1) Epididymitis
This is an infection of the epididymis within the scrotum. It is
typically caused by gonorrhea or chlamydia, but common infections such
as E.coli can also cause this. From UptoDate:
"Men with acute epididymitis typically have unilateral testicular pain
and tenderness, hydrocele, and palpable swelling of the epididymis."
A typical presentation is an otherwise healthy male complaining of
scrotal pain. Several factors may predispose men to develop subacute
epididymitis, including sexual activity, heavy physical exertion, and
bicycle or motorcycle riding.
This is typically diagnosed with a physical examination and/or scrotal
ultrasound that can detect the inflammation. A urinalysis and culture
should also be performed. Treatment is with proper antibiotics.
2) Prostatitis
Infection of the prostate can also cause pain radiating to the groin
or testicle. There are many types of bacteria that cause prostatitis.
Entry of bacteria through the urinary tract is the most common cause.
Diagnosis would typically include a urinalysis and prostatic massage
for secretions. These secretions can then be cultured and analyzed to
see if an infection is present. Initial treatment would typically be
with antibiotics based on the sensitivity to the culture.
Unfortunately, not all prostatitis syndromes can be easily treated.
There are many men with chronic prostatitis that requires anywhere
from 4-12 weeks of antibiotics. Imaging studies with an ultrasound
can also be considered to evaluate for an abscess.
3) Scrotal pathology
Any number of scrotal conditions can cause discomfort and a burning
feeling within the scrotum that can radiate to the groin.
One example would be torsion of the appendix testes. The appendix
testis is a small structure on the anterosuperior aspect of the
testis. Its onset is usually more gradual than with testicular
torsion; it is not uncommon for patients to have several days of
scrotal discomfort from appendiceal torsion before they present for
evaluation.
Another condition would be a varicocele - which are dilated veins
within the scrotum which can cause discomfort. The pain is normally
described as dull and aching - typically presenting on the left side.
Any number of scrotal cysts, such as hydroceles, spermatoceles or
epididymal cysts can also cause scrotal discomfort - with or without
the palpable presence of masses.
Each of these conditions warrant a scrotal ultrasound for further
evaluation.
4) Referred nerve pain
There are a variety of nerve disorders that can radiate to the
scrotum. The diseases that may cause referred scrotal pain are
diverse, reflecting the somatic nerves that travel to the scrotum: the
genitofemoral, ilioinguinal, or posterior scrotal nerves. Reported
causes of referred pain include abdominal aortic aneurysm,
urolithiasis, lower lumbar or sacral nerve root impingement,
retrocecal appendicitis, retroperitoneal tumor, and postherniorrhaphy
pain.
A referral to a neurologist can be done to further evaluate these
neurologic causes of pain. Electrodiagnostic testing can also be
considered.
5) Inguinal hernia
An inguinal (groin) hernia can present with groin discomfort,
radiating to the scrotum. These can be ruled in or out by an exam by
a physician. If there is doubt, an ultrasound or CT scan can be
considered for further evaluation.
To summarize, I would recommend a referral to a urologist for further
evaluation on the various causes of scrotal and groin discomfort. I
would have your urine tested for infection and prostate and prostatic
secretions examined. A scrotal ultrasound would be reasonable.
If the urological evaluation is not revealing, I would pursue a
neurology referral to evaluate if any number of nerve conditions that
can lead to the burning pain and discomfort you are experiencing.
I stress that this answer is not intended as and does not substitute
for medical advice - please see your personal physician for further
evaluation of your individual case.
