Epididymitis

By Adin Smith, MS | Posted June 5, 2021

Epididymitis is an inflammatory condition affecting the epididymis (a coiled tube located on the back of the testicle that carries sperm). It can cause swelling, irritation, and pain in the testicle.

There are two types of epididymitis, acute and chronic.

Type


Acute



Chronic

Duration 


6 weeks or less



More than 6 weeks

Causes


Bacterial infections
 (i.e., sexually transmitted infection (STI) such as chlamydia or gonorrhea)


Causes are largely unknown
Risk factors include prolonged periods of sitting, bicycling, and wearing tight-fitting pants.

Acute Epididymitis

Duration: 6 Weeks or less

Causes: Bacterial infections 
(i.e., sexually transmitted infection (STI) such as chlamydia or gonorrhea) 

Chronic Epididymitis


Duration
: More than 6 weeks 


Causes
: Largely unknown

Risk factors
include prolonged periods of sitting, bicycling, and wearing tight-fitting pants.

What causes epididymitis?

Sexually transmitted infections (STIs) such as C. trachomatis
(chlamydia) or N. gonorrhoeae (gonorrhea) represent the most common causes of acute epididymitis—especially for men under age 35.[1]Tracy CR, Panchal B. Diagnosis and management of epididymitis. Urol Clin North Am. 2008 Feb;35(1):101-8.

Other causes

Urine backflow: Sometimes, urine can flow backward (reflux) into the epididymis, causing inflammation and irritation. Risk factors leading to urine reflux include heavy lifting or straining and obstruction of the prostate or bladder.

Trauma: Direct impact to the groin area (i.e., sports injury)

Escherichia coli bacteria may spread to the epididymis resulting from anal sex.

Urinary bladder obstructions most often seen in older men may cause urine to enter the epididymitis, causing infection.[2]Chan PT, Schlegel PN. Inflammatory conditions of the male excurrent ductal system. Part II. J Androl. 2002 Jul-Aug;23(4):461-9.

Urinary tract infections may also cause acute epididymitis.

Mycobacterium tuberculosis (TB), in rare instances, may cause epididymitis.

Symptoms

  • One-sided testicular pain that usually gets worse during prolonged periods of sitting
  • Swelling in the back of the testicle
  • Swollen and red-colored scrotum that feels warmer than usual
  • Uncomfortable intercourse
  • Pain during ejaculation
  • Having a frequent or urgent need to urinate
  • Painful or difficult urination
  • Fever and chills
  • Other signs of infection such as penile discharge or blood in the semen

Diagnosis

Because epididymitis and testicular torsion symptoms are similar (testicular torsion is a medical emergency that occurs when the sperm cord gets twisted), men must receive an ultrasound.[3]Epididymitis (Last reviewed June 4, 2015) https://www.cdc.gov/std/tg2015/epididymitis.htm STI tests will determine if gonorrhea and chlamydia may be causing epididymitis. Urine and blood tests are also analyzed to determine if infection or other abnormalities are present.

Treatments

Fortunately, acute epididymitis typically resolves quickly with antibiotic treatment. In contrast, chronic epididymitis is much more difficult to treat. The causes and risk factors linked to chronic epididymitis are discussed below.

What causes chronic epididymitis?

The cause of chronic epididymitis is often unknown and can potentially last for years.[4]Nickel JC. Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma. Rev Urol. 2003;5(4):209-215. Unresolved inflammation after acute epididymitis may be responsible for the development of chronic epididymitis.

Strategies that may help

Seat cushions

Sitting is one of the most common triggers of epididymitis pain, especially among those participating in jobs requiring prolonged sitting periods.  Seat cushions designed with a space that alleviates pressure from the testicles may help reduce epididymitis symptoms.

Tight-fitting pants

Especially when sitting, tight pants can put even more pressure on the testicles, aggravating epididymitis symptoms. Non-restrictive pants designed with stretch material are helpful for many.

Supportive wear

Physical activities like running increase movement of the testicles, which may exacerbate epididymitis. Wearing an athletic supporter during exercise provides testicular support and helps maintain activity levels.

Low-impact exercise

High-impact exercise like running may cause excessive jarring of the testicles—which could aggravate epididymitis. Instead, select low-impact exercises at the gym such as an elliptical trainer, revolving stairs, or light walking on a slightly inclined treadmill to reduce the impact. Although bicycling is considered a low-impact exercise, it may aggravate epididymitis symptoms.

Ice packs and pain medication

Intermittent application of ice packs and taking pain medications can help relieve epididymitis discomfort. Be sure to follow the guidelines and instructions given by your doctor.

Regular ejaculation

Even though ejaculation may exacerbate epididymitis symptoms, there is an opposite school of thought. For instance, some urologists believe that regular “cleaning of the pipes” may decrease the risk of unfavorable bacteria from entering the epididymis. It’s also thought that regular ejaculation helps clear out or dilute chemical irritants such as urine that may “backflow” into the epididymis. Although this approach isn’t formally studied, many urologists recommend that men with chronic epididymitis ejaculate at least every two days.

What is the outlook?

Overall, acute or chronic epididymitis typically does not lead to long-term health problems. Treatment with antibiotics resolves a large percentage of acute epididymitis cases. Some men may develop chronic epididymitis, which typically resolves on its own. The duration of chronic epididymitis is highly variable from person to person, with symptoms that come and go—sometimes lasting for years. The most critical component to addressing chronic epididymitis is to manage symptoms through developing a unique treatment plan with your physician.

References

References
1Tracy CR, Panchal B. Diagnosis and management of epididymitis. Urol Clin North Am. 2008 Feb;35(1):101-8.
2Chan PT, Schlegel PN. Inflammatory conditions of the male excurrent ductal system. Part II. J Androl. 2002 Jul-Aug;23(4):461-9.
3Epididymitis (Last reviewed June 4, 2015) https://www.cdc.gov/std/tg2015/epididymitis.htm
4Nickel JC. Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma. Rev Urol. 2003;5(4):209-215.

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