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Forum Name: Urology Topics

Question: 3 week pain on chords holding low hanging left testicle


 markzander - Sat Jul 24, 2010 12:05 pm

Dear Dr,

My left testicle hags lower and doesn't move. I can tighten my abdominal muscles and the right testicle moves accordingly, but the testicle on the left side doesn't even seem to respond to the cremaster reflex. The left side epididymis feels sour constantly as does from the top of the testicle all the way to the body next to the penis on the left side. It's not sensitive to touch. It's just a permanent ache.

I've had this ache that is very uncomfortable and is interrupting my activities for 3 weeks now. It's not getting better.

There is no discharge from the penis and no pain urinating. It does take a while to start urinating sometimes, but there is not pain and everything appears normal once I start.

I had an inguinal hernia operation also on the left side almost 8 months ago.

Two weeks ago, I was at the hospital and they checked. They did an echosonogram and reported that all was normal. They only found that a lymph node in my groin on the left side was inflamed: 10x3.5mm. I took a low dose of antibiotic for 5 days and they said to rest a bit.

I can get aroused and have sex. It's not painful. I just feel a dull ache that extends alongside the left base of my penis down to the top of the testicle. Sometimes the pain radiates to my thigh and lower abdomen all the way to the left hip-bone.

Now 2 weeks later, I don't feel better. What could it be?
 Dr.M.Aroon kamath - Sat Jul 24, 2010 10:26 pm

User avatar Hi,
You indicate that you underwent an inguinal hernia repair about 8 months ago.

The cremaster muscle on the side of an hernia gets frequently thinned out in some large hernias and in hernias of long duration and becomes so thinned out that it can not be identified at surgery as a separate layer of muscle(only the cremasteric fascia remains identifiable).Thus, it may get removed with the hernial sac. Also, surgeons often remove the cremaster muscle deliberately (a well known and accepted procedure-it is part of "skeletonizing the elements of the inguinal canal"), which makes repair simpler and better. Resection of the cremaster muscle is considered an essential part of Shouldice's hernia repair.

Therefore,lack of or a weak cremasteric reflex on the side of the hernia repair is not in any way to be considered abnormal in this situation.

Chronic groin pain is a significant problem following open inguinal hernia repair, with a incidence ranging from 19% to 62.9%.The ilioinguinal nerve is a sensory nerve that innervates the skin over the groin region, the medial aspect of the thigh, the upper part of the scrotum and the penile root.This nerve gets caught up in the fibrous tissue following repair(during the healing phase). This may result in a "entrapment neuropathy", causing pain in the distribution of the nerve. (There are two other nerves-the iliohypogastric nerve and the genital branch of genitofemoral nerve, that also may be involved similarly). The symptoms usually occur in the early post operative period but, may be delayed by several months or even years.In a fair number of cases that present early, the pain tends to disappear sponteneously.

This possibility also needs to be considered in your case.

In these cases, the initial management is a conservative(non-operative). Only if symptoms persist despite this and are debilitating, surgical option would be considered.

I hope that your symptoms(which could well be due to a minor infection) will subside in due course with on-going management.
Best wishes!

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