Characterizing patients with chronic scrotal content pain: a retrospective review of clinical presentations

Abstract

Background: Men with chronic scrotal content pain (CSCP) commonly present to various providers within the healthcare system. Despite its prevalence, little research has been done to understand risk factors for the development of CSCP. In many cases, the cause of pain is unknown, and there are no widely accepted protocols for evaluation or management.

Objective: To characterize associated symptoms and concomitant concerns of those presenting with CSCP.

Design and methods: Retrospective review of validated questionnaires including the Chronic Orchialgia Symptom Index (COSI), the internal index of erectile function, the NIH-chronic prostatitis symptom index, the American Urological Association symptom index/international prostate symptom score, the hip dysfunction and osteoarthritis outcome score, the Oswestry low back pain questionnaire, the patient health questionnaire-9, the general anxiety disorder-7, and a comprehensive intake form on men presenting to a single urologist's office with CSCP was performed. The analysis included constructing linear best-fit lines between subjective chronic testicular pain rating and other numerical rating scales.

Results: Questionnaires from 94 male patients were reviewed. The average pain subscore on the COSI was 8.00 out of 17. When assessing the association between pain and other domains, more severe chronic scrotal pain was associated with worse pain in and around the genitourinary system (p < 0.001), worse urinary symptoms (p = 0.001), worse hip (p = 0.001) and back (p < 0.001) symptoms, worse sexual function (p = 0.025), and worse anxiety (p = 0.019) and depression (p = 0.003) symptoms. Patients in our study were found to have a wide variety of presentations with differing aggravating and relieving factors, urological and surgical histories, and interventions.

Conclusion: Men presenting with CSCP may present with many co-occurring symptoms. More severe scrotal content pain may be associated with worse symptoms in multiple other domains. In order to create a personalized treatment plan, a more comprehensive understanding of these men is critical. Future studies should focus on further developing a standardized approach for assessing these patients and how directed interventions on associated symptoms may impact outcomes.

Keywords: chronic orchialgia; chronic scrotal content pain; chronic testicular pain.

Figure 1.

Scatter plot of the chronic prostatitis symptom index and Chronic Orchialgia Symptom Index (n = 77). The plot is overlayed with a line of best fit (ß = 0.693, p < 0.001). For both scales, a higher score indicates more symptom severity.

Figure 2.

Scatter plot of the international prostate symptom score total score and the Chronic Orchialgia Symptom Index pain score (n = 75). Higher scores indicate greater severity. Data show a positive association (ß = 0.158, p = 0.001).

Figure 3.

Scatter plot of the hip disability and osteoarthritis outcomes score total and the Chronic Orchialgia Symptom Index pain score (n = 81). Higher scores indicate greater severity. Data show a positive association (ß = 0.275, p = 0.001).

Figure 4.

Scatter plot of the Oswestry disability index and the Chronic Orchialgia Symptom Index pain score (n = 83). Higher scores indicate greater severity. Data show a positive association (ß = 0.109, p < 0.001).

Figure 5.

Scatter plot of the PHQ-9 total score and the Chronic Orchialgia Symptom Index pain score (n = 67). Higher scores on the PHQ-9 indicate greater severity. Data show a positive association (ß = 0.233, p = 0.003). PHQ-9, patient health questionnaire-9.

Figure 6.

Scatter plot of the GAD-7 total score and the Chronic Orchialgia Symptom Index pain score (n = 69). Higher scores on the GAD-7 indicate greater severity. Data show a positive association (ß = 0.177, p = 0.019). GAD-7, generalized anxiety disorder-7.

Figure 7.

Scatter plot of the IIEF-5 total score and the Chronic Orchialgia Symptom Index pain score (n = 51). For the IIEF-5, lower total scores indicate greater symptom severity. Data show a negative association (ß = −0.192, p = 0.025). IIEF, internal index of erectile function.