Genital Pain & Discomfort

Male Genital Pain and Discomfort
The male genital area is primarily made up of the penis, scrotum, testes, epididymis, vas deferens, seminal vesicles and the prostate gland.

Epididymal pain
This type of pain is also well localized and upon examination will reveal tenderness with a focal bead-like thickening on the epididymis.

Penis Pain
Penis discomfort and pain may show up with many different signs and symptoms. Pain may be more sharp or burning in acute infections which MAY be related to STD’s and should be diagnosed by a professional. Other more mild pain may be from possible scar tissue from prior traumatic injuries.

Prostate Pain
Prostatic pain is predominantly perineal and possibly associated with other static symptoms. A loaded rectum or a digital rectal examination can increase the prostate pain or discomfort. If a prostate problem is expected a rectal examination if recommended. Possible disorders of the prostate are infections, swelling and cancer. Prostate pain is most often associated with urination and show similarities with urinary obstruction. In acute prostatitis (swollen prostate) patients generally will have an unwell feeling with a possible fever. In chronic prostate pain, patients may be mostly asymptomatic except for their perineal and lower back pain.

Scrotum and Testicular Pain
Possibly due to hydrocoele – fluid surrounding the testis making the testicles unable to be palpated.
If there is marked scrotal swelling it may be due to a indirect hernia.

Testicular Pain
With this type of pain, the area of pain should be easily identifiable although the pain may radiate upwards into the lower abdomen it should be rooted in the testicles. Testicular pain may be caused by an acute traumatic injury but should improve quickly. If there is a torsion pain the pain will persist for a long period of time.

Female Genital Pain and Discomfort
Generally there is no pelvic or groin pain in females. Possibilities of pain are from the multiple organs found in the female perineal and lower abdominal area. Examples of such organs are the ovaries, uterus, vagina, labia, bladder, urethra and many more. The uterus is supported by various ligaments which may become weekend and allow the uterus to prolapse causing a sinking type of pain. Many other organs may give similar pain in the same area such as the bladder which will press on the vaginal wall if prolapsed. The labia becomes dry and more rigid in post menopause which can cause discomfort and pain. This is only a general reference for these types of pain and a proper diagnosis is recommended by a professional in this field.

Acute Pelvic Inflammatory Disease
Pain in the lower abdominal area which may be caused by gonorrhea, chlamydia, gardnerella vaginalis infection. It is an inflammatory disease related with pain and a variety of other signs and symptoms.

Cervicitis
Pain similar to that or a urinary tract infection or mucopurulent vaginal discharge. It is caused by sudden or chronic inflammation of the narrow lower end of the uterus. In acute cases there may be pain accompanied with bleeding, redness and swelling of the cervix. Other symptoms may be a foul smelling odour with leucorrhea and a burning or itching sensation around the vaginal area. In chronic cases of cervicitis there are similar symptoms of the acute cervicits but are more commonly found among women in their reproductive years. If chronic, cysts are more likely to form with a congested and swollen cervix.

Dysmenorrhea – Menstrual pain
Dysmenorrhea is pain which associates with the menstrual period generally causing worse pain at the beginning of menstruation. The pain may be continuous or spasmodic (colicky) in nature. Menstrual pain can be felt in the lower back and pelvis areas. Dysmenorrhea may be related to endometriosis if it is felt for several days prior to menstruation.

Dyspareunia – Painful Sex
Pain during sex maybe caused by several reasons and may have many types of different pain (sharp, dull, burning, …) The possible causes of shallow vaginal pain are: a rigid hymen, proposed ovaries into perivaginal area, narrowed vagina due to scaring (operations), poor coital technique and genital tract infection. If the pain is found more deeply (deep dyspareunia) the cause may be cervicitis, endometriosis, salpingitis or in rare cases malignancies. Dysparenuia may also have a psychological background or cause.

Endometriosis Pain
Pain associated with menstruation (dysmenorrhea) due to a growth of endometrial tissue outside the uterus with ectopic uterine tissue which secretes blood. With endometriosis the pain may also be felt during sexual intercourse (dyspareunia) or with bowel movements.

Ovarian Pain
Generally, ovarian pain will be unilateral and diagnosis depends greatly on when the pain occurs. If ovarian pain occurs in the middle of a woman’s cycle (mittelschmerz) it is diagnosed as ovulation pain. This is usually due to torsion of an ovarian cyst producing a unilateral lower abdominal pain. If the pain is severe there will be cell death (infarction) at the site of the torsion. If there is a haemorrhage into an ovary or ovarian cyst the pain will be similar but be less severe. A ruptured ovary or part of an ovary (from a small cyst or corus luteum) will produce unilateral ovarian pain signs of peritoneal irritation which may be similar to that of appendicitis.

Salpingitis
Inflammation of one or both fallopian tubes which will give rise to unilateral or bilateral lower abdominal pain. There may be swellings palpable in the lower regions where the fallopian tubes are found and may cause pain. A vaginal examination may cause pain on movement of the cervix. Salpingitis is a type of Pelvic Inflammatory Disease.

Uterine Pain
Uterine Pain is an anterior lower abdominal pain which is not lateralized like ovarian pain. Uterine pain may also be felt in the lower back area.


Reference:
Mosby Medical Encyclopedia
Penguin Books LTD, 1996


Clinical History Taking and Examination
An Illustrated Colour Text
P.D. Welsby
Churchill Livingstone, 2002