The long, tightly coiled tube that is located behind each testicle and carries sperm from the testicle to the vas deferens is the epididymis. Inflammation of this structure, usually as a result of bacterial or chlamydial infection that travels from the urinary tract to the sperm duct, is called epididymitis.
If each testicle is rolled gently between the fingers and thumb, a comma-shaped lump can be felt draped over the top. This “lump” is a narrow tightly coiled-up tube. If the coils were stretched out, the tube would measure 20 feet - over three times average male height.
The lumps are the epididymes (plural), which is Greek for “upon the twins.” When sperm are made, they enter the epididymis, and are stored while they mature. They need this extra time to develop before they set out on the long journey in the race for the egg.
Epididymitis is an infection of the epididymis, the comma-shaped lumps which “sit upon the twins.”
In youth, the infection can be due to sexually transmitted infection from chlamydia or gonorrhea and is associated with urethritis (inflammation of the urethra). In older men over 40, it is associated with urinary tract infections and prostatitis.
The main symptoms are fever and pain, developing progressively over several hours, in the back portion of the testicles. Symptoms include fever and chills, pain in the groin, and tender, swollen epididymes.
Sudden pain in the scrotum, rapid unilateral scrotal enlargement, and marked tenderness of the testes, spermatic cord, and groin are characteristic manifestations.
Symptoms may follow acute physical strain (heavy lifting), trauma, or sexual activity. There may also be pain at the tip of the penis and urethral discharge.
Secondary orchitis with a swollen, painful testicle may occur. Orchitis is the generic name for any inflammation of the testicles. The symptoms of epididymitis and orchitis are much the same. Sometimes the names are used interchangeably. The symptoms of both are reddened scrotum, tense swollen testicles with sudden acute pain and fever. Orchitis can also be the result of a sports injury, or after surgery to remove a scrotal cyst, or vasectomy.
The diagnosis of acute epididymitis is established on the basis of history and physical findings. Urinalysis and urine culture may help to confirm the diagnosis. Additional tests may include gram-staining of a smear of urethral discharge and a scrotal ultrasound study.
Therapy is by antibiotics (often up to 3 weeks) and pain relief. Hospitalization is an option, depending on the degree of infection. Bed rest is essential until the pain subsides. If at home, raise and support the swollen scrotum on a soft pad for comfort. Avoid very hot compresses to soothe the inflammation; they can damage the sperm-making tubes.
Application of ice bags may reduce pain. Non-steroidal anti-inflammatory drugs (NSAIDs) may be of use when there is evidence of a severe inflammatory process. Examination and treatment of the sexual partners of younger men with epididymitis should be done.
Complications of acute epididymitis include abscess formation, testicular infarction, and the development of chronic pain and infertility. Prompt establishment of a diagnosis and initiation of treatment is therefore of the essence.
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