Condition & Treatments
-/ Chronic scrotal pain
Chronic scrotal or testicular pain: finding the cause, and a way forward
Pain in the testes or scrotum that lasts three months or more is called chronic scrotal pain (chronic orchialgia). It can be exhausting, affect work and relationships, and men are often told nothing can be done. With careful assessment, most men can be helped.
Sudden, severe testicular pain is an emergency. Go to A&E straight away, as it may be a twisted testicle.
I N S H O R T
Common causes include previous vasectomy, varicocele, past infection, hernia surgery, and pain referred from the back or pelvis. Sometimes no single cause is found.
Treatment starts with medicines and physiotherapy, and moves to surgery only when needed.
A nerve block test can show whether surgery on the nerves is likely to help.
Treatment options
Medicines: anti-inflammatories, and nerve pain medicines such as amitriptyline or gabapentin.
Pelvic floor physiotherapy, when tight pelvic muscles are part of the problem.
Treating the cause: for example, repairing a varicocele.
Microsurgical denervation of the spermatic cord. Under an operating microscope, the small nerves carrying pain signals are divided, while the artery, vas and lymph vessels are kept.
Vasectomy reversal or removal of the epididymis, in selected men with pain after vasectomy.
Why an expert assessment matters
The real cause is found. Pain can come from the testis, epididymis or cord, but also from a hernia, the back, the pelvic floor or a kidney stone. A careful examination and the right scans tell these apart.
Surgery is only offered to men likely to benefit. A spermatic cord block shows whether the nerves in the cord are the source of the pain before any operation is planned.
The microsurgery protects what matters. Denervation should divide the pain-carrying nerves while keeping the testicular artery, vas and lymph vessels. Prof Raheem also adds a small window in the tunica vaginalis to prevent fluid collecting afterwards [3].
Your fertility and the testis are protected. Choosing denervation over more destructive options, such as removing the epididymis or the testis, keeps both fertility and testosterone production intact.
The whole picture is treated. Medicines, pelvic floor physiotherapy and the emotional toll of long-term pain are part of the plan, not an afterthought.
Chronic scrotal pain has many possible causes, and the wrong treatment can leave the pain in place or make things worse. Seeing a specialist first means:
Why this matters to your care
Prof Raheem's work on nerve-sparing and nerve-dividing microsurgery, including his modified vasectomy technique, means he understands exactly which nerves cause scrotal pain and how to treat them precisely.
Professor Raheem was the first surgeon at University College London Hospital to adopt microsurgical denervation of the spermatic cord for chronic testicular pain, in 2015, at a time when men with refractory testicular pain were rarely offered a targeted surgical option. Instead, they were usually offered removal of the epididymis (epididymectomy) or of the testis itself (orchidectomy). He went on to train fellows and other surgeons in the technique, several of whom are now consultants, and one of whom has since taken it to Egypt. He also introduced a technical modification of his own, tunica vaginalis fenestration at the time of surgery, to prevent hydrocele formation, a recognised complication of denervation.
His work on microsurgical denervation has been presented at international congresses, including the European Society for Sexual Medicine (2019) and the International Society for Sexual Medicine (2023), and published as a prospective case series [3, 4]. It consistently argues that men with chronic testicular pain deserve access to this procedure before less targeted or irreversible surgery is offered.
Common questions
Does chronic scrotal pain mean cancer?
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Very rarely. An ultrasound will check, which is often a relief in itself
Will surgery cure the pain?
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Most men benefit. Across 12 published studies of 707 men, denervation was effective in 71–96%, with complete pain relief in around 3 in 4 [1, 2, 5]. In Prof Raheem's own published series of 27 men, 93% (25 of 27) had a significant improvement in their pain and 74% (20 of 27) became completely pain-free, in line with published figures. The median pain score fell from 8.4 to 1.1 out of 10 [3, 4].
Will treatment affect my fertility?
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Denervation is designed to keep the vas and blood supply intact. Prof Raheem will discuss any fertility implications before surgery.
Prof Raheem's published work on this topic
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Microsurgical denervation of the spermatic cord for chronic scrotal pain: a prospective pilot study. African Journal of Urology, 2026. Link
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Microsurgical denervation of the spermatic cord for chronic scrotal pain: results from a prospective case series. Journal of Sexual Medicine, 2024 (congress abstract). Link
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Microsurgical denervation of the spermatic cord with tunica vaginalis fenestration: results of a case series with a review of the literature. Research Square, 2023 (preprint). Link
References
1. Levine LA, Matkov TG. Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia. Journal of Urology, 2001;165(6):1927–1929. Link
2. Chaudhari R, et al. Microsurgical denervation of spermatic cord for chronic idiopathic orchialgia: long-term results from an institutional experience. World Journal of Men's Health, 2019;37(1):78–84. Link
3. Almekaty K, Raheem A, Gamal M, Ragab M, Abo El Enein M, Gameel T, Ghaith A. Microsurgical denervation of the spermatic cord for chronic scrotal pain: a prospective pilot study. African Journal of Urology, 2026. Link
4. Abdel Raheem A, Fathy Soliman I, Hafez K. (131) Microsurgical denervation of the spermatic cord for chronic scrotal pain: results from a prospective case series. Journal of Sexual Medicine, 2024;21(Suppl 2):qdae002.119. Link
5. Almekaty K, AbdelRahman I, Moubasher A, Abdel-Raheem T, Zeidan A, Abdel Raheem A. Microsurgical denervation of the spermatic cord with tunica vaginalis fenestration: results of a case series with a review of the literature. Research Square, 2023 (preprint). Link