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Pain Driving you Nuts?


Let’s face it, talking about your “land down under” can be uncomfortable, but not as uncomfortable as living with testicular pain! Did you know that chronic testicular pain, or orchialgia, affects approximately 100,000 men in the United States alone? So you are not alone, and there is help!


The testicles are the male gonads, or sexual reproductive organs, and are housed externally by the scrotum. The scrotum is actually an outpouching of the abdominal wall from embryological development, meaning some of the musculature and fascia is continuous with that of the abdomen - see picture below.




So what does this mean? Why am I having testicular pain? The answer may surprise you. Some common drivers of testicular pain that physical and occupational pelvic floor therapy can identify and address include:


  • Overactive abdominal musculature

  • Overactive Pelvic floor musculature

  • Overactive adductors

  • Stress

  • Spinal dysfunction/Pelvic malalignment

  • Pudendal nerve dysfunction

  • Trauma



Other potentially more serious drivers of testicular pain should be screened for and may warrant a visit to your PCP or ER:


  • Inguinal hernia: This is a bulge in the area on either side of your pubic bone, which becomes more prominent with increased abdominal pressure such as coughing or straining, and will affect nearly 25% of men in their lifetime.


  • Varicocele: This is an enlargement of the veins within the scrotum and often produces no signs or symptoms. A varicocele is identified in 15% of healthy men and up to 35% of men with primary infertility. Potential signs and symptoms may include:

  • Dull/achy pain relieved by lying down

  • A mass in the scrotum - like a “bag of worms”

  • Differently sized testicles

  • Infertility


  • Epididymitis: An inflammation of the tube at the back of the testicle that stores and carries sperm. Epididymitis is the most common cause of acute scrotal pain in adults with more than 600,000 men affected annually in the US. Common signs and symptoms may include:

  • A swollen, discolored, or warm scrotum

  • Testicle pain and tenderness that often comes on slowly

  • Firm testicle

  • Pain with urination

  • Urinary urgency or frequency

  • Discharge from the penis

  • Lower abdomen or pelvic pain/discomfort

  • Blood in the semen



  • Testicular torsion: This is more rare, with an annual incidence of 1 in 4,000, but is considered emergent. Usually occurs in boys between 12-18 but can occur at any age (usually wake with pain in the middle of the night or early morning). Presentations to screen for potential torsion include:

  • Sudden, severe pain in the scrotum

  • Swelling, redness, tenderness, or hardening of the scrotum

  • Nausea and vomiting

  • Abdominal pain on the same side as the torsion

  • Testicle in a strange position, such as higher than normal or an unusual angle

  • Discoloration of the scrotum


How can pelvic floor therapy help me? When you see a pelvic floor therapist, we start by performing an evaluation including discussing bowel, bladder, and sexual function, and walk you through what to expect out of the examination. Once the physical examination has been performed, we create a treatment plan that is tailored to the exam findings and your goals for therapy. Some of the treatment techniques we may utilize to help alleviate pain include:


  • Manual treatment techniques such as: Soft tissue and fascial mobilization, trigger point dry needling, nerve mobilization

  • Exercise focusing on: Reciprocal inhibition, stretches to lengthen mm, lumbopelvic strengthening and stabilization, nerve glides

  • Calming autonomic nervous system and taking you out of the “fight or flight” response by way of: Guided meditation, diaphragmatic breathing, and stress management


Still unsure if you would benefit from pelvic floor therapy? Give us a call and chat with one of our therapist about any lingering questions or concerns you may have!


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