Chronic Scrotal Content Pain: A Practical Guide to Diagnosis and Management

ABSTRACT Chronic scrotal content pain (CSCP) is a common but often poorly understood condition that presents a significant diagnostic and therapeutic challenge. The broad differential diagnosis and frequent absence of an identifiable cause can lead to repeated investigations, delayed treatment and unnecessary surgery. This review provides a practical overview of the assessment and management of CSCP, based on contemporary American Urological Association and European Association of Urology guidance, and the current literature. We describe a structured approach to history, examination and investigation, highlighting important red flags and common causes, including post‐vasectomy pain syndrome, chronic epididymitis, neuropathic pain, pelvic floor dysfunction, referred pain and malignancy. Management should begin with conservative, multidisciplinary treatment tailored to the underlying pain mechanism. Medical therapy, pelvic floor physiotherapy, psychological support and specialist pain management all have important roles. When conservative measures fail, a diagnostic spermatic cord block can help identify patients most likely to benefit from surgery. Microsurgical denervation of the spermatic cord is the preferred surgical option for appropriately selected patients, while epididymectomy, vasectomy reversal and orchidectomy are reserved for specific indications. A systematic, patient‐centred approach can improve diagnostic accuracy, avoid unnecessary intervention and support appropriate treatment selection. This review aims to provide clinicians with a practical framework for the assessment, management and referral of patients with CSCP. Trial Registration: N/A