The epididymis is a series of small tubes attached to the back of each testicle that collects and stores sperm. One of the most common causes of pain in the scrotum is epididymitis, which is an infection that causes inflammation of these coiled tubes.
Epididymo-orchitis is the spread of the infection to the testicle.
Epididymitis is usually a secondary bacterial infection that can be triggered by a range of conditions, such as a urinary tract infection or a sexually transmissible infection (STI).
The bacteria in the urethra (the tube carrying urine and sperm from the penis) move through the urinary and reproductive structures to the epididymis.
Treatment options include antibiotics and bed rest. Some men develop chronic epididymitis, which is inflammation even when there is no infection.
Symptoms of epididymitis
The symptoms of epididymitis include:
- slight fever
- feeling of heaviness in the affected testicle
- sensitivity to touch or pressure in the affected testicle
- enlarged testicle
- pain in the abdomen or pelvis
- frequent urge to urinate
- burning feeling when urinating
- discharge from the penis
- blood in the urine
- pain when ejaculating.
Causes of epididymitis
Most cases of epididymitis are caused by bacterial infection. Causes include:
- urinary tract infections
- STIs, such as chlamydia or gonorrhoea
- recent genito-urinary surgery, including prostatectomy (the surgical removal of all or part of the prostate gland)
- the use of urinary catheters
- some congenital kidney and bladder problems.
Causes of testicular lumps and swellings
Most testicular lumps and swellings are caused by benign (non-cancerous) conditions, although occasionally they can be a symptom of testicular cancer.
It’s important to see your GP if you notice a lump or swelling in one of your testicles so they can try to identify the cause and arrange any further tests if necessary. Read more about diagnosing testicular lumps and swellings.
Some of the main types of testicular lumps and swellings are outlined below.
Benign testicular lumps and swellings
There are a number of different benign causes of testicular lumps and swellings.
Most of these conditions are largely harmless and may not require treatment, although you should seek immediate medical advice if you suspect you have testicular torsion (see below) because it needs to be treated quickly.
Varicoceles are soft lumps that usually develop gradually above the testicle and mostly on the left side of the scrotum (the loose sac of skin that contains the testicles).
They are sometimes described as feeling like a “bag of worms”.
The exact cause of varicoceles is not clear, but it is widely thought that they occur as the result of abnormalities in the veins in the testicles leading to a build-up of excess blood in the veins, which makes them swell.
The size of varicoceles can vary.
Some may only be noticeable when you touch them. Others can be larger and seen easily. The side of the scrotum that contains the varicoceles may hang slightly lower than the other side.
Besides a lump, varicoceles do not usually cause any other symptoms, although some men who have them experience a heavy feeling or aching pain in their scrotum or groin.
In a few cases, varicoceles have been linked to infertility in men. However, there is no evidence that surgically removing them improves your chances of being able to father a baby.
Complications of epididymitis
If left untreated, acute epididymitis can lead to a range of complications, including:
- chronic epididymitis – the inflammation can become persistent, even when there is no bacterial infection
- abscess – a ball of pus can accumulate inside the epididymis or nearby structures, requiring surgery to drain the pus
- destruction of the epididymis – the inflammation can permanently damage or even destroy the epididymis and testicle, which can lead to infertility
- spread of infection – the infection can spread from the scrotum to any other structure or system of the body.
Diagnosis of epididymitis
It can be hard to tell the difference between epididymitis and testicular torsion, especially in younger men.
Testicular torsion is when the testicle has twisted and cut off its supply of blood. Sometimes, epididymitis and testicular torsion occur at the same time.
Epididymitis can be diagnosed using a number of tests, including:
- physical examination
- medical history
- urine tests
- STI tests
- blood tests
Treatment for epididymitis
The treatment options for epididymitis include:
- antibiotics for any sexual partners (if an STI was the cause)
- bed rest
- pain-relieving medication
- cold compresses applied regularly to the scrotum
- elevation of the scrotum
- a stay in hospital (in cases of severe infection)
- check-ups afterwards to make sure the infection has cleared up.
Some men develop chronic epididymitis, which is inflammation even when there is no infection.
The cause is not known, but it is thought that hypersensitivity of certain structures, including nerves and muscles, may cause or contribute to the condition.
Some of the known risk factors include genito-urinary surgery, exposure to STIs and past acute epididymitis. However, a man without these risk factors can still develop the condition.
Diagnosis of chronic epididymitis
Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain, such as testicular cancer, enlarged scrotal veins (varicocele) or a cyst in the epididymis.
Tests can include a physical examination and ultrasound.
Treatment for chronic epididymitis
Chronic epididymitis is difficult to treat. Antibiotics should not be used, as there is no infection.
Treatment options include:
- frequent warm baths
- non-steroidal anti-inflammatory medication
- medication to relax associated muscles
- medication to alter nerve messages to the scrotum
- anaesthetic or steroid injections into the scrotum
- surgery to remove the affected epididymis
- stress management techniques.