Epididymitis

Epididymitis is swelling (inflammation) or pain in a series of tubes called the epididymis, located on the side and in back of the testicle. The epididymis stores sperm, which then travels via the vas deferens to the seminal vesicles and prostate. There, the sperm mixes with fluid to produce semen. Epididymitis can occur in males of any age.

• A swollen, red, or warm scrotum.
• Testicle pain and tenderness, usually on one side, comes on gradually.
• Painful urination or an urgent or frequent need to urinate.
• Discharge from the penis.
• Pain or discomfort in the lower abdomen or pelvic area.
• Blood in the semen.
• Fever (less common).

Complications of epididymitis include:

• Pus-filled infection (abscess) in the scrotum.
• Epididymo-orchitis, if the condition spreads from your epididymis to your testicle.
• Reduced fertility (rare).

If epididymitis lasts longer than six weeks or recurs, it is considered chronic. Symptoms of chronic epididymitis can come on gradually, and the cause can’t always be identified. If scrotal pain is severe, seek emergency treatment. See a doctor if you have discharge from your penis or pain when you urinate.

Epididymitis is most often caused by a bacterial infection. Sometimes, a testicle also becomes inflamed (epididymo-orchitis). Causes of epididymitis include:

• Sexually transmitted infections (STIs). Gonorrhea and chlamydia are the most common causes of epididymitis in young, sexually active men.
• Other infections. Bacteria from a urinary tract or prostate infection might spread from the infected site to the epididymis. Viral infections, such as the mumps virus, can also cause epididymitis.
• Urine in the epididymis (chemical epididymitis). This condition occurs when urine flows backward into the epididymis, possibly due to heavy lifting or straining.
• Trauma, such as a groin injury.
• Reaction to medication.
• Tuberculosis (rare).

• A history of STIs, and sexual behavior that puts one at risk for developing an STI, including sex with a partner who has an STI and sex without a condom.
• History of prostatitis or urinary tract infections.
• A history of medical procedures that affect the urinary tract, such as insertion of a urinary catheter or scope into the penis.
• An uncircumcised penis or an anatomical abnormality of the urinary tract.

Prostate enlargement increases the risk of bladder infections.

Your doctor will check for enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor might also do a rectal examination to check for prostate enlargement or tenderness. Possible tests include:

• STI screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is examined in the laboratory for gonorrhea and chlamydia.
• Urine and blood tests, to check for abnormalities.
• Ultrasound. This imaging test might be used to rule out testicular torsion. Ultrasound with color Doppler can determine if the blood flow to your testicles is lower than normal (indicating torsion) or higher than normal, which helps confirm the diagnosis of epididymitis.

Scrotal pain or swelling can be caused by a number of conditions. Some require immediate treatment to avoid permanent damage. During examination, the physician checks for other possible causes of scrotal pain, such as testicular tumor, hernia, or varicocele.

In most cases, epididymitis can be treated very effectively, and most men can be relieved of their symptoms. Typical treatments include:

• Sitz baths. Sitting in a warm tub for 20 minutes a day helps lessen inflammation.
• Scrotal support. Using an athletic supporter or tight jockey-style underwear lessens the tension of the spermatic cord.
• Anti-inflammatory medication. Ibuprofen (Advil or Nuprin) at doses of 400-600 mg, 3 times a day, can provide pain relief and reduce swelling.
• Antibiotics. These are used to treat bacterial epididymitis and epididymo-orchitis. If the cause of the bacterial infection is an STI, your sexual partner also needs treatment.

Epididymitis may take 2 to 4 weeks to resolve. See your doctor if symptoms persist beyond that period.

Occasionally, epididymitis becomes chronic in nature and is more difficult to treat. Sometimes the groin area is injected with a mixture of Novocain and cortisone, which “blocks” the spermatic cord. In rare cases, an epididymectomy is performed, in which the epididymis is surgically removed.

To ease your discomfort from epididymitis:

• Rest in bed.
• Lie down so that your scrotum is elevated.
• Apply cold packs to your scrotum as tolerated.
• Wear an athletic supporter.
• Avoid lifting heavy objects.
• If caused by an infection, avoid sexual intercourse until your infection has cleared.