6059089c0357024b8624599f_main in pain

Cremaster Muscle Pain: The Likely Cause of Your Achy Balls

Dr. Joe Pazona

Nothing is more frustrating for men, or their urologists, than achy balls. You’re in pain and want help. The problem is that you’ve seen several “specialists” and all they seem to do is throw antibiotics at the problem or tell you “nothing’s wrong.”

As a result, you’ve likely consulted Dr. Google in an attempt to gain clarity, and more importantly, find a solution for the vice grip on your huevos. Fear not! Help is finally on the way.

At VirtuCare we are experts in all things ball-related, including testicle pain. And in our experience, the number one cause of testicular pain has nothing to do with your testicle! It’s actually cremaster muscle pain.

Whether you’ve already done your homework on cremaster muscle pain and are looking for a solution, or if you have no idea where the cremaster muscle is located, we are here to help.

Let’s review all things cremaster muscle to help relieve your achy balls. Because let’s be honest, they are the family jewels.

What is NOT cremaster muscle pain?

Before we go further, let’s make sure you’re in the right place. We’d hate to miss a more obvious medical condition of your junk before assuming you have cremaster muscle pain.

If you have any of the following signs or symptoms, you probably DON’T have cremaster muscle pain and should seek immediate in-person medical attention:

  • A firm, hard mass of the testicle
  • An enlarged or reddened scrotum
  • Severe pain with nausea or vomiting
  • Urinary symptoms (burning or blood in the urine, excessive urination)

An infection (epididymitis), twisted testicle (testicular torsion) or kidney stone can all present with severe testicular pain. So if you have any of the above symptoms, then go immediately to your local ER. Otherwise, if you don’t have these symptoms, then take a deep sigh of relief, and continue reading.

What is the cremaster muscle? Where is the cremaster muscle found?

The cremaster muscle is actually a series of small muscle fibers running within the spermatic cord to the testicle. The spermatic cord includes:

  • Cremaster muscle
  • Veins to the testicle (pampiniform plexus)
  • Arteries to the testicle (testicular arteries)
  • Vas deferens
  • Nerve fibers


scrotal anatomy and cremaster muscle

The spermatic cord and cremaster muscle run from your groin along the side of your Johnson down to you each of your testicles. Two balls, two cords, two cremaster muscles.

Where did the cremaster muscle come from? As a fetus, the testicles begin their development by your kidneys. As you grew inside yo momma, your balls then descended down inside your body towards the pelvis.  In the groin area, the testicles “popped out” to say hello to the world.  They then completed their journey to your ball sack.

When the testicle “pops” out and becomes an external organ, it gathers all of the layers of your abdominal wall including the internal oblique muscle fibers which run on the side of your abs. These muscle fibers become the cremaster muscle. This explains why cremaster muscle pain often radiates from the lower abdomen, along the groin, down to the testicle.

Can the cremaster muscle cause pain?

Yes. In fact, most patients (>90%) who see me in person at my clinic in Nashville have cremaster muscle pain. When the cremaster muscle becomes inflamed, it sends a pain down to the testicle and up along the groin. Additionally, there are microscopic nerves which run within and next to the cremaster muscle. Irritation of these nerves is a common cause of chronic testicular pain. Cremaster muscle inflammation goes hand-in-hand with nerve irritation.

What causes overactive cremaster muscle?

There are many causes of an overactive or inflamed cremaster muscle. Stress and anxiety are common triggers. Some people when they are stressed get headaches, others back aches, and for some guys, their balls ache. As stress levels increase, you tense muscles, even subconsciously, to the point where they become overactive. The cremaster muscle is no different.

Musculoskeletal issues elsewhere can cause cremaster muscle pain as well. If you suffer from back, hip or knee pain, this changes how you sit, stand, walk and move. As a biped (that means we walk on two feet), whenever our body is not moving in a smooth, symmetric fashion, it throws our muscles out of balance. As you start stressing muscles, they become overactive (spasm), leading to pain.

For example, as your back spasms from heavy lifting, this places a stress on your balancing muscles in your lower abdomen and groin, which in turn into your cremaster muscle. This is why so many men with cremaster muscle pain also have a history of chronic back pain.

Along the same lines, obesity and inactivity seem to correlate with cremaster muscle pain. If you’re carrying 20-50 extra pounds, and don’t move your body in the gym (especially with stretching), it’s no wonder why your cremaster muscles are screaming for help. It’s not uncommon for a man to report back to me that the best treatment for his cremaster muscle pain was a dedicated work-out regimen coupled with healthier eating and weight loss.

How do you diagnose cremaster muscle pain?

Cremaster muscle pain is a diagnosis of exclusion. This means you have to rule out other causes of testicular pain first. Typically this starts with a good history by your doctor. As above, if you have any severe attacks with nausea, swelling of the scrotum, or urinary symptoms, then this makes cremaster muscle pain less likely. Although the symptoms of cremaster muscle pain can vary, the diagnosis is suggested if the pain alternates sides, last seconds to minutes, is associated with specific movements, and is associated with low back or groin pain.

Most men with cremaster muscle pain have a normal physical exam with no palpable lumps or bumps. The testicles or the spermatic cord itself may be tender, but swelling is unusual. A scrotal ultrasound to visualize the testicles and spermatic cord structures can definitively rule out anything “bad” going on.

What are the conservative treatments for cremaster muscle pain?

In our opinion, health care should always start with conservative measures regarding lifestyle. Cremaster muscle pain, like many ailments, are brought on by our daily habits. First, stress reduction. No doubt it’s easier said than done, however, if you don’t address the route cause of your stress, then you have little hope of addressing the inflammation and muscle tension associated with stress. This is not hippie dippie stuff. Stress activates your sympathetic nervous system, which releases catecholamines (adrenaline), which lead to a flight or fight response including tense muscles.

Second, examine your diet, exercise and sleep habits. Do you put good food in your body 80-90% of the time? Do you exercise and stretch outside of your job at least 5 days a week? Do you sleep 8 hours a night? If the answer to any of these questions is “NO”, then you have some work to do.

Assuming you take good care of yourself, then a number of therapies can help cremaster muscle pain. If the pain started after a particular event (e.g. moving your sister’s couch up the stairs), then maybe a little rest, ice packs and ibuprofen (NSAIDS) are all you need. Sometimes a change in undies helps. Tight fitting clothes can exacerbate an already overactive cremaster muscle.

Once you’ve reached a limit with your DIY options, then your next best step is pelvic physical therapy. Physical therapists are experts in optimizing how you move your body. This includes addressing an overactive cremaster muscle to relieve your testicular pain. A great pelvic physical therapist can work wonders, but it takes a commitment on your end. Don’t expect to go to one session and cure your cremaster muscle pain immediately.

Prescription medications are sometimes used to help relieve cremaster muscle pain. Medications like amitriptyline (tricyclic antidepressants), gabapentin (neuromodulating drugs) and tamsulosin (alpha blockers) are the most commonly used. They improve cremaster muscle pain in about 60% of patients. One class of medications that should be avoided at all costs are narcotics. The possibility of developing an addiction is not worth the risk.

Can the cremaster muscle be removed?

If the cremaster muscle hurts, and you’re not using it for any important tasks anyway (trust me you’re not), then logic would dictate removal of the cremaster muscle would relieve pain. This line of thinking is typically correct. However, before considering surgical removal of the cremaster muscle, there are some steps to take.

First, you want to have failed all of the above options. Jumping to surgery may seem like the “quick fix”, but surgery has risks. Next, you should simulate removal of the cremaster muscle by having a spermatic cord nerve block with anesthesia. A urologist can inject lidocaine, a local anesthetic, alongside the cremaster muscle fibers in the upper scrotum. If the pain goes away, even for a few hours, then surgery may cure your issue.

The best surgery to remove the cremaster is called a microsurgical spermatic cord denervation. A fellowship trained microsurgeon, a urologist who performed extra training after residency in using a microscope to perform surgery, will make a small incision in the pubic area. He/she will then identify all of the cremaster muscle fibers and nerves of the spermatic cord, and ligate (cut) them. By essentially removing all muscles and nerves headed to the testicle, patients report a 77-100% improvement rate in their cremaster muscle pain.

What if surgery for cremaster muscle pain doesn’t work?

Don’t worry, there are other options. Injections of botox (Scrotox anyone?), nerve stimulation, nerve destruction higher in the pathway (e.g. ilioinguinal cryoablation) and removal of the testicle (radical orchiectomy) can all help cremaster muscle pain if the microscopic spermatic cord denervation fail. Again, these procedures are not performed by most urologists, so it’s important to find an expert in surgery for cremaster muscle pain.

Next steps

We hope that you found this information useful. In our experience ball pain is one of the most mismanaged urological conditions. It’s a lot easier to tell patients “you’re fine” or to throw unnecessary antibiotics at a problem. But at VirtuCare, we try to always do what’s right for our patients.

If you’d like some personal guidance, including a recommendation for an in-person microsurgical expert, then you can consider a telemedicine visit with one of our urologists today. The cost of a virtual urology visit is $89. We’ll even be able to visit with you this week from the comfort of your home. Look through the calendar below to schedule.

Otherwise, we wish you the best on your journey towards relieving your achy balls. Don’t feel like all hope is lost. Help is closer than you think.


Dr. P


Dr. Joe Pazona

Dr. Joseph Pazona is the founder and President of VirtuCare, a telemedicine solution for connecting patients with physician experts.

We’re here to help.

At VirtuCare, we believe that patients deserve direct access to the experts. There should be no gatekeeper standing between you and a healthcare specialist. VirtuCare puts you in control.

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