Epididymitis

The epididymis is a series of small tubes that collects and stores sperm. It is attached to the back of each testicle.

One of the most common causes of pain in the scrotum is epididymitis#

Epididymitis is inflammation of these coiled tubes, which is often due to an infection. When the infection spreads to the testicle as well, it is known as epididymo-orchitis.

Epididymitis is usually a secondary bacterial infection. Bacteria in the urethra (the tube that carries urine and sperm out through the penis) travel through the urinary and reproductive structures to reach the epididymis. Some people develop chronic epididymitis, which is inflammation that continues even when there is no infection.

Symptoms#

The symptoms of epididymitis can include:

• a swollen, red or warm testicle
• a feeling of heaviness in the affected testicle
• tenderness or pain in the affected testicle
• pain in the abdomen or pelvis
• a frequent urge to urinate
• a burning feeling when urinating
• discharge from the penis
• blood in the urine
• pain when ejaculating
• a slight fever and chills

Causes#

Most cases of epididymitis are caused by a bacterial infection. Causes include:

• urinary tract infections (UTIs)
• sexually transmissible infections (STIs), such as chlamydia or gonorrhoea
• recent genito-urinary surgery, including prostatectomy (surgical removal of all or part of the prostate gland)
• the use of a urinary catheter
• some congenital kidney and bladder problems

Complications#

If left untreated, acute epididymitis can lead to a range of complications, including:

• chronic epididymitis, where the inflammation becomes persistent even when there is no bacterial infection present
• an abscess, where a ball of pus accumulates inside the epididymis or nearby structures and may require surgery to drain
• destruction of the epididymis, where inflammation causes permanent damage to the epididymis and testicle, which can lead to infertility
• spread of the infection from the scrotum to other structures or systems of the body

Telling epididymitis apart from testicular torsion#

It can be hard to tell the difference between epididymitis and testicular torsion, especially in younger people. Testicular torsion is when the testicle twists and cuts off its own blood supply. It is a surgical emergency, and assessment should be made at a hospital emergency department. Sometimes epididymitis and testicular torsion occur at the same time.

Diagnosis and treatment#

Epididymitis can be diagnosed through:

• physical examination
• medical history
• urine tests
• STI tests
• blood tests
• ultrasound of the testes

Treatment options for epididymitis include:

• antibiotics
• antibiotics for any sexual partners, if an STI was the cause
• bed rest
• pain-relieving medication
• cold compresses applied regularly to the scrotum
• elevation of the scrotum
• a stay in hospital, in cases of severe infection

A check-up afterwards is recommended to make sure the infection has cleared. If symptoms have not improved after 48 to 72 hours, the diagnosis should be re-evaluated.

Chronic epididymitis#

Some people develop chronic epididymitis, which is inflammation where there has been no infection for at least three months. The cause is not known, although it is thought that hypersensitivity of certain structures, including nerves and muscles, may play a part.

Some of the known risk factors for chronic epididymitis include:

• past acute epididymitis
• genito-urinary surgery
• exposure to STIs

Even if you do not have any of these risk factors, you can still develop chronic epididymitis. Tests are needed to distinguish it from other disorders that cause constant scrotal pain, such as testicular cancer, enlarged scrotal veins (varicocele) or a cyst. Tests may include physical examination and ultrasound.

Chronic epididymitis is difficult to treat. Antibiotics should not be used, as there is no infection. Treatment options include:

• frequent warm baths
• non-steroidal anti-inflammatory medication (NSAIDs)
• medication to alter nerve messages to the scrotum
• rarely, surgery to remove the affected epididymis
• stress management techniques

Key points#

• One of the most common causes of pain in the scrotum is epididymitis.
• Most cases of epididymitis are caused by a bacterial infection.
• Treatment options include antibiotics and bed rest.
• It can be hard to tell epididymitis apart from testicular torsion, which is a surgical emergency.

Where to get help#