A Question Of Health: Testicular pains that just won't go away; and the right drugs for osteoarthritis

I have been suffering since I was at least 15 (I am now 24) with severe pain in the right testicle and groin/abdominal region after ejaculation. Over this period of time I have seen numerous types of specialists and have undergone a wide range of tests (blood, urine samples, flow tests, ultrasounds, MRI on my back and hip, X-rays, etc) but the only definite diagnosis was that my prostate was inflamed and that I may have prostatitis (for which I have received many doses of antibiotics). However, the pain after masturbation is now unbearable, and I am experiencing severe pain after walking.

PAINFUL TRUTH

I have been suffering since I was at least 15 (I am now 24) with severe pain in the right testicle and groin/abdominal region after ejaculation. Over this period of time I have seen numerous types of specialists and have undergone a wide range of tests (blood, urine samples, flow tests, ultrasounds, MRI on my back and hip, X-rays, etc) but the only definite diagnosis was that my prostate was inflamed and that I may have prostatitis (for which I have received many doses of antibiotics). However, the pain after masturbation is now unbearable, and I am experiencing severe pain after walking.

My current urologist still insists on focusing on my bladder (I need to urinate frequently), but the majority of the pain is coming from my right testicle (which is not swollen itself, but the "tubes" around it are always swollen and the testicle doesn't seem to be lying at the same angle as my left one). I am frustrated by my lack of progress (which is probably not helping my condition). Are there some professionals who specialise in reproductive problems, or is it only urologists that deal with these issues?

The male genito-urinary apparatus consists of kidneys, ureters (the tube that connects the kidney to the bladder), bladder, prostate, testicles and penis. All of these organs are interconnected and a problem with one can lead to symptoms in another. A kidney stone, for example, can cause pain in the testicle, even though the stone is many centimetres away from the testicle. An inflamed prostate might well cause pain in one testicle. The inflammation is unlikely to be confined to the prostate – it may be more widespread.

Prostatitis – the medical term for an inflamed prostate – can be an incredibly troublesome condition. The standard treatment is antibiotics, often given for many months. Sometimes, a series of courses of different antibiotics are used, in the hope that any lurking infection will eventually be eradicated. Chronic inflammation that goes on for many years will undoubtedly cause damage and scarring to the surrounding tissues. This is probably the reason why you are continuing to get pain. If your semen is trying to pass through scarred tubules, it may well cause terrible pain.

Urologists are usually the people who deal with this type of problem. If you are unhappy with your current urologist, ask for a second opinion. But if you have already seen a number of urologists, I think you need to face the fact that your problem is not going to be easy to solve.

ARTHRITIS ANGST

You recently suggested the use of methotrexate to help treat inflammatory arthritis and possibly rheumatoid arthritis. Would the same advice apply to osteoarthritis, which is affecting both my hip and my knees? An X-ray confirms mild osteoarthritis of the hip. It is very sore and seems to be worsening.

Methotrexate is definitely not a suitable treatment for osteoarthritis. Although the causes of osteoarthritis are the subject of endless debate, it is quite a different condition from both rheumatoid and "inflammatory" arthritis. Osteoarthritis is sometimes mistakenly called "wear and tear" arthritis, because the cartilage that lines the joints and prevents bones rubbing directly against other bones seems to wear away. Osteoarthritis tends to affect older people, while rheumatoid arthritis can strike at any age, including in childhood.

The word "inflammatory", used to describe rheumatoid arthritis, refers to what is happening in the tissues surrounding the joint. Look at these tissues with a microscope, and they are full of a type of cell that is involved in inflammatory reactions. These cells are not present in significant numbers in the tissues around an osteoarthritic joint. Methotrexate is a powerful drug that suppresses the body's immune system. In true inflammatory arthritis, it can prevent the progression of the disease.

With regard to the X-ray that shows only "mild osteoarthritis", the appearance of a joint on an X-ray is not a good predictor of how painful the arthritis can be. Joints that don't look bad on X-ray can cause disabling pain. And terrible-looking joints can be virtually pain-free. To find out more about the different types of arthritis, consult the Arthritis Research Campaign's website: www.arc.org.uk.

HAVE YOUR SAY: READERS WRITE

In DB's household, the cat was the cause of his daughter's nasal polyps:

In response to your recent notes on nasal polyps, my daughter suffered from quite severe polyps for a few years. Eventually, they became so bad that she had surgery, which was very effective for about two months, but then they started to return. Like your previous correspondent, I looked for allergy causes. We got no real clue from our GP or consultant, who both seemed content to prescribe steroid nasal spray followed by surgery again if necessary. However, internet searches indicated that Fel D1 from cats could be a cause – and we had two cats, one with long hair. Fel D1 flakes off the cat's fur after it has licked itself and dried: it is, essentially, dried spittle and cats produce a great deal of it. Fel D1 can be a severe irritant, and particles are very small. The cats were re-homed and the house was cleaned from top to bottom. After two weeks, things improved, and after a year the polyps have gone. Polyps may have many causes: for us, it was the cats.

Please send questions and suggestions to A Question of Health, The Independent, Independent House, 191 Marsh Wall, London E14 9RS; fax: 020-7005 2182; e-mail: health@independent.co.uk. Dr Kavalier regrets he is unable to respond personally to questions