Many athletes with sports hernias often report a component of their pain involves the testicle. The pain is usually characterized by an ache and swelling of the testicle after aggressive physical activity or sex. Pain usually gets better with rest. Shorts that provide scrotal support and ice bags are also often helpful. Many athletes have seen a urologist, who report that the genital examination is normal. Ultrasound of the scrotum and testicle is normal.
In my experience, many of these athletes have scarring between the posterior aspect of the spermatic cord and the pubic tubercle. This can be easily identified on physical examination by gentle traction on the testicle, and noticing that the spermatic cord no longer slides over the pubic tubercle. In these athletes, it is important at the time of surgery to examine the spermatic cord at the pubic tubercle. This can be easily done by positioning the Richardson retractors medially and with gentle traction on the spermatic cord anteriorly and inferiorly. The adhesions are often quite dense, but they can be easily divided with Metzenbaum scissors. Be careful to avoid genital nerve. The athlete will be very thankful for something that only adds a few minutes to the procedure.
I only rarely encounter these adhesions in standard direct or indirect hernia. I am unsure of the etiology, but it is probably related to local trauma. I have not found any literature discussing this scarring of the spermatic cord and would welcome feedback.
In the photo to the left, a right sports hernia is being repaired. The spermatic cord is behind the Richardson Retractor. The arrow points to the pubic tubercle. The lines highlight the adhesions between the pubic tubercle and the spermatic cord.