Epididymitis: What It Feels Like for Men and How to Treat It
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What is epididymitis?
Even experts have difficulty definitively diagnosing epididymitis versus torsion by symptoms and exam alone. It is often necessary to have an ultrasound to rule out testicular torsion, which is twisting of the testicle. It can lead to loss of testicle and infertility if not diagnosed and surgically treated as soon as possible. —Dr. Chandra Manuelpillai
Epididymitis is inflammation (swelling) caused by an infection of the epididymis. The epididymis is a tube located in the back of the testicle. It stores and transports sperm—and also helps sperm mature. It is usually caused by a bacterial infection, sometimes from a sexually transmitted disease.
The most common symptom is gradual pain by the epididymis. See a doctor as soon as possible because other serious diagnoses can have similar symptoms. For example, testicular torsion is a twisting of the testicles and a surgical emergency. Fournier’s gangrene, though uncommon, is an infection in the groin area that can lead to death if not treated right away.
The most common symptom of epididymitis is a gradual onset of scrotal pain. It is usually along the back of the testicle, but you may feel it in other parts of the area. Swelling is common too.
Other symptoms you may have
- Reddened skin
- Mild fever
- Pain when urinating
- Urinating more frequently
- Penile discharge (not urine or semen)
Causes of epididymitis
Be honest with your doctor. People are often embarrassed to discuss their sexual history with their doctor, including if they are sexually active, have had unprotected intercourse, or engaged in insertive anal intercourse. They also avoid getting medical attention when symptoms involve their genitalia. Delay in diagnosis and treatment may lead to worsening infection, loss of fertility, and even death. Your doctor is there to help you, not judge you. —Dr. Manuelpillai
Epididymitis is often caused by an infection from other areas—like the urethra, bladder, prostate, or kidney—that spreads to the epididymis. In men under 35 years old, it is more commonly caused by a sexually transmitted disease (STD) such as gonorrhea and chlamydia.
In older men, it is more likely to be caused by an enlarged prostate. Males of any age who have anal intercourse are at risk of infection from exposure to bacteria in the rectum.
In children and teenagers (teens who are not sexually active), it may be due to anatomic abnormalities that can lead to urinary tract infections. Scrotal pain and swelling in children could also be caused by orchitis, which is another type of infection of the testes.
Teenagers who are sexually active are more likely to have an infection caused by an STD.
What is the best way to treat epididymitis?
If you suddenly have scrotal pain, go to the emergency room to rule out more serious issues like testicular torsion.
Epididymitis is treated with antibiotics. Which ones depends on whether you have an STD, urinary tract infection, or enlarged prostate. Finish all antibiotics to prevent the infection and symptoms from returning.
If you are diagnosed with an STD, make sure your sexual partner is tested and treated too.
Other symptoms can be relieved with over-the-counter or prescription pain medications and icing the area. You can also use scrotal support like supportive boxers.
Symptoms should start to improve after 3 days of home care. If not, you should see your doctor again. You want to make sure you have the correct diagnosis. Or you may need a different antibiotic.
Follow up with referrals including to a urologist. They are experts on epididymitis and its causes, particularly when related to an anatomical abnormality. It is especially important for children and teenagers with suspected abnormalities to be evaluated. These conditions are usually surgically correctable. But if left untreated, they can lead to recurrent infections. —Dr. Manuelpillai
How to prevent epididymitis
Practicing safe sex (i.e., using condoms) helps prevent epididymitis from an STD.
Older men with an enlarged prostate can help prevent a urinary tract infection by drinking plenty of fluids.
Dr. Manuelpillai is a board-certified Emergency Medicine physician. She received her undergraduate degree in Health Science Studies from Quinnipiac University (2002). She then went on to graduated from Rosalind Franklin University of Medicine and Sciences/The Chicago Medical School (2007) where she served on the Executive Student Council, as well as was the alternate delegate to the AMA/ISMS-MSS Governing Council and the student representative to the Illinois State Medical Society (ISMS) Education and Health Workforce committee. She completed an internship year with UCLA-Harbor Medical Center's Department of Internal Medicine followed by an emergency medicine residency program at Boston Medical Center (2011) while also serving as the resident representative to the Massachusetts Medical Society (MMS) committee on Student Health & Sports Medicine. She then started working at Saints Medical Center (later Lowell General Hospital/Saints Campus and Main Campus) in Lowell Massachusetts where she served as the Continuous Quality Improvement Director for the emergency medicine group, as well as was the representative for the emergency department on the Sepsis, Stroke and PCI Quality Assurance and Compliance Committees. She joined Buoy Health in 2019. She currently works in multiple emergency departments both in the community and academics, as well as previously worked in multiple urgent care centers. She believes this mix of experiences has given her a unique perspective on the care of acute illnesses.