectomy" If the pain is really from Kidney stones? Well the surgery won't help and the patient now has a good case in court. If the patient has an infection that can be cured with drugs? Orchiectomy again is not the right answer.

The basic idea is to eliminate the easy to fix things that are not ireversable first. EA is exceptional in that there are men here who seek "castration" for none health reasons. They just want it. Many guys don't want to have themselves castrated except to stay alive or to combat chronic pain. Those that want this for other reasons such as Gender Identity etc have a different path and playbook. I just wanted to talk up another health reason and perhapes meet some others who had this done to see what hoops they had to jump thru.

In a case like this id say you have to go to your docor and say

"This is the problem This is what i wont will you do it"

NOT

"This is the problem what do you think i should i do about it"

You have to prove right from the start that your in control of your own body you cant sue a doctor if you ASKED them to do it"

Its like walking in and asking for a BREAST enlargement then later changing your mind and thinking to yourself that my tits are now to big going back to the doctor and complaing and threatning to sue for doing what you asked him to do.

Whats his answer going to be.

"BUT YOU ASKED ME TO DO IT"

(Sory about using Breast enlargement as an EG but i think it makes my point By the way i dont want breast enlargement LOL )

Unfortunatly it's not that simple and logical. A doctor has an obligation, by todays standards, to follow accepted practice and guidelines. Your permission does not constitute a defence. Doctors no longer have the freedom to act as they see fit regardless of other opinions. This is not all bad. It came about due to abuse of privilege by doctors. However it does not serve some patients well. --FLO--

An interesting thread. I will add some to it. I came into this world with almost no scrotal tissue, and with undescended testes. They were cajoled and massaged, and poked and prodded, and they still made no effort to drop into that small bit of scrotum until I was 16. Several times as a child , and a teenager, doctors recommended that they be removed. My father steadfastly refused. Once I passed into adulthood, they took up their current position in the lowest part of the inguinal canal. They are very small, (the size of small grapes), and do not manufacture either sperm or testosterone. I have been on low dose HRT for years.On average I suffer moderate pain 5 days a week.Sometimes the pain is bad enough that I can only lay in a fetal position and try to sleep. This has gone on unabated for almost 30 years now, and only one physician has agreed to remove them. I backed out of that opportunity because my then partner was against it. No doctor since will even entertain the surgery. It is well documented in my records that these are two atrophied non functional lumps of flesh. My current urologist has finally consented to take them out , only if my medical insurance provider agrees to fund the procedure. His concern is that if it is elective surgery that I pay for, then my current and any future health insurance company may refuse to cover the cost of HRT. Much of the refusal to do this has been in my opinion the knee jerk reaction that the doctor has to the idea of being ball free. I even pursued possible legal challenges against the medical community for failing to act to relieve my pain. That was a dead end. I am not concerned with anything other than eliminating my own pain, I have had the appearance of a eunuch all my life, and am comfortable with that. So there in a nutshell is my situation, hope that I have shed some more light on this.

Raymar

Uncle Flo (imported) wrote: Tue Apr 10, 2007 4:54 am Unfortunatly it's not that simple and logical. A doctor has an obligation, by todays standards, to follow accepted practice and guidelines. Your permission does not constitute a defence. Doctors no longer have the freedom to act as they see fit regardless of other opinions. This is not all bad. It came about due to abuse of privilege by doctors. However it does not serve some patients well. --FLO--

I think what you say has merit and when I sat down with a surgeon and showed him several items that show Orchiectomy to be a high percentage "cure" for chronic pains his attitude clearly changed. Is it a matter of just not knowing? I suspect Orchialgia is not the that common vrs all the ED/Impotence, cancer etc they deal with 9-5.

As to the comment about cosmetic surgery and destroying "function" such as breast implants that make it impossible (or unsafe) to nurse a baby? I think a person has some choices when your talking cosmetic surgery. For example a man who has had all the kids he wants and asks for a vasectomy. Or a woman past child bearing age that wants breast implants. Personally I think asking for an Orchiectomy when you have chronic testicular pain is even more of a slam dunk but it has that "E" word associated with it. And as you know this is not considered desirable to most of the male population under ANY circumstances.

Take the men with prostate cancer who opt to just die rather then suffer surgical or chemical castration. I know that seems insane but.... This is the gist of the issue with those who have Orchialgia and are sick of the pains, atrophy etc etc etc.

raymar2020 (imported) wrote: Tue Apr 10, 2007 4:55 am An interesting thread. I will add some to it. I came into this world with almost no scrotal tissue, and with undescended testes. They were cajoled and massaged, and poked and prodded, and they still made no effort to drop into that small bit of scrotum until I was 16. Several times as a child , and a teenager, doctors recommended that they be removed. My father steadfastly refused. Once I passed into adulthood, they took up their current position in the lowest part of the inguinal canal. They are very small, (the size of small grapes), and do not manufacture either sperm or testosterone. I have been on low dose HRT for years.On average I suffer moderate pain 5 days a week.Sometimes the pain is bad enough that I can only lay in a fetal position and try to sleep. This has gone on unabated for almost 30 years now, and only one physician has agreed to remove them. I backed out of that opportunity because my then partner was against it. No doctor since will even entertain the surgery. It is well documented in my records that these are two atrophied non functional lumps of flesh. My current urologist has finally consented to take them out , only if my medical insurance provider agrees to fund the procedure. His concern is that if it is elective surgery that I pay for, then my current and any future health insurance company may refuse to cover the cost of HRT. Much of the refusal to do this has been in my opinion the knee jerk reaction that the doctor has to the idea of being ball free. I even pursued possible legal challenges against the medical community for failing to act to relieve my pain. That was a dead end. I am not concerned with anything other than eliminating my own pain, I have had the appearance of a eunuch all my life, and am comfortable with that. So there in a nutshell is my situation, hope that I have shed some more light on this.

Raymar

I can't wrap my head around the idea that your on HRT and after your Orchiectomy will continue to be on HRT but your insurance will suddenly say they won't pay? I would pull my own head off at this point and scream at my headless corpse.