Investigating and managing chronic scrotal pain.

Few data are available on the true incidence of chronic scrotal pain and most figures relate to post-vasectomy pain syndrome. However, a crude incidence of 350-400 cases of chronic scrotal pain per 100 000 men per year has been estimated on the basis of a questionnaire among Swiss urologists. Data on the impact of scrotal pain on quality of life are lacking. These patients are challenging to both the general practitioner and urologist, and a clear understanding of the aetiology and unpredictable course of this common condition is needed when treating them. Chronic scrotal pain refers to an ill understood complex of symptoms. Various terms have been used to describe the condition including orchalgia and orchidynia, which really refer to the testicle itself, and chronic epididymitis. Both the European Urological Association (EAU) and the International Continence Society have adopted the generic term scrotal pain syndrome to include testicular pain syndrome, post-vasectomy pain syndrome, and epididymal pain syndrome. The condition is defined as persistent or recurrent episodic scrotal pain associated with symptoms suggestive of urinary tract infection or sexual dysfunction without confirmed epididymo-orchitis or other obvious pathology.