Testicular pain after prostate exam
27 year old white male with dull testicular pain that comes and goes for 3 months now...
Presented to physician for lower back pain, and increased urinary frequency 3 month back. On that visit, During digital rectal exam, experienced first onset of pain especially in right testicle. Pain was alleviated in severity by stopping the prostate exam but has persisted for 3 months now. Pain was recently noticed to be coupled with, on one occasion, abdominal discomfort that felt like "I needed to go to the bathroom (diarrhea)." The epididymis is tender to touch where the cord meets the testicle. Patient denies pain on urination or ejaculation, weak urine stream, or any other symptoms (the initial back pain and urinary frequency went away during Cipro treatment). Physician who performed rectal exam suspected prostatitis and treated with 1 month of Cipro. No improvement after 1 month of Cipro, so patient followed up with Urology Nurse Practitioner. Was provided with another digital exam of prostate which revealed no pain in testicles or signs of inflammation. Practitioner suspects possible epididymitis and prescribed 1 month of Bactrim and high doses of Ibuprofen as well as activity restriction. The Ibuprofen brought pain down to 0/10, but pain returned in one week after lowering the dose from 600mg three times daily to 400mg twice daily. After finishing course of Bacrim and Ibuprofen along with activity restriction, no improvement. A General Practitioner was seen who wants to rule out testicular cancer by running an alfa fetal protein and beta HCG blood tests. He also would like to do a urinalysis after a prostate massage. The urine has been within normal limits up to this point, but was not checked post prostate examinations previously mentioned in this report. The General Practitioner wants to run these tests pending the patients follow up with the Urology Nurse Practitioner which is scheduled soon. He suspects the urology practitioner may do an ultrasound of the testicles and perhaps the prostate as well. Does anyone out there have any ideas or remarks about the possible etiology of these symptoms? I have been unable to find any information about testicular pain related to digital prostate examination. Thanks so much for any ideas or comments.