Most of the cases of pain in scrotum, penis, and pelvis are simple: kick to the groin, sexually transmitted diseases, acute and chronic prostatitis, urinary tract infection, and penile trauma. Reasons for chronic pain may be more difficult to diagnose especially in younger men: voiding dysfunction and Peyronie’s disease can also be seen in younger men. The most difficult reason to uncover for genital pain is physical, emotional, and sexual abuse experienced by the patient as a child or young man. Unfortunately by some estimates 8% of the general population of men in USA report history of sexual abuse. Among college students with drinking history, 1/3 to 1/2 of male students report a history of sexual abuse or coercion over last 5 years, however because of social stigma men are less likely to report the history of sexual and physical abuse. In these men, the pain in the genital area may be a sign of psychological trauma they experienced at the vulnerable age of psychosexual stage of development. In my practice 1/3 of my young men (18-29) who suffer from difficult to define genital pain or sexual dysfunction eventually report a history of emotional, physical or sexual abuse as children and young adults.
These are difficult patients to help but they are very appreciative patients when they start to rebuild their sense of trust in other human beings and sense of self-worth. With the help of psychologists and psychotherapy focused on rebuilding the patient’s trust and sense of self-worth, along with the medical therapy we offer, we can impact the lives of our young patients to a huge extent. Yes, we have to first exclude medical reasons for genital pain but as physicians, we have to consider non-organic reasons for somatic symptoms.