Groin and Genital Pain

male genitalia

What is genital pain?

Some men develop pain in the groin region which can be longstanding and very troubling. The worry of course is that there is a serious underlying cause for the pain and although many men have seen their GP or even a hospital consultant for the problem they may still have on going pain. Worse, for some men they feel that their concern that there may be a serious underlying problem has not always been dealt with.

Some men develop pain in the testicles or penis following surgery, trauma or infections. Although the majority gets better following treatment of the underlying cause, in a proportion of men the pain is on-going despite multiple antibiotics and painkillers.

Why see a specialist?

In all patients with on-going symptoms – and particularly with pain – it is very important that they are seen and assessed by a consultant with special expertise in sorting these problems out.

A thorough assessment is always required to make sure nothing serious or sinister is going on before focussing efforts on treating just the symptoms. As a specialist in this field I always perform a thorough assessment of my own, even if you have been seen by a specialist elsewhere. This often means high resolution imaging using  ultrasound, CT or MRI scanning to look in detail for an underlying cause. It may also mean blood and urine tests to exclude other specific problems too.

For many patients conventional treatments may have been exhausted already and I have a full arsenal of alternative approaches to the problem as required.

TESTICULAR PAIN

How common is testicular pain?

It is very common for men to have testicular pain at some point during their lifetime.  In the majority of cases the pain is not due to a serious cause at all.

My assessment always starts with taking a careful history of what the symptoms are, how long the problem has been going on for and so on. I will need to know about previous injury to the area as well as past surgery such as vasectomy.

After examining you I will then arrange a high-resolution ultrasound scan of the scrotum and urine tests to look for evidence of infection and other problems.

Because of the way the male genitals are connected sometimes the problem lies with the prostate gland or blockage of the ejaculatory ducts, sometimes it is within the testicle itself. Treatment is then based on the underlying cause.

What causes testicular pain?

Any irritation or inflammation in the structures related to the testicle may cause testicular pain. This includes the epididymis and prostate gland. Some people develop pain following surgery to the testicles or following a vasectomy. Pain can also be caused by a problem elsewhere such a stone in the ureter, the tube linking the kidney to the bladder.

What are the treatment options?

If a particular problem is found – such as a blocked duct or a stone – then of course treatment is aimed at dealing with that problem itself.

However in some instances men with testicular pain do not have any cause that can be found. In these cases I will reassure you that there is nothing sinister such as a cancer going on and we can focus on treating the symptoms. There are a wide range of treatments that can be offered to help with this.

For persistent pain with no obvious physical cause, I often involve other consultants such as pain specialists in patients’ care. Local anaesthetic nerve blocks combined with oral medication can be particularly helpful in these cases.

For persistent pain which has failed all treatment measures, I can offer a procedure called micro-surgical cord denervation. This is only suitable for carefully selected patients and involves dividing the nerves in the spermatic cord. This can be very effective in treating testicular pain, particularly in those patients who have responded well to local anaesthetic spermatic cord injections.

PAIN IN THE PENIS

Why see a specialist for penile pain?

On-going pain in the penis needs to be investigated to find the underlying cause.

Problems such as Peyronie’s disease, penile fracture and trauma need to be looked for and treated. An occasional cause of pain in the penis is a problem in the urethra or “water pipe” and sometimes I will pass a small telescope down the urethra to make sure that all is well.

What are the options for penile pain?

Once obvious conditions such as Peyronie’s disease and trauma such as penile fracture have been excluded, an MRI scan of the penis can help to localise the cause of the pain. Occasionally the pain may be due to a problem elsewhere, such as a kidney stone that has moved down into the ureter (the tube connecting the kidney to the bladder).

The good news is that in most cases pain in the penis is not due to a serious problem and does not require an operation. Medicines alone are usually very effective in treating the pain.

PROSTATITIS

What is Prostatitis

The prostate gland lies just below the bladder inside the pelvis. Occasionally patients can get an infection in the prostate gland and this causes prostatitis. Patients with prostatitis often have severe pain, a high temperature and problems passing urine. This is an emergency and requires hospital admission for antibiotic injections.

After an episode of prostatitis the problem may go on to become a chronic one with regular flare ups and intermittent pain.

Although this does not require admission to hospital it is pretty unpleasant. For some men the pain can become longstanding and once I have made sure there is no serious underlying problem I usually involve a pain specialist colleague to help in treatment.

Genital pain in men can be very troublesome but as an expert with many years’ experience of treating the condition I would reassure you that the underlying cause is not likely to be serious. However it does require an expert to look into the problem carefully and to make sure nothing sinister is going on. You can expect a thorough assessment and be reassured that I will be able to advise you on the best way of dealing with your symptoms.

How do I make an appointment to be seen?

Making an appointment is very straightforward.

If you wish to see me privately contact my secretary Julie Jones at (020) 7034 8464 and she will take your details and book the appointment. I can usually see you within a day or two at a time and date to your convenience, and we can usually start treatment that day. (see Making an Appointment for more details)

If you would like to see me through the NHS you will need to see your GP and ask him to refer you to me at University College London Hospital.

Case study

A 35 year old patient had pain after ejaculation in the scrotum and perineum. His wife had also failed to conceive after 2 years. Having been treated with multiple antibiotics and even been referred to a psychiatrist he eventually underwent an MRI scan which showed that the pain was probably due to a prostatic cyst blocking his ejaculatory duct. This was opened up using endoscopic surgery which required an overnight stay. Following the procedure he had a normal sperm count and a healthy baby girl.

What patients say

“After having an infection I had ongoing pain in the testicle. I’d been to a number of specialists to deal with ongoing pain in the testicle. It was very difficult to find someone who was specialized in this area until I was referred to Mr Muneer’s clinic. All options were discussed and I successfully underwent injections to try and alleviate the pain. These did work for a while until the pain returned. I then decided to have a microsurgical cord denervation which got rid of the pain and now I am free of any medication and back to doing the things I enjoy.”

Initials, London.

“Spent years looking for a treatment. It’s worked and now pain free!”

Initials, London.