The Biomechanical Links Between Pelvic Floor Dysfunction and Testicular Pain: A Clinical Review
Chronic scrotal content pain affects 100,000 men in the United States annually. Up to 50% of these cases do not resolve by following conventional treatment algorithms and are deemed to be idiopathic. There is little peer-reviewed literature supporting the specific cause and effect relationship between pelvic floor dysfunction and chronic scrotal content pain. Additionally, the specificity of the physical exam in these types of patients is not present in the literature. Overall, the literature is deficient in proposed treatment algorithms that address the large number of cases that are deemed to be idiopathic. Patients presenting with chronic scrotal content pain may benefit from an osteopathic diagnostic and treatment approach. In these types of patients, we recommend osteopathic manipulative therapy (OMT) or pelvic floor manual therapy prior to surgical intervention. This conservative approach may reduce the large portion of cases that aredeemed to be idiopathic. The emphasis on structure and function within osteopathic medical education places osteopathic family physicians in a unique position to be able to properly diagnose and treat this type of pain. Since most cases of chronic scrotal content pain are initially addressed in the primary care setting, it is important for osteopathic primary care physicians to remain vigilant in considering musculoskeletal dysfunction when evaluating these types of patients. This clinical review is underscored by a unique case presentation of a male collegiate athlete who helps demonstrate the larger gap that is present in the literature on male pelvic floor and scrotal content pain.