BackTable / Urology / Article
Destigmatizing Testicular Pain
Devante Delbrune • Nov 14, 2022 • 35 hits
Men with testicular pain often refrain from discussing their symptoms with healthcare providers because of the complexity and sensitivity of the topic. To better combat this problem and the accompanying stigma, providers must develop a solid understanding of both the patient experience and how to effectively approach testicular pain. Urologists Dr. Jamin Brahmbhatt and Dr Jose Silva discuss the common obstacles from the patient perspective, an overall approach to evaluating testicular pain, and his organization's health advocacy movement, the Drive for Men’s Health Initiative. Taken together, an increased understanding of patient struggles and a focus on advocacy for men’s urologic health can create progress in removing the stigma surrounding testicular pain.
This article features excerpts from the BackTable Urology Podcast. We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
The BackTable Urology Brief
• Common obstacles to treatment for individuals with testicular pain include provider-associated biases, lack of available clinical experts, and prior healthcare interactions that were either negative or unhelpful.
• Initial evaluation of a patient with testicular pain should consist of a thorough patient history, physical examination, labs, and abdominal and testicular imaging. Referral to a testicular pain specialist is advised for physicians that are not well-versed in pain diagnosis or differentials.
• Drive for Men’s Health Initiative is a nonprofit health advocacy organization that participates in extensive community education and outreach to better engage men in their urological health.
Table of Contents
(1) Care Obstacles for Patients with Testicular Pain
(2) Evaluating Testicular Pain
(3) Avenues for Advocacy: The “Drive for Men’s Health” Initiative
Care Obstacles for Patients with Testicular Pain
While many patients seek out assistance or treatment for any number of conditions or issues, patients with testicular pain can face unique challenges. Common obstacles encountered include stigma, availability of expert healthcare professionals, and negative healthcare experiences. In regards to stigma, oftentimes patients are labeled as drug-seeking, particularly during the current opiate epidemic, due to their chronic pain symptoms that often have no obvious pathology. The lack of expert physicians versed in treating patients with testicular pain leads to a series of referrals resulting in numerous office visits for the patient with minimal or no results. Repeated unproductive healthcare experiences can culminate in increased patient distrust or anxiety. It is important to understand that these are only a few of the obstacles that these patients face, and providers should work to re-establish a trusting therapeutic relationship with the testicular pain patient.
[Jamin Brahmbhatt MD]
This is one of those things where they're usually not seeking drugs. They're usually not seeking pain medication. Yes. Out of a hundred patients, you may see maybe one or two that may be kind of like searching for that script. But a majority of them are very legit, but the reason when you're seeing them in your office, and they're so anxious and they're so stressed out and they seem so overwhelming is because you're probably the number second, third, four fourth doctor they've seen. On average patients have seen about seven Health care professionals, before they get something done with them. In our office, we've seen over 8,000 plus men with some degree of testicular pain or groin pain or pelvic pain. So we have a lot of experience. But we can also tell that a lot of these patients, they're not really looking for pain meds and not really looking for surgery. What they're really looking for is just someone to listen. And that can be hard when we have busy clinics, but I think it is definitely something we can do a better job of.
Yes, we're based here in central Florida. But at the same time, with virtual care, we were able to do virtual things, but you know, obviously when it's something that's procedure driven, people have to come down. But I think a lot of what I do is just talking and going over things and I probably don't operate on every patient. I’d say maybe 50% need an operation.
The reason referred pain to them is like “oh my God, they think I'm crazy”. I do think some of the crazy is the healthcare system making them crazy because then they get anxiety and PTSD from their experiences. So I think some of that is self-induced as well. But how do you tell a patient they have referred pain?
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Evaluating Testicular Pain
When evaluating patients with testicular pain, it is important to obtain a history and some basic labs, but the most important part of the initial encounter is the physical examination. Physicians will often stick to conducting virtual visits, standard diagnostic tests, and extensive medical history. Though these are important parts of the initial evaluation, the physical exam is needed for multiple diagnoses. For example, a hernia, a potential cause of testicular pain, is only clinically diagnosed through a physical exam.
If the history and physical exam conclude with no abnormal findings, a CAT scan can rule out structural abnormalities or blockages causing referred pain. Negative imaging may imply a neurological source and should decrease the suspicion of structural referred pain.. From here, an interdisciplinary approach may be required to address the potential nervous component causing the pain. While the process of evaluating the patient in a stepwise fashion is important, listening to the patient is key, as their testimony may be the only thing that can clue in a provider to the cause of the testicular pain.
[Jamin Brahmbhatt MD]
You’ve got to examine the patient. So I want to really touch on that. I would say that one out of every six patients I see has a hernia and I'm not an expert at diagnosing hernias, but the ever hernia or something else. And that unfortunately you can only find on exam. And knowing how to do that exam
So the history, the physical evaluation for hernias, varicoceles, other abnormalities. But I would say beyond that, all of our patients now, you know, some people may have already had this done, so people may need it. Every patient gets a CAT scan. Cause most of these patients do have referred pain. So up the abdomen or in the groin. So we have justification to get the imaging. I would say about 10% of patients, we find either kidney stones or blockages or something weird inside their abdomen.
And as long as I know, based on imaging, that there's really nothing anatomic or physical or surgical causing the pain then I know it's some referred pain. So hey, I'm just going to focus on these nerves. And when you kind of set that precedence with them, like, okay, we're just going to focus on these nerves. What's towards the end. I think they're much happier. You know, the first thing I usually say to these patients, is “I can give you a hundred percent of our team’s effort. But I can't guarantee anything.” So zero guarantee. So I think having those initial expectations.
Avenues for Advocacy: The “Drive for Men’s Health” Initiative
Understanding testicular pain from the patients perspective and how to evaluate for testicular pain pathology are only part of the equation. Outreach advocacy provides an opportunity for health care providers to reach patients prior to their arrival at a clinic. Currently, advocacy is extremely beneficial in decreasing the stigma behind urological health, not just testicular pain. Dr. Brahmbhatt and his partner came up with a unique way to engage men in discussing their urologic health. They noticed that while men often felt uncomfortable talking about their health concerns with medical providers, they were more open to talking about topics they were quite knowledgeable about such as cars. Dr. Brahmbhatt and his team decided to incorporate this into advocacy for men’s health.
The Drive for Men’s Health Initiative is a nonprofit organization that incorporates a popular ground campaign with population surveying in order to better understand and reach men and engage them about their urological health. The ground campaign consists of starting in a designated city, driving across the U.S., stopping in major cities, and meeting with people at sponsored events. In the first year of activity, they drove from Florida to New York meeting men along the way. During this process they would survey men, obtain their three largest concerns about engaging with healthcare and develop focused education towards those key issues. The overall goal of the organization is to increase male engagement in healthcare. The movement has sparked conversations about men's health worldwide and not only highlights the concerns with men’s health but creates a positive environment for men to talk about these concerns. The movement was on a hiatus due to the COVID-19 pandemic, but Dr. Brahmbhatt is very excited and optimistic for the return of the movement going forward. For more information about the organization and upcoming events refer to www.driveformenshealth.com.
[Dr. Jamin Brahmbhatt MD]
The drive for men's health. You know, it was something really cool. So this was Dr. Paracoddle and I, when we were partners, you know, we got very frustrated with how much we could do just in our office. So you could see 30 patients, 40 patients operating eight people a day, we wanted to do something more, broader. It was also our experience with these patients that come in with this pain. It was also our experience with these patients that come in with this pain. Cause there's like incidents of a hundred thousand men a year that have some kind of pain in their pelvis or their testicle. And we also saw that even us as dudes, like we really don't communicate well, don't engage health care as best we should.
What can we do to incorporate the car and get men to start talking about their health. So two crazy guys that we are, we got buy-in with the team and we drove over 24 hours from Florida to New York the first year. We had. we just went like, it was, it was crazy, but they got so much traction that the next year we went even crazier, 6,000 miles, over 10 days. And then we did this for almost seven years straight. We took it global to Dubai and India and other places.And it gave people a way to kind of have that conversation. Let's talk about the car. And we actually did these surveys every single year where we kind of found the psyche of men. So men actually know more about their cars and their health. And then we found the top three excuses that men have. So we would tailor our messages every single year. Based on this survey, we surveyed men about things like, you know what, doesn't get you engaged with the healthcare system. So we did a lot and then we drove across and it was a big on the ground campaign, social media campaign. We did all this media and met thousands of men. And what's really cool to see then is like universities had all these men's health initiatives and they use the car as an analogy. And you know, that kind of positive message is perpetuated and propagated and I think it's cool.
It may not come back and in its true form. But there's definitely going to be an evolution. and the whole process and, you know, just look at the urologist on social media, like you at the AUA, you know, we have like social media forums. Yeah. So like, back then not many of us were engaging people beyond just our offices and now we've got like a whole, like all these troops on the ground on social media. I'm very proud that urologists professionals remain very professional on social media. At least the people I follow. So, is there a need just because there's a need? I don't think so anymore. I think a lot more of us have engaged the general population. So I think again, I think it is going to come back in some form. I just don't know when, but thank you to all the other urologists out there. Pushing the effort, not just for men's health, but just general health awareness overall.
Dr. Jamin Brahmbhatt
Dr. Jamin Brahmbhatt is the director of urology and robotic microsurgery at the Orlando Health Medical Group Urology PUR Clinic in Florida.
Dr. Jose Silva
Dr. Jose Silva is a board certified urologist practicing in Central Florida.
Cite This Podcast
BackTable, LLC (Producer). (2022, July 27). Ep. 47 – Management of Chronic Testicular Pain [Audio podcast]. Retrieved from https://www.backtable.com
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