# Scrotal or Testicular Symptoms - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Acute Scrotum Pain - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470404/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GS21 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication · Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose and duration for this indication - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Chronic Testicular Pain and Orchalgia - disease-level clinical article (scrotal-testicular-symptoms-clinical.txt) ## Treatment metadata - Referral & safety-netting (no drug therapy) - Ibuprofen — 600 mg — oral.solid - Amitriptyline — 25 mg — oral.solid - Gabapentin — 300 mg — oral.solid - Pregabalin — 75 mg — oral.solid ## Complete treatment card ```text SCROTAL OR TESTICULAR SYMPTOMS Sources: Acute Scrotum Pain - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470404/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GS21 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication · Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose and duration for this indication Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Chronic Testicular Pain and Orchalgia - disease-level clinical article (scrotal-testicular-symptoms-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Pain linked to voiding, bowel movements, exercise, sex, or prolonged sitting should be explored [testicular pain] - Prolonged sitting and constipation often worsen pain from idiopathic chronic orchialgia [constipation · testicular pain] - Dull, aching testicular pain worsened by gentle compression suggests a nociceptive mechanism [testicular pain] - A burning quality, altered sensation, and pain radiating to the scrotal skin points to a neuropathic mechanism - Walking, stooping, or hip hyperextension can trigger neuropathic pain, and lying down or thigh flexion can relieve it [burning pain] SIGNS - what you find (4) - Interstitial cystitis tends to cause suprapubic pain tied to bladder filling and emptying, unlike orchialgia [abdominal pain · lower abdominal pain] - Each part of the testis, epididymis, and vas should be checked for tenderness, swelling, and nodules [scrotal swelling] - A digital rectal exam looks for prostatitis and abnormal pelvic floor muscle tension - Most men with chronic idiopathic orchialgia have at least one finding of pelvic floor dysfunction on exam TESTS (6) - Urinalysis and urine culture are routine; semen culture is reserved for select cases - Testosterone and B12 run low in a large majority, about 76 percent, of patients with chronic orchialgia - Scrotal ultrasound is the main imaging study and principal diagnostic aid - Abdominopelvic CT is considered when ureteral stones, an aneurysm, or an inguinal hernia could be contributing - Spinal MRI is reserved for patients who also have back or hip pain - Cystoscopy, voiding cystourethrography, and pyelography are generally not helpful IF NOT THIS - what else fits (3) - Hydrocele, non-seminomatous testicular tumours, orchitis, and scrotal trauma are on the differential - Spermatocele, testicular seminoma, and testicular torsion must also be considered - Testicular tumour, testicular trauma, and varicocele round out the list Source StatPearls "Chronic Testicular Pain and Orchalgia" - disease-level clinical article Status traced to the source above Rx: Main treatment | First-line NSAID for chronic scrotal pain, once the emergencies are excluded | Tricyclic for chronic neuropathic scrotal pain when an NSAID has not worked | Anticonvulsant added when the tricyclic has failed | Anticonvulsant alternative when gabapentin is not tolerated MAIN TREATMENT 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult A broad symptom category covering pain, lumps, and other scrotal complaints; a GP can give pain relief but the differential (torsion, tumour, hernia, infection) needs urgent ultrasound and urology input. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why A broad symptom category covering pain, lumps, and other scrotal complaints; a GP can give pain relief but the differential (torsion, tumour, hernia, infection) needs urgent ultrasound and urology input. Caution Referral is the pathway; the medicines listed alongside are what primary care can give before or while it happens. RED FLAG - Amiodarone-induced orchialgia is not noted as a potential drug-induced cause requiring drug discontinuation RED FLAG - Sudden severe scrotal pain, which may be testicular torsion and a surgical emergency, or a hard, painless, irregular testicular mass, which may be testicular cancer. FIRST-LINE NSAID FOR CHRONIC SCROTAL PAIN, ONCE THE EMERGENCIES ARE EXCLUDED 2. IBUPROFEN [1st line] Adult 600 mg three times daily - At least 30 days before deciding it has not worked Peds No paediatric dose for this indication in the sources opened. Choice The article's first pharmacological step for chronic scrotal pain; the tricyclic and the anticonvulsants come after a month of it. Source Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose and duration for this indication Why A man with months of scrotal ache, once the emergencies have been ruled out, still needs analgesia. This is the article's first pharmacological step. Caution Only after torsion, epididymo-orchitis and a testicular mass have been excluded - a sudden painful testis is a same-day surgical problem, not an NSAID problem. Do not give it to anyone who has had asthma, hives or an allergic reaction after aspirin or another NSAID. A month of a full-dose NSAID is a real ulcer and kidney risk - think about gastroprotection and check the kidney function in older men. Egypt DAJUANOFEN 600 MG 20 F.C. TABS. COPAD PHARMA 6.50 EGP (0.33/unit) FLABU 600 MG 20 F.C. TABS. DELTA PHARMA 9.50 EGP (0.47/unit) MAXIPROFEN 600MG 10 TAB. PHAROPHARMA 4.75 EGP (0.47/unit) FLAMOTAL 600 MG 20 F.C.TABS. GLOBAL NAPI P... 56.00 EGP (2.80/unit) ALPHAFEN 600MG 30 TAB. ALFACURE PHAR... 86.00 EGP (2.87/unit) BRUFEN 600 MG 30 TABS. KAHIRA > ABBO... 99.00 EGP (3.30/unit) BRUFEN 600 MG 20 EFF. GR. IN SACHETS KAHIRA > ABBOTT LABORATORIES 120.00 EGP SPIDIDOL 600 MG 12 EFF. GR. IN SACHETS ZAMBON > PHARMACON 132.00 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid TRICYCLIC FOR CHRONIC NEUROPATHIC SCROTAL PAIN WHEN AN NSAID HAS NOT WORKED 3. AMITRIPTYLINE [2nd line] Adult 25 mg as a single dose at bedtime - Allow at least 2 to 4 weeks, and sometimes up to 8 weeks, before judging it Peds Safety and effectiveness in children have not been established. Source Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication Why For a man with months of scrotal ache once the emergencies are excluded, this is the article's second step and a GP can prescribe it. Caution This is for long-standing scrotal pain, not for a sudden painful testis - that needs same-day assessment for torsion. Never combine it with a monoamine oxidase inhibitor. Expect sedation, dry mouth and postural dizziness; be careful in the elderly, in glaucoma and where urinary retention is already a problem. Egypt TRYPTIZOL 25 MG 30 TABS. KAHIRA 33.00 EGP (1.10/unit) GRANITYLLIN 25MG/5ML SYP. 120 ML GRAND PHARMA ... 5.00 EGP -> ? strength differs, ? different route - not oral solid ZINOTRAVAL 25MG/5ML SYP. 120 ML DEBEIKY > PHA... 10.00 EGP -> ? strength differs, ? different route - not oral solid ANTICONVULSANT ADDED WHEN THE TRICYCLIC HAS FAILED 4. GABAPENTIN [3rd line] Adult 300 mg three times daily Peds No paediatric dose for this indication in the sources opened. Source Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication Why The article's third conservative step, reached when a month of tricyclic has not worked. It matters on a card that otherwise sends the man away with nothing. Caution It causes drowsiness and dizziness - tell the patient not to drive until he knows how it affects him. Reduce the dose in kidney impairment, and stop it gradually over at least a week rather than abruptly. This is for long-standing pain, not for a sudden painful testis. Egypt EZAPENTIN 300MG 10 CAPS. MULTI-APEX 11.00 EGP (1.10/unit) PENTALIPSY 300MG 10 CAPS. SAFE PHARMA 14.40 EGP (1.44/unit) OCTOCONVAL 300 MG 30 CAPS. OCTOBER PHARMA 72.00 EGP (2.40/unit) NEUROGLOPENTIN 300 MG 30 CAPS. GLOBAL NAPI P... 111.00 EGP (3.70/unit) SHALGATEN 300MG 30 CAPS. EGPI > MASH P... 126.00 EGP (4.20/unit) GABALEPSY 300MG 30 CAPS. EL-OBOUR 135.00 EGP (4.50/unit) GABAVERONA 300 MG 30 H.G. CAPS. AVERROES PHARMA 126.00 EGP SAJALIPSY 300 MG 30 H.G. CAPS. SAJA PHARMACE... 126.00 EGP STABLENTIN 6MG/120ML SYRUP MEPACO 21.60 EGP -> ? strength differs, ? different route - not oral solid ADAPTAN 250MG/5ML ORAL SOLUTION 100 ML EUROPEAN EGYPTIAN PHARM. IND. 37.00 EGP -> ? strength differs, ? different route - not oral solid ANTICONVULSANT ALTERNATIVE WHEN GABAPENTIN IS NOT TOLERATED 5. PREGABALIN [3rd line] Adult 75 mg to 150 mg daily Peds No paediatric dose for this indication in the sources opened. Source Chronic Testicular Pain and Orchalgia - StatPearls - NCBI Bookshelf (NBK482481) - the article states the dose for this indication Why Same step as gabapentin in the article, kept as the alternative because the article says gabapentin is normally tried first. Useful where gabapentin's three-times-daily schedule or its side effects defeat the patient. Caution Stop it at once and treat as an emergency if the throat, face or neck swells. Taper it rather than stopping abruptly - withdrawal symptoms and seizures have followed sudden discontinuation. It is sedating and causes dizziness; warn about driving, and reduce the dose in kidney impairment. Egypt FORPREGAB 75 MG 30 CAPS. GRAND PHARMA ... 45.00 EGP (1.50/unit) SNAPGAB 75 MG 30 CAPS. MASH PREMIERE... 49.50 EGP (1.65/unit) LYRIBALIN 75MG 10 CAPS. BORG 18.00 EGP (1.80/unit) NEURAGABALIN 75 MG 10 CAPS. DELTA GRAND P... 23.00 EGP (2.30/unit) NERVATYCA 75 MG 20 CAPS. ALFACURE PHAR... 48.75 EGP (2.44/unit) QUEENLEPT 75 MG 30 CAPS. FUTURE PHARMA... 93.00 EGP (3.10/unit) LYRICA 75MG 20 CAPS. PFIZER 232.00 EGP (11.60/unit) PREGABEDIUM 75 MG 20 H.G. CAPS. SABAA > ACTIV... 56.66 EGP LOCIKASWAB 100MG/5ML 20 UNIDOSE ORAL SOLN. UNISWAB > VODACHEM 43.50 EGP -> ? strength differs, ? different route - not oral solid AVEROPREG 100MG/5ML SYRUP 60 ML AVERROES PHAR... 55.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)