Brief Answer:
Some possible causes and diagnoses to rule out.

Detailed Answer:
Hello,

Thank you for using HealthcareMagic,
I read your question carefully and I can understand your concern.

These are my thoughts and something to consider:

- If you are sexually active you need to make sure you get checked for the sexually transmitted infections like Gonorrhea and Chlamydia in the first place and rule those out by investigations and treatment accordingly.

- Sometimes these infections can affect the epididymitis or orchitis. You will need a urologist exam in order to rule that out and you will need a prescription with antibiotics to treat that.

- Varicose veins (varicocele- when veins become enlarged inside your scrotum, the pouch of skin that holds your testicles) may give pains also. An ultrasound of the scrotum will be able to diagnose them.

- Also, you need to rule out if there are any masses in your testicles to be the cause of the pain. Testicular malignancies are very aggressive, which is quite common in your age.

So, I think that it is worth to consider a checkup and rule out these important causes. These one mentioned above are the most common causes. Of course can be others, which can be considered step by step depending on the results of the labs and physical exam.

Hope this is helpful.
Let me know if you need more clarifications.

Regards,
Dr. Papaqako

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Brief Answer:
Treat the inflammation despite if the tests come out negative.

Detailed Answer:
Hello,

Thank you for the follow up question and the extra information you provided.

From what I understand from your description, seems like you have been done almost everything that is needed to diagnose the most common causes of testicular pain.

You are saying that your epididymis has been inflamed, and so the pain started with it. If I was your caring doctor I would insist on treating that inflammation, despite if the tests have come negative. So getting a treatment that would cover a wide range of possible bacteria, I think would treat the inflammation and the pain as a result.
I would suggest that if you haven't gotten any treatment with antibiotics, talk with your doctor about this suggestion so they can prescribe you the antibiotics and you give it a try.

Hope this helps.

Kind regards,
Dr. Papaqako

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Brief Answer:
Pain with conversion origin?

Detailed Answer:
Hello again dear,

I see you have done also my last recommendation.

I am afraid I am out of recommendations. But again, it is even more difficult when I don't have a full medical history and haven't done myself a physical examination.

At last, when everything seems to have been ruled out, no infection, normal physical exam for masses of fluids- I would also try to try using medicines which are for conversion problem. It means that if you have everything normal, the pain comes only from your head, and these medicines are the ones that are used for anxiety.

If you agree with this, discuss this with your doctors so they can approve too that you are cleared of having anything pathological in your testicles.
I don't know if this makes sense, but weirdly this diagnoses is very common and these medicines are very helpful when it comes to the case of a pain without a visible cause.

Let me know your thoughts if you want.
I hope this has helped to give you a suggestion of the next step.

Kind regards,
Dr. Papaqako

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