Pain in the testicles when sitting for a long time, or a dragging pain in the area of the perineum, is a problem that many men meet, but they do not know where they should begin examining.

Some people worry that it is an infection, an inflamed prostate gland, an abnormal lump, or a serious disease. But in many cases, pain of this character may be related to the state of chronic pelvic pain in men, or Chronic Pelvic Pain Syndrome (CPPS), which usually has factors from the muscles of the pelvic floor, the nerves, and the cycle of chronic pain, rather than from infection alone.

This article explains what pain in the testicles when sitting for a long time or pain in the perineum may arise from, when a doctor should be seen, and which systems a suitable assessment should look at.

What is chronic pelvic pain in men, or Chronic Pelvic Pain Syndrome (CPPS), like

Patients usually describe the symptoms as a dragging, heavy, tight pain, or a deep discomfort in the area of the testicles, the perineum, the base of the genital organ, or the anus, which usually becomes clearer when sitting for a long time, such as driving, sitting working in front of a screen, or sitting on a hard chair.

The characters met often are

A dragging pain in the area of the testicles or the perineum
Pain radiating to the base of the genital organ or the anus
The symptoms becoming worse when sitting for a long time
Getting up to walk or changing posture making it better temporarily
Pain that comes and goes, or that is continuous for several weeks
There may be incomplete urination, pain after ejaculation, or a feeling of tightness in the pelvic floor as well

These symptoms do not always have to have fever, burning urination, or clear signals of infection.

Why do antibiotics not help the pain go away

Many people who have symptoms of this character have received antibiotics several rounds over without them going away, since the pain does not arise from bacterial infection.

The cause of these symptoms is usually related to the muscles of the pelvic floor (Pelvic Floor) being in a state of held spasm (Hypertonicity). When the muscles in this area are in spasm continuously, hidden points of pain (Myofascial Trigger Points) arise in the area of the Levator ani and Obturator internus muscles and the muscles around the base of the genital organ. This compression may compress the Pudendal nerve and the blood vessels that pass through that area, giving rise to pain radiating to the testicles or the perineum.

Why does sitting for a long time cause pain

Sitting for a long period increases the pressure in the area of the perineum and the pelvic floor, particularly when sitting on a hard chair, driving for a long time, or sitting in a posture that compresses the same area repeatedly.

If the muscles of the pelvic floor are already tight or already have hidden points of pain, the pressure from sitting may stimulate the nerves to become more sensitive and make the dragging or radiating pain clearer. Some patients feel better when they stand, walk, change posture, or avoid sitting in a way that compresses the area of the perineum.

What kind of symptoms should lead to seeing a doctor

Seeing a doctor should be considered when

The pain in the testicles or the perineum is continuous for more than two or three weeks
The symptoms do not respond to antibiotics or to general painkillers
There is an effect on sitting, on work, or on having sexual intercourse
Other symptoms are met along with it, such as incomplete urination, pain after ejaculation, or feeling a line of tight, pulling muscle

Pain in the testicles does not always mean a serious disease, but it should be examined in order to distinguish states that need urgent care, such as an infection, torsion of the testicle, or an abnormal lump, before concluding that it is CPPS.

What should the clinical assessment look at

The assessment of pain in the testicles when sitting for a long time or of chronic pain in the perineum should not look only at the testicles or the prostate gland, but should assess the pelvic system as a whole. The examination at PYONG MEN may consist of

Examination by palpation in order to identify hidden points of pain in the muscles of the pelvic floor
Assessment of the external reproductive organs and the prostate gland in order to distinguish other lesions
Transrectal Color Doppler Ultrasonography (TRUS) in order to assess the prostate gland and the system of blood circulation in the deep area of the pelvic floor
Uroflowmetry and Biofeedback in order to assess the rhythm of the working of the muscles of the pelvic floor

These assessments help the doctor understand which factors the pain arises from, and in which direction care should be planned.

The approach to care at PYONG MEN

If the result of the assessment finds that the pain is related to CPPS or to the muscles of the pelvic floor being in held spasm, the plan of care will emphasise releasing the muscles, restoring the nerves, reducing the cycle of pain, and adjusting the working of the pelvic floor systematically.

Pelvic Floor Release & Neuromuscular Rehabilitation helps reduce the held spasm of the muscles of the pelvic floor, and restores the working of the muscles so that they can release more suitably
Doctor’s Selection Pain Recovery may use Western Medical Dry Needling together with High Power Laser in some cases, in order to help care for the points of muscle pain, reduce the tightness and pulling, and support the restoration of the tissue
Transrectal QMR uses energy waves of a kind that does not create heat, in order to support the restoration of the deep structure of the pelvic floor, the nervous system, and the tissue involved
Focused Shockwave Therapy may be used in some people in order to support the restoration of the tissue, the circulation, and the response of the nerves in the target area
Advanced Pelvic Neuro-Vascular Protocol uses technology related to the nervous system and the blood vessels, in order to support the release of the deep muscles and the working of the pelvic floor

The plan of care will be designed according to the result of the assessment of each individual.

In brief

Pain in the testicles when sitting for a long time or chronic pain in the perineum is usually not always an infection
The cause met often is the muscles of the pelvic floor being in held spasm, and hidden points of pain
Sitting for a long time may increase the pressure in the area of the perineum and stimulate the symptoms so that they become clearer
If the symptoms recur, are continuous, or do not respond to antibiotics, a systematic assessment should be received
Care should be designed specifically for the individual according to the cause found on examination, not treated in the same way repeatedly without further assessment

Frequently asked questions (FAQ)

1. Is pain in the testicles when sitting for a long time a signal of a serious disease? For the most part it does not always mean a serious disease, but pain in the testicles should receive assessment in order to distinguish causes that need urgent care, such as an infection, torsion of the testicle, or an abnormal lump, before concluding that it is CPPS.

2. After taking antibiotics the pain is still there; what should be done? The symptoms may not arise from bacterial infection, but be related to the muscles of the pelvic floor, the nerves, or hidden points of pain. A doctor should be seen for a new systematic assessment.

3. Does using a seat cushion help reduce the symptoms? Using a cushion that reduces the pressure on the perineum may help relieve the symptoms temporarily, but it does not put right the root cause of the muscles being in held spasm or of the nerves that are sensitive to stimulation. A doctor should therefore be seen in order to put right the root cause.

4. Is CPPS related to sexual capacity? It may be related in some people. Patients may have symptoms of pain during or after ejaculation, premature ejaculation, or reduced erection, because the muscles of the pelvic floor, the nerves, and the system of circulation in this area are linked to one another.

5. Is the assessment inside the pelvic floor painful? The feeling during the examination depends on the level of tightness of the muscles in each individual. The doctor will assess according to what is necessary and will carry it out in an environment that is private and respectful of the patient.

6. Can symptoms like these go away by themselves? Some people may improve temporarily when they rest or avoid the postures that stimulate the symptoms, but if there is a chronic or recurring pattern, an assessment should usually be received in order to find the cause and care for it on target.