What is Epididymitis?

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By Yolanda Smith, B.Pharm.

Epididymitis is a health condition involving inflammation of the epididymis, the tube that stores and transports sperm in the back of the testicles. Men of any age can be affected by the condition, but it is most common in young men aged between 19 and 35 years and frequently causes hospitalization in the military.

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Epidemiology

Approximately 1 in 1000 men is affected by epididymitis each year, making the condition the most common cause of scrotal inflammation. It is among the top five most diagnosed urologic condition for men aged between 18 and 50 years.

Acute epididymitis usually occurs in young men aged between 19 and 35 years but may affect men of any age. Chronic epididymitis is often under-diagnosed for several years, and the average age of presentation is approximately 50 years. Epididymitis is uncommon in children, although it can occur.

Causes

There are various possible causes of epididymitis, including:

• Sexually transmitted infections (STIs) such as chlamydia and gonorrhea
• Urinary tract infection (UTI)
• Enlarged prostate
• Use of catheter
• Surgery to the prostate, bladder or groin region
• Structural abnormalities of the urinary tract
• Groin injury

STIs are the most common cause, particularly in young men between the age of 19 and 35 that have engaged with multiple sexual partners without using condoms.

Symptoms

The symptoms of epididymitis tend to present gradually and worsen over time if left untreated. The symptoms may include:

• Inflammation (swollen, red and warm) scrotum
• Pressure or pain in the testicles, usually unilateral
• Enlarged lymph nodes in the groin
• Pain with urination or bowel movements
• Increased frequency and urgency of urination
• Pain with intercourse and ejaculation
• Discharge from penis
• Blood in semen
• Pain in the abdominal and pelvic region
• Low fever and chills

The specific symptoms depend on the cause of the condition. For example, epididymitis caused by an STI is more likely to be associated with a discharge from the penis, whereas a UTI is more likely to be associated with increased pain, frequency and urgency of urination.

Diagnosis

When a patient presents with symptoms that may be indicative of epididymitis, the first step in diagnosing the condition is to conduct a physical exam to check for signs and symptoms, such as inflammation of the testicles or lymph node enlargement. This may also include a rectal examination to check for prostate enlargement.

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There are a number of other tests that may then be conducted, including:

• STI screening tests
• Complete blood count (CBC)
• Urinalysis and culture
• Doppler ultrasound imaging
• Testicular nuclear medicine scan

It is important to distinguish epididymitis from other similar health conditions such as testicular torsion in the diagnostic process. Testicular torsion usually presents more suddenly and is associated with severe consequences if not treated immediately.

Treatment

The treatment of epididymitis is based on the resolution of the underlying infection, which leads to an improvement in symptoms.

A course of antibiotics is usually recommended, in addition to analgesic and anti-inflammatory medication to ease the immediate symptoms. Other techniques to relieve the pain include cold therapy and elevation of the scrotum. Additionally, it is important that patients rest and allow their bodies to fully recover. Abstaining from sexual intercourse is recommended during treatment to prevent a recurrence of the infection.

With appropriate treatment, the pain associated with epididymitis usually improves within 1-3 days. However, some symptoms may take several months to resolve.

In some cases, further treatment techniques are required. This may include draining of pus with a needle if an abscess forms or surgical procedures in severe cases.

References

• http://www.healthline.com/health/epididymitis#Overview1
• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epididymitis
• http://emedicine.medscape.com/article/436154-overview#showall
• https://www.nlm.nih.gov/medlineplus/ency/article/001279.htm
• http://www.nhs.uk/conditions/epididymitis/Pages/epididymitis.aspx

Further Reading

• All Epididymitis Content
• Epididymitis Treatment
• Epididymitis Causes
• Epididymitis Diagnosis
• Epididymitis Symptoms

Last Updated: Apr 6, 2021

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What You Need to Know

Medically reviewed by Drugs.com. Last updated on Jun 6, 2023.

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• Español

What is epididymitis?

Epididymitis is inflammation of your epididymis. The epididymis is a coiled tube inside your scrotum. It stores and carries sperm from your testicles to your penis. Acute epididymitis lasts for 6 weeks or less. Chronic epididymitis lasts longer than 6 weeks.

What causes epididymitis?

The cause of epididymitis may be unknown. It may be caused by any of the following:

• A urinary tract infection (UTI) that spreads to the epididymis
• Urine that flows backward from your urethra to the epididymitis
• Use of heart medicine called amiodarone
• Sexually transmitted infections (STIs) such as gonorrhea or Chlamydia

What increases my risk of epididymitis?

• Urinary tract conditions that cause frequent UTIs
• Having an indwelling urinary catheter (thin, flexible tube inserted into the bladder and left in place to drain urine)
• Recent surgery of the urinary tract
• Physical strain that puts pressure on the abdomen, such as heavy lifting
• Prostate disorders such as benign prostatic hypertrophy or prostatitis

What are the signs and symptoms of epididymitis?

• Pain or tenderness in your scrotum, abdomen, or groin
• Redness or swelling of your scrotum
• Pain or burning during urination, or frequent urination
• Discharge from your penis or blood in your urine or semen
• Fever

How is epididymitis diagnosed?

Your healthcare provider may examine your penis, prostate, and scrotum. He or she may ask about your symptoms and any health conditions you have. You may need any of the following tests:

• Blood and urine tests may be done to see if you have an infection. If you have discharge, a small amount of this fluid will be tested for bacteria.
• An ultrasound uses sound waves to show pictures of your testicles on a monitor. An ultrasound may be used to check blood flow to your testicles.
• A nuclear scan checks the blood flow in your testicles. A small amount of radioactive material may be injected into your blood. The radioactive material helps your blood vessels show up better.

How is epididymitis treated?

Your treatment depends on the cause of your epididymitis and may include any of the following:

• Antibiotics may be given if epididymitis is caused by a bacterial infection.
• NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask if NSAIDs are safe for you. Always read the medicine label and follow directions. Do not give these medicines to children younger than 6 months without direction from a healthcare provider.
• Acetaminophen decreases pain and fever. It is available without a doctor’s order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly.
• Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
• Surgery may be needed if your condition gets worse or becomes chronic. Surgery to drain an abscess (collection of pus) may be needed. Surgery to remove part or all of your epididymis or testicle may also be done.

How can I manage epididymitis?

• Apply ice on your testicles for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
• Rest in bed as directed. Elevate your scrotum when you sit or lie down to help reduce swelling and pain. You may be asked to do this by placing a rolled-up towel under your scrotum.
• Scrotal support may be recommended. An athletic supporter provides scrotal support and may make you more comfortable when you stand. Ask your provider how to use an athletic supporter.
• Do not lift heavy objects. You can make swelling worse if you lift heavy objects or strain.

When should I seek immediate care?

• You have severe pain in your testicles.
• Your symptoms become worse even after you start treatment with medicine.

When should I call my doctor?

• Your symptoms do not get better within 3 days of treatment or come back after treatment.
• You have a hot, red, tender area on your testicles.
• You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright Merative 2023 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.

Learn more about Epididymitis

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• Medications for Epididymitis
• Medications for Infection

Care guides

• Epididymo-Orchitis
• Orchitis

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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