Diagnosis and treatment of groin and genital pain

Groin and testicular/labial neurogenic pain (termed as groin neurogenic pain in this chapter), also termed ilioinguinal and testicular/labial neuralgia, is a life-debilitating condition for many patients. Usually arising after surgical interventions in the inguinal and testicular/labial region, this neurogenic pain is caused by a combination of lesions in the ilioinguinal and/or genitofemoral nerves and occasionally the iliohypogastric nerve. Patients typically complain of burning, stabbing pain that may be accompanied by sensory deficits in the inguinal, groin, and medial thigh regions. A systematic detailed history of the pain and a thorough physical exam are vital in diagnosing groin neurogenic pain. Nerve blocks can help precisely delineate the affected nerves and confirm diagnosis. Treatment usually involves surgical neurectomy and implantation of the injured nerves either within the abdominal musculature or pre-peritoneum. It is advisable to work in a multidisciplinary team while treating this patient population. Postoperatively, a majority of patients are discharged and prescribed pain medication, NSAIDs, and perioperative antibiotics with instructions to avoid strenuous activities for the first 3 months.