Brief Answer:
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Detailed Answer:
Hello Mr. XXXX,

I am sorry that the staff where your son is incarcerated have not helped. If the primary care doctor who visits the prison cannot help, your son should be referred to a urologist. I'll go through the most common causes of testicular and scrotal pain and what should be done for each.

There are some causes of testicular pain that are surgical emergencies, but as your son has continued to have the pain for 1.5 yrs, it is unlikely the cause is an emergency type cause. These include testicular torsion (where the testis twists on it's stalk and can get strangulated), and trauma/injury that creates a hematocele (collection of blood around the testicle). These situations come on more abruptly and with torsion, there can be nausea and vomiting.

I am thinking given that the pain goes away when lying down, that this may be an inguinal hernia. An inguinal hernia is a weak spot that allows part of the abdominal contents to push into the inguinal canal. Usually coughing, sneezing, and weight bearing makes the pain worse. I can't say for sure this is what he has without examining him.

Another possibility is a varicocele. This usually involves the left side. Basically it's an enlarged area of vein. If other causes have been ruled out, surgical repair of the varicocele is usually done.

Epididymitis - this is an infection around the testicle in the epididymis. Usually the scrotum feels swollen and hot. It can be caused by a UTI, gonorrhea, or chlamydia and is treated with antibiotics.

Orchitis - inflammation of the testicle. Usually there are symptoms of fever because it can be caused by a virus like mumps. Pain medications and steroids can help.

Testicular tumor - these usually do not cause severe pain but can cause swelling. Testicular cancer can be treated and cured if caught early.

So, I strongly advise that your son advocate to be referred to a urologist if the person who has been treating him hasn't or doesn't know what to do for him.

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