What your doctor can do. If you have pain in the scrotum or testicle you need to see your doctor, or go to a genitourinary medicine clinic . Your doctor will test you for infection, and will try to work out the cause of the pain. Even if no infection is evident, your doctor may prescribe an antibiotic. Your doctor may prescribe a low dose of amitriptyline; this is a drug that helps to block pain. (In higher doses it is also used as an antidepressant, but not in this case.) Pelvic floor physiotherapy can help, but it is available only in specialized hospitals.
Serum studies should include testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and müllerian-inhibiting substance (MIS). Elevations in LH and FSH, as well as the absence of detectable MIS, suggest testicular absence. 23 Measurements of thyroid hormone and cortisol levels should be considered because hypogonadism may occur with pituitary aplasia. A stimulation test using intramuscular human chorionic gonadotropin (hCG) can be administered to check for evidence of testosterone production. Definite hormonal evidence of testicular absence may preclude surgical exploration in the rare case of a newborn with bilateral absent testicles, but a minimum of both a negative hCG stimulation test and elevated gonadotropins must be included. Normal gonadotropin levels or detectable MIS levels warrant surgical exploration, even with a negative hCG stimulation test.