What type of specialist should a male with groin pain see?

Specialist Referral for Male Groin Pain

A male with groin pain should initially see a urologist, as many causes of groin pain in men are urological in nature, including emergencies like testicular torsion and epididymitis that require prompt urological evaluation. 1

Primary Causes of Male Groin Pain

Urological Causes

• Emergent conditions requiring immediate urological assessment:

  • Testicular torsion (sudden onset, severe pain, high-riding testicle, absent cremasteric reflex) 2
  • Acute epididymitis (gradual onset, positive Prehn sign, increased blood flow on Doppler) 2
  • Renal colic (severe flank pain radiating to groin) 1

• Non-emergent urological conditions:

  • Varicocele, spermatocele, hydrocele 1
  • Lower urinary tract symptoms related to prostate issues 3
  • Chronic prostatitis/chronic pelvic pain syndrome 3

Musculoskeletal Causes

If urological causes are ruled out, referral to orthopedics or sports medicine may be appropriate for:

• Adductor muscle strain
• Osteitis pubis
• Stress fractures
• Sports hernia
• Iliopsoas-related pain 4

Other Potential Causes

• Inguinal hernia (surgical referral)
• Ilioinguinal neuralgia (neurology or pain management)
• Enthesopathy at pubic insertion of inguinal ligament 5

Diagnostic Approach

1. Initial urological evaluation should include:

   • Focused history on pain characteristics, urinary symptoms, and sexual function
   • Physical examination including testicular exam with evaluation of Prehn sign and cremasteric reflex
   • Urinalysis and urine culture if infection suspected 2
   • Scrotal ultrasound with Doppler for testicular symptoms 2

2. If urological causes are ruled out:

   • Musculoskeletal examination including adductor, pubic, inguinal, and iliopsoas testing 4
   • Consider MRI of pelvis for persistent adductor-related pain 4
   • Dynamic ultrasonography for suspected inguinal-related pain 4

Treatment Pathways

For Urological Conditions

• Epididymitis: Antibiotics (ceftriaxone plus doxycycline for younger men; fluoroquinolones for older men), supportive measures including rest, scrotal elevation, and NSAIDs 2
• Lower urinary tract symptoms: Alpha-blockers, 5α-reductase inhibitors, or combination therapy depending on prostate size and symptoms 3
• Chronic prostatitis/pelvic pain: Consider IC/BPS therapies as well as CP/CPPS-specific treatments 3

For Non-Urological Conditions

• Musculoskeletal causes: Active, supervised physical therapy focusing on core strengthening 4
• Enthesopathy: Consider infiltration with long-acting steroid and local anesthetic 5

When to Refer to Other Specialists

• General Surgery: If inguinal hernia is confirmed
• Orthopedics/Sports Medicine: For persistent musculoskeletal causes
• Pain Management: For chronic pain not responding to initial treatments

Red Flags Requiring Immediate Attention

• Sudden onset of severe unilateral scrotal pain with nausea/vomiting
• High-riding testicle with absent cremasteric reflex
• Severe, colicky pain radiating from flank to groin
• Fever with scrotal swelling and tenderness

In summary, while groin pain in males can have multiple etiologies spanning several specialties, a urologist is the most appropriate initial specialist due to the high prevalence of urological causes and the need to promptly rule out urological emergencies.