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Sir,

We read with interest this excellent and detailed account of chronic orchialgia [1]. The authors indicate that in < 25% of cases no obvious precipitating cause is found. In a study conducted at our hospital (unpublished data) we found a strong association between chronic orchialgia and men who drive for > 30 h per week and have a body mass index of > 25 kg/m2 (r2= 0.41). We suspect that this is caused by the pressure effect of obese thighs on the testes while in the driving position, combined with mechanical rubbing that occurs as a result of continued use of the foot pedals. A thorough occupational history should be sought in men presenting with chronic orchialgia and, as part of a multidisciplinary approach [2], referral to an occupational health physician and dietician may be of benefit.