Differential Diagnosis for Pelvic, Groin, and Scrotal Pain in Males

Single Most Likely Diagnosis

• Epididymitis: This is an inflammation of the epididymis, a tube at the back of the testicle that stores and carries sperm. It's often caused by a bacterial infection and can lead to pain in the scrotum, groin, and pelvic area. The likelihood of epididymitis is high due to its relatively common occurrence in men, especially those who are sexually active or have urinary tract issues.

Other Likely Diagnoses

• Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. It can cause severe pain in the testicles, groin, and lower abdomen.
• Prostatitis: Inflammation of the prostate gland, which can be acute or chronic. Symptoms include pelvic pain, difficulty urinating, and pain in the groin and scrotum.
• Inguinal Hernia: A condition where tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. It can cause groin pain that may radiate to the scrotum.
• Testicular Torsion: A medical emergency where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It causes sudden, severe pain in the testicle and groin.

Do Not Miss Diagnoses

• Testicular Cancer: Although less common, testicular cancer can present with a painless testicular mass, but sometimes it causes pain, especially if there's bleeding or if the tumor has spread.
• Appendicitis: In some cases, especially if the appendix is located near the pelvic area (retrocecal appendix), appendicitis can cause lower abdominal or pelvic pain that might be confused with scrotal or groin pain.
• Kidney Stones: While primarily causing flank pain, kidney stones can sometimes cause pain that radiates to the groin or testicles, especially if the stone is moving down the ureter.

Rare Diagnoses

• Spermatocele: A benign cystic accumulation of sperm that arises from the head of the epididymis. It usually causes a painless mass but can occasionally be painful.
• Varicocele: An enlargement of the veins within the scrotum, similar to varicose veins. It's usually asymptomatic but can cause a dull ache or discomfort in the scrotum.
• Henoch-Schönlein Purpura (HSP): A form of vasculitis that affects blood vessels and can cause a variety of symptoms, including scrotal pain and swelling, though it's more commonly associated with skin, joint, and gastrointestinal symptoms.

Each of these diagnoses has distinct characteristics and requires careful consideration based on the patient's history, physical examination, and sometimes additional diagnostic tests.