The male genital area is a complex network of tubes and tissues with unique roles. Proper sexual and reproductive function depends on the function of all cells, tissues, and tubes that are located in a man’s penis, testicles, scrotum, prostate, among other things.
Wise lifestyle choices are vital for the prevention of conditions that harm your reproductive health and overall quality of life. Some conditions affecting your manhood area are well-known, others aren’t. In this article, we’re going to focus on epididymitis, a common yet misunderstood condition.
Epididymitis is a condition indicated by inflammation of the tube called epididymis. This leads to swelling and pain in testicles too. The condition affects men of all ages, but it is most prevalent among men who are between 14 and 35-50 years old.
We can categorize the condition into three main types:
- Acute Epididymitis – Occurs suddenly, but it can be successfully cured with immediate treatment
- Chronic Epididymitis – Manifests itself as pain that aggravates gradually and although treatment can help patients feel better, it doesn’t cure the condition entirely
- Orchi Epididymitis (Epididymo-Orchitis) – Characterized by inflammation that moves up to the testicles
Epididymitis should not be mistaken for testicular torsion. Both conditions tend to misdiagnosed or mistaken for one another due to similarity of their symptoms. Testicular torsion is a condition that occurs when a testicle rotates, twists the spermatic cord that brings blood to the scrotum.
The obstructed blood flow induces severe pain and swelling. Unlike epididymitis, testicular torsion requires emergency surgery and although the exact cause is unknown it is assumed that an inherited trait plays the role in the development of this condition. Testicular torsion affects patients aged between 12 and 16 primarily.
What are the Prevalence of Epididymitis?
Figures show that 1 in 1000 men in the United States develops acute epididymitis annually. The condition accounts for more than 600,000 medical visits each year.
The epididymitis is the most common cause of intrascrotal inflammation which leads to swelling of the scrotum. More than 80% of patients with scrotal pain treated in outpatient setting suffer from chronic epididymitis.
In addition, the epididymitis is fifth most common diagnosis among men between the ages of 18 and 50. The average age of incidence of chronic epididymitis is 49. In most cases, patients have been experiencing symptoms of the condition for five years prior to the diagnosis.
What is Epididymis?
In order to understand the condition, it’s important to learn more about the reproductive system’s area it affects.
The epididymis is a tightly coiled mass of thin tubes whose purpose is to carry sperm from the testes to ductus deferens in a male reproductive system.
As it passes through the epididymis the sperm matures and it’s ready to fertilize ova (female reproductive cells) by the time it reaches ductus deferens or vas deferens.
The epididymis has a crescent shape and it is located inside the scrotum and posterior to the testes. The total length of the epididymis is 6-7cm (2-2.7 inches) but only because it is coiled. The uncoiled epididymis would measure up to 6m (22ft).
We can divide Epididymitis into three parts:
- Head – The largest and most recognizable part of the epididymis, found at the superior pole of the testis. It receives sperm from the efferent ducts of the testis
- Body – Slightly narrower in diameter than the head and it descends along the posterior edge of the testis
- Tail – Very narrow, joins with the ductus deferens
What are the Causes of Epididymitis?
In most instances, the epididymitis is caused by a bacterial infection. This happens when bacteria move through urethra, prostate, vas deferens, and reach the epididymis. In 80% of bacteria-caused epididymitis doctors successfully identify the type of bacteria involved.
Sexually transmitted diseases and coliforms are responsible for the vast majority of epididymitis cases. Sexually transmitted diseases (STDs) are defined as diseases that are transmitted from one person to another through sexual contact including vaginal, anal, and oral intercourse.
The report shows that 1.59 million cases of Chlamydia were reported in 2016, which is a 4.7% increase compared to 2015. In addition, 468,514 cases of gonorrhea were diagnosed in 2016. The rates of this STD increased by 18.5% compared to the year before.
Why is this important?
In patients younger than 39, the epididymitis is usually caused by same bacteria that are involved in STDs such as Chlamydia and gonorrhea. About 50% to 60% all cases of the condition account for organisms that are responsible for Chlamydia.
These bacteria are called Chlamydia trachomatis, the most common cause of curable bacterial STI worldwide. On the other hand, Neisseria gonorrhoeae is the name of bacteria that cause gonorrhea and could also cause epididymitis during unprotected sex.
The most common causes of the epididymitis in men older than 39 are coliforms which are bacteria like Escherichia coli usually found in the intestinal tract of both humans and animals. These microorganisms are also present in your waste, water, and soil.
Even though most coliforms don’t cause any disease, some of them do. In some instances, coliforms can cause bladder infections. How do coliforms cause epididymitis? Men get infected with E. coli or other types of coliforms through anal intercourse.
The STDs aren’t the only infections that lead to the epididymitis. The condition can also occur when bacteria from a urinary tract or prostate spread from the affected site to the epididymis, as mentioned above, but viral infections like mumps virus can play the role too.
Urine in the epididymis (chemical epididymitis) is yet another potential cause of this condition. This happens when urine flows backward into the epididymis after heavy lifting and straining.
Chemical epididymitis is a rare occurrence and besides heavy lifting and straining, it can be a consequence of exercising and having sex with a full bladder.
A groin injury, tuberculosis, and amiodarone or Nexterone heart medication can cause epididymitis as well.
What are the Risk Factors of Epididymitis?
Every man can develop epididymitis, but some men are at a higher risk. Common risk factors for this condition include:
- Bladder obstruction due to enlarged prostate or urethral abnormality
- Frequent urinary tract infections
- Having an uncircumcised penis or anatomical abnormality of the urinary tract
- History of medical procedures that affect the urinary tract e.g. insertion of a catheter or scope into the penis
- Severely compromised immunity
- Sexual intercourse with a partner who has an STI
- Unprotected sex
- Untreated bacterial prostatitis (bacterial infection of the prostate gland)
- Untreated bacterial STD
What are the Symptoms of Epididymitis?
At the very beginning, the condition manifests itself through a few mild symptoms only. When left untreated the inflammation aggravates and causes more symptoms and they become more intense. The most common signs and symptoms of epididymitis include:
- Abnormal penile discharge
- Blood in the semen
- Enlarged lymph nodes in the groin
- Feeling pressure in testicles
- Frequent and urgent urination
- Low-grade fever
- Pain and tenderness in testicles usually on one side come and go
- Pain during bowel movements and urination
- Pain during sexual intercourse and ejaculation
- Pain in lower abdomen pelvic area
- Warmth and redness in the scrotum
In cases when symptoms of epididymitis last longer than six weeks or they recur, the condition is considered chronic. Signs and symptoms of chronic epididymitis tend to develop gradually.
Epididymitis in Children
Adult men, aged 19 – 35 to 40, are most likely to develop the epididymitis, but children can get this condition too. In fact, the epididymitis is the most common cause of acute scrotum (testicular pain and swelling) in older boys.
In infants and young boys, the most common cause behind the development of epididymitis is some kind of a genitourinary abnormality.
The exact prevalence of this condition among children is not known. Older studies report that epididymitis is rare amongst pre-pubertal boys. With the invention of Doppler ultrasonography and radionuclide scans of the scrotum, diagnosis of this condition has become more frequent.
According to some estimates, 5 to 40 cases of acute epididymitis among boys are recorded each year.
Unlike adult men who develop the condition due to inflammation usually caused by bacteria involved in the STDs, children can get epididymitis as a result of:
- Direct trauma
- Reflux of urine into the epididymis
- Some medications
- Twisting or torsion of the epididymis
- Urinary tract infections that spread to the epididymis and urethra
Bacterial epididymitis in younger patients can be a result of infection caused by coliforms of Pseudomonas species. It’s also important to mention that epididymitis in younger patients can be secondary to systematic diseases such as:
- Sarcoidosis – An inflammatory disease that affects multiple organs in the body particularly lungs and lymph glands. Abnormal masses or nodules comprising of inflamed tissues formed in affected areas
- Kawasaki Disease – A rare childhood illness that affects blood vessels
- Henoch-Schonlein Purpura – A disease indicated by inflammation of small blood vessels, the most prevalent among children
Signs and symptoms associated with pediatric epididymitis include:
- Temperature higher than 100°F (37.7°C)
- Increased concentration of leukocytes or white blood cells
- Nausea and vomiting
- Discharge from the urethra
- Tenderness of the scrotum
- Pain and burning sensation while urinating
How to Diagnose Epididymitis?
Pain and swelling in the scrotum area should never be ignored. Numerous conditions can cause these symptoms and some of them require urgent treatment in order to minimize the risk of permanent damage.
Ideally, you should see your doctor when you notice the above-mentioned symptoms. In some cases, nausea can occur too.
Even though symptoms you describe point out to epididymitis, the physician suggests necessary tests to rule out other potential conditions, especially those that require urgent treatment like testicular torsion or necrotizing fasciitis. If the pain in the scrotum is severe, seek emergency treatment.
For an accurate diagnosis, a patient should describe in detail all symptoms he experiences. The doctor will probably ask questions about your medical history which also includes sexual habits or whether you’ve had a sexually transmitted disease.
During the physical examination, a doctor looks for swollen testicles, swellings in lymph nodes and groins, discharge from the penis. In case there is a discharge, the physician takes a swab to collect a sample that will be tested for sexually transmitted infections.
With a goal to confirm the diagnosis and rule out other conditions, the doctor orders several laboratory tests including:
- Urinalysis and Urine Culture – Aid in diagnosis of bladder infection (urinary tract infection), urine is also used to test for STDs
- Urethral Culture – To identify infections in urethra
- White Blood Cells Count – To determine the presence of infection; higher count of white blood cells indicates the existence of infection
- Rapid tests for bacteria that cause the condition such as C. trachomatis and N. gonorrhea which detect the organisms through immunological methods and PCR (polymerase chain reactions; used to amplify trace amounts of DNA)
Diagnosis of epididymitis may involve a rectal examination, too. The purpose of this test is to determine whether the enlarged prostate caused the condition. The doctor usually orders imaging tests such as ultrasound and nuclear scans that differentiate epididymitis from testicular torsion.
In addition, CT and MRI are utilized in some cases only. The goal of these imaging tests is to rule out other conditions with similar symptoms such as hydrocele formation (fluid-filled area), cysts, cancerous tissue, hernia, and others.
Since epididymitis has similar symptoms as other conditions, doctors use different tests to avoid misdiagnosis. That’s why doctors take your complete medical history (including sexual history) and ask for detailed information about symptoms. Once the diagnosis is established, your physician recommends adequate treatment.
What are the Treatment for Epididymitis?
Treatment of this condition focuses on decreasing severity of symptoms and management of the underlying infection. The most common treatment options include:
- Antibiotics – Such as ceftriaxone or Rocephin (a single dose through IV or intramuscular shot) and doxycycline or Vibramycin (twice a day for 10 days) for men under the age of 39 years. Men who are older than 39 usually receive ciprofloxacin (Cipro) and sulfamethoxazole and trimethoprim (Bactrim DS), all of which are taken twice a day for 10-14 days. Acute epididymitis caused by enteric organisms is usually treated with levofloxacin (Levaquin) taken once a day for 10 days
- Painkillers – In over-the-counter or prescription form, depending on the severity of pain
- Anti-inflammatory medications like ketorolac or Toradol and piroxicam or Feldene
If the cause of epididymitis is an STI, then your partner will need a treatment too. In this case, you should abstain from sexual intercourse until you are fully cured.
Most men usually feel better within 48 to 72 hours after starting with the use of antibiotics, but it can take up to several weeks for discomfort and soreness to go away entirely. It takes up to three months, on average, to cure epididymitis.
While medications coupled with bed rest and other measures are very helpful for most patients, sometimes additional treatment approach is required. When an abscess forms on a patient’s testicles, the doctor uses a needle to drain the pus or he/she may recommend a surgical procedure.
Surgery is also recommended for patients who don’t experience relief with medications. During the procedure, a part of the entire epididymis is removed. The surgical procedure is a viable solution for men whose physical defects cause epididymitis.
Self-Management of Epididymitis
The epididymitis is a common and serious condition, but successful treatment is possible. Of course, it’s vital to see your doctor when you start experiencing the above-listed symptoms and adhere to the recommended treatment.
Besides antibiotics, painkillers, and anti-inflammatory medications, patients who are diagnosed with this condition should also try:
- Bed rest
- Limit their physical activity levels
- Avoiding lifting heavy objects
- Elevating scrotum for at least two days (the easiest way to keep scrotum elevated is to lie down)
- Wearing an athletic cup for support
- Applying cold packs to scrotum for 15-20 minutes two to three times a day. Cold packs reduce the swelling, lower inflammation, and numb the pain
- Sitz baths (warm, shallow baths)
When left untreated, acute epididymitis can induce a number of complications such as:
- Chronic epididymitis
- Cutaneous fistulization from rupture of an abscess through the tunica vaginalis (a serous sac that holds the testicle, and part of the head and body of the epididymis)
- Death of the testicular tissue
- Fertility problems
- Fistula (an abnormal passageway in the scrotum)
- Scrotal abscess and pyocele (accumulation of pus in the scrotum)
- Testicular atrophy (a condition in which the testes diminish in size (shrink) and may be accompanied by the loss of function)
- Testicular infarction due to cord swelling that limits testicular artery blood flow
Remember, these complications don’t affect every patient with epididymitis. Don’t ignore the symptoms and treatment recommendations. That way, you’ll minimize the risk of complications and recover faster.
How to Prevent Epididymitis?
Epididymitis is associated with a number of symptoms that are, we can safely say, uncomfortable and frustrating. The condition affects a patient’s quality of life as it prevents you from performing activities you used to do with ease.
Since you have to elevate your scrotum and decrease physical activity time, you might have to take a few days off work especially if symptoms are unbearable.
At the same time, the condition can affect an adult patient’s relationship. As a man, you don’t feel comfortable discussing problems affecting reproductive system with your wife, girlfriend, friends, or anyone else. Keeping things to yourself causes a friction in the relationship.
Good news is that you can prevent epididymitis. Here’s how:
- Abstinence (no sexual intercourse)
- Maintaining proper hygiene prior to and after sexual intercourse
- Maintain adequate hygiene in genital area, particularly anal region
- Monogamy where both partners are healthy and free of any STD
- Mumps vaccination
- Wear a condom to prevent getting an STD
Since most cases of this condition among adult men are caused by sexually transmitted infections, preventative measures center around practicing safe sex and avoiding engaging in high-risk sexual behaviors.
Although having multiple sexual patterns is considered a proper alpha male lifestyle in the modern age, it increases the risk of developing STDs, epididymitis and many other problems.
Also, if you got an STD from your significant other then it’s important to encourage your partner to get checked out and treat their infection. Otherwise, there’s always the risk of developing this condition again.
Prevention of child abuse in pediatric patients is an important strategy to minimize the risk of this condition among boys. Management of underlying infections and diseases that could lead to epididymitis among younger patients is also recommended.
Even though pain, swelling, and discomfort in scrotum area are always serious, epididymitis is treated successfully. Naturally, the success of the treatment depends on an accurate diagnosis.
Men who experience the above-mentioned symptoms should see their doctor instead of waiting for them to go away on their own. The sooner you see your doctor, the easier it gets to treat the condition.
When treated properly, epididymitis doesn’t cause long-term sexual and reproductive problems in most cases. Even with the successful treatment, the condition may return.
The best way to prevent complications, manage symptoms, and treat the condition is to adhere to doctor’s instructions and take antibiotics as recommended.
Doctor schedules a follow-up to check whether infection cleared entirely, and you shouldn’t avoid it even if you feel everything’s okay.
Epididymitis is a serious condition that one can overcome successfully with a proactive attitude which involves seeing a doctor to check the cause of symptoms you experience and adhering to the recommended treatment.
With a healthy lifestyle and wiser choices, you can improve your sexual and reproductive health and avoid subsequent problems.
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