Skrotales Schmerzsyndrom: Chronische Hodenbeschwerden bei unauffälligen Befunden

Zuletzt aktualisiert: 15. August 2026

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A steady stream of men come to my clinic with scrotal pain or discomfort that is not severe but never quite goes away. They have usually been investigated already, often more than once — and every test comes back normal. What they are rarely given is an explanation, so they leave with the results but not the answer, and two questions take up residence: could this be a tumour? und am I going to feel like this for the rest of my life?

Let me answer both of those now, before anything else. No, this is not cancer — scrotal pain syndrome is a nerve-related pain condition and does not turn into a malignancy. And no, you are not necessarily stuck with it: there is a long list of treatments, and they are worked through in order. The condition has a name, a mechanism and a management pathway, which is the part most patients have never been told.

What scrotal pain syndrome is

It is defined as at least 3 months of unusual scrotal discomfort that interferes with daily activities. You may have seen it under any of a dozen names — chronic orchialgia, testialgia, testicular pain syndrome, chronic scrotal content pain, and post-vasectomy pain syndrome where it follows that operation — but they describe the same condition.

Around 2.5% of patients seen in a urology clinic have it. The mechanism is irritation of the nerves supplying the scrotum, which can follow trauma, infection or prolonged irritation — and in a good number of men, follows nothing identifiable at all. Because those nerves share branches with the nerves of the groin and flank, the discomfort often radiates into those areas too, which is why the pain can seem to move around.

How it presents

1. Hodenschmerzen
2. Schmerzen im Nebenhoden
3. Schmerzen entlang des Samenleiters
4. Schmerzen beim Samenerguss
5. Vorzeitige Ejakulation
6. Schmerzen beim Pressen beim Wasserlassen
7. Schmerzen nach langem Sitzen

Why normal test results are the point, not the problem

The purpose of investigation here is to exclude every condition that could explain the pain structurally. Since scrotal pain syndrome is a nerve problem rather than a structural one, the expected result of every one of those tests is negative.

That sounds like a paradox, and it is worth stating plainly: a normal ultrasound and a normal set of blood and urine tests, in a man with three months of scrotal discomfort, is not a failure to find the answer — it is part of the answer. Being told that everything is normal, without that explanation, is what leaves men anxious and doctor-shopping.

One important limit to all of this. Everything written here is about long-standing discomfort in a man who has already been examined and investigated. It does not apply to new symptoms. Sudden, severe testicular pain, particularly with nausea or a testis that sits higher than usual, is a surgical emergency — testicular torsion — and needs a hospital immediately, not a clinic appointment. A new lump or swelling in the testis, or pain with fever, redness or difficulty passing urine, also needs assessing on its own merits rather than being assumed to be this syndrome. Reassurance about chronic scrotal pain is only valid once those have been excluded.

Treatment, from least to most invasive

Treatment is stepwise: start with the gentlest options and move on only if the response is inadequate.

• Psychological assessment and support — not because the pain is imagined, but because chronic pain and mood feed each other in both directions
• Pelvic floor physiotherapy
• Akupunktur
• Antibiotics — only where an infection is actually present
• Nicht-steroidale entzündungshemmende Medikamente
• Antidepressant medication — used here for their effect on nerve pain, at doses far below those used for depression
• Anticonvulsant medication — again, prescribed as nerve-pain agents
• Radiofrequency therapy
• Blockierung des Samenstrangnervs
• Surgery — the last resort

Two of those deserve a note, because patients often bristle at them. Being referred for psychological support does not mean anyone thinks you are inventing the pain, and being offered an antidepressant does not mean you are being treated for depression — these drugs act on nerve signalling and are standard tools in chronic pain of every kind.

With a list this long, the treatment that eventually works varies from man to man, and finding it takes some patience on both sides. What makes the difference is understanding what you are dealing with — knowing that the negative tests are expected, that the condition is not dangerous, and that there are still options further down the list if the current one is not enough. If you are living with this and no one has explained it to you, that conversation is worth asking for.

Wenn Sie unter chronischen Beschwerden im Hodensack oder Hoden leiden und eine ordnungsgemäße Untersuchung und einen schrittweisen Behandlungsplan wünschen, bietet Dr. Soarawee Weerasopone Spezialsprechstunden in der Zentrale des Bangkok Hospital an. Beratungstermin buchen. Termine im Samitivej Sriracha Krankenhaus können vereinbart werden, indem Sie die Abteilung für Urologie anrufen unter 088-022-1445.

Bangkok Hospital also runs a Telemedicine service, which suits this condition well once the first assessment has been done in person: reviewing how a medication is working, or deciding whether to move to the next step on the list, rarely needs another examination. Arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. New or sudden pain, however, should never be dealt with by video.

Häufig gestellte Fragen zum Skrotalschmerzsyndrom

Haftungsausschluss: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. No medical advice, diagnosis or prescription is provided through personal messaging channels. Sudden or severe testicular pain is an emergency and should be assessed at a hospital straight away. Always consult a qualified healthcare professional before starting any medical treatment.