Epididymitis, also known as epididymitis, is an inflammation of the epididymis – the structure behind and on top of the testicle that is responsible for storing and transporting sperm. The condition can cause pain, swelling and tenderness in the scrotum and occurs in men of all ages.
The inflammation is most often caused by bacteria that spread from the urinary tract or via sexually transmitted infections. In some cases, epididymitis can also occur in connection with a urinary tract infection or inflammation of the prostate. Because the testicles also play a central role in the production of the sex hormone testosterone, problems in the testicular area can sometimes raise concerns about fertility or hormone function, although epididymitis rarely affects hormone production.
Symptoms of epididymitis
Symptoms often develop gradually and can vary in intensity. Common symptoms include:
Pain in one testicle or in the epididymis.
Swelling in the scrotum.
Tenderness in the testicle area.
Redness or warmth in the scrotum.
Pain when urinating.
Frequent urge to urinate.
In some cases, fever and general malaise.
The pain can sometimes radiate to the lower abdomen or groin and worsen with movement or physical exertion.
Causes of epididymitis
Epididymitis is usually caused by bacteria that spread to the epididymis via the urinary tract or bloodstream. The infection can sometimes start in the urethra, bladder or prostate and then spread further.
Common causes include:
Sexually transmitted infections such as chlamydia or gonorrhea.
Urinary tract infection.
Bacteria from the prostate or urethra.
In some cases after medical procedures in the urinary tract.
In younger men, sexually transmitted infections are a common underlying cause, while bacteria from the urinary tract are more common in older men.
Diagnosis and examination
If epididymitis is suspected, a clinical examination is first performed in which the doctor feels the testicles and epididymis to assess swelling, tenderness and possible redness. The examination is often supplemented with tests and imaging to confirm the diagnosis and rule out other causes of pain in the testicle area.
Common examinations include:
Urine test to detect bacteria or signs of infection.
Sampling for sexually transmitted infections.
Blood tests to identify inflammation.
Ultrasound of the testicles to rule out other causes of pain or swelling.
Ultrasound is often used to differentiate epididymitis from other conditions such as testicular torsion, sperm cysts, or other changes in the epididymis.
Treatment of epididymitis
Treatment depends on the underlying cause of the inflammation. For bacterial infections, antibiotics are the most common treatment. Common treatment options include:
Antibiotics for bacterial infections.
Pain-relieving medications to relieve pain and inflammation.
Rest and elevate the scrotum to reduce swelling.
Ice to the area to relieve discomfort.
Most patients experience improvement within a few days of starting treatment, but it may take several weeks for swelling and tenderness to completely disappear.
When should you seek medical attention?
Pain or swelling in the testicles should always be taken seriously. Contact your healthcare provider if you experience:
Sudden or severe pain in the testicle.
Swelling or redness in the scrotum.
Fever along with testicular pain.
Pain that does not improve.
It is important to quickly rule out other conditions, such as testicular torsion, which require immediate treatment.
