Epididymitis

Definition

Epididymitis is inflammation or infection of the epididymis. In this long coiled tube attached to the upper part of each testicle, sperm mature and are stored before ejaculation.

Description

Epididymitis is the most common cause of pain in the scrotum. The acute form is usually associated with the most severe pain and swelling. If symptoms last for more than six weeks after treatment begins, the condition is considered chronic.

Epididymitis can occur any time after the onset of puberty but is most common between the ages of 18 and 40. It is especially common among members of the military who exercise for extended periods without emptying their bladders.

Factors that increase the risk of developing epididymitis include:

• Infection of the bladder, kidney, prostate, or urinary tract
• Other recent illness
• Narrowing of the urethra (the tube that drains urine from the bladder)
• Use of a urethral catheter.

Causes & symptoms

Although epididymitis can be caused by the same organisms that cause some sexually transmitted diseases (STDs) or occur after prostate surgery, the condition is generally due to pus-generating bacteria associated with infections in other parts of the body.

Epididymitis can also be caused by injury or infection of the scrotum or by irritation from urine that has accumulated in the vas deferens (the duct through which sperm travels after leaving the epididymis).

Epididymitis is characterized by sudden redness and swelling of the scrotum. The affected testicle is hard and sore, and the other testicle may feel tender. The patient has chills and fever and usually has acute urethritis (inflammation of the urethra).

Enlarged lymph nodes in the groin cause scrotal pain that intensifies throughout the day and may become so severe that walking normally becomes impossible.

Diagnosis

Laboratory tests used to diagnose epididymitis include:

• Urinalysis and urine culture
• Examination of discharges from the urethra and prostate gland
• Blood tests to measure white-cell counts.

Treatment

Because epididymitis that affects both testicles can make a man sterile, antibiotic therapy must be initiated as soon as symptoms appear. To prevent reinfection, medication must be taken exactly as prescribed, even if the patient's symptoms disappear or he begins to feel better. Over-the-counter anti-inflammatories can relieve pain but should not be used without the approval of a family physician or urologist.

Bed rest is recommended until symptoms subside, and patients are advised to wear athletic supporters when they resume normal activities. If pain is severe, a local anesthetic like lidocaine (Xylocaine) may be injected directly into the spermatic cord.

Self-care

A patient who has epididymitis should not drink beverages that contain caffeine. To prevent constipation, he should use stool softeners or eat plenty of fruit, nuts, whole grain cereals, and other foods with laxative properties.

An ice bag wrapped in a towel can reduce pain and swelling but should be removed from the inflamed area for a few minutes every hour to prevent burns.

Strenuous activity should be avoided until symptoms disappear. Sexual activity should not be resumed until a month after symptoms disappear.

If a second course of treatment doesn't eradicate stubborn symptoms, longterm anti-inflammatory therapy may be recommended. In rare instances, chronic symptoms require surgery.

Surgery

Each of the surgical procedures used to treat epididymitis is performed under local anesthesia on an outpatient basis. Both of them cause sterility.

Epididymectomy involves removing the inflamed section of the epididymitis through a small incision in the scrotum.

Bilateral vasectomy prevents fluid and sperm from passing through the epididymis. This procedure is usually performed on men who have chronic epididymitis or on elderly patients undergoing prostate surgery.

Prognosis

Pain generally subsides 24-72 hours after treatment begins. Complete healing may take weeks or months.

Prevention

Using condoms and not having sex with anyone who has an STD can prevent some cases of epididymitis.

Further Reading

For Your Information

Books

• Shaw, Michael, ed. Everything You Need to Know About Diseases. Springhouse, PA: Springhouse Corporation, 1996.

  Other

• "Epididymitis." http://www.duj.com/epididymitis.html. (7 June 1998).
• "Epididymitis." http://www.thriveonline.com/health/Library/illsymp/illness203.html. (6 June 1998).

Gale Encyclopedia of Medicine. Gale Research, 1999.