The epididymis is a structure of tubules that transport sperm from the testicle. It is palpable on physical examination on the posterior or rear of the testicle. The tubules within the epididymis merge to form the vas deferens. The vas deferens is the tube that is cut during a vasectomy to prevent sperm from mixing with the remainder of ejaculatory fluid.
Epididymitis is an inflammation or infection of the epididymis. This can occur as the result of trauma or infection. Frequently, the cause is not determined. Symptoms of epididymitis include discomfort in the region of the testicle. This pain and tenderness is often referred into the groin and occasionally into the abdomen. Swelling and firmness in these tissues can also be a component of epididymitis. As with any change in testicular exam or sensation, this should be examined by a physician.
Acute epididymitis is self-limited and, with good immune support and appropriate medical care, will resolve without complications. Chronic epididymitis is uncommon and is generally seen as an irreversible end stage of a severe acute attack which has not been treated or has not responded, and has been followed by frequent mild attacks.
Organisms associated with epididymitis include chlamydia trachomatis, cryptococcus neoformans, hemophilus influenzae (rare), mumps, mycobacterium tuberculosis, nisseria gonorrhea, nisseria meningifidis, salmonella typhi (rare), various filaria (tropical regions only). Chlamydia trachomatis may be the major cause of acute epididymitis in men under 35 years of age. Epididymitis from an STD like this will generally present with urethritis.
Treatments of epididymitis include antibiotic therapy, anti-inflammatories, and scrotal support. Bedrest and local ice for the first 48 hours is very beneficial. Cold therapy can be used for acute epididymitis. An athletic supporter will further relieve pain once normal activity is resumed. Emptying the bladder prior to strenuous activity is a good idea, strenuous activity should be interrupted if there is a sensation of a full bladder. In cases where the epididymitis has progressed to a firmness or induration of the tubules, treatment usually produces relief of the pain prior to complete resolution of firmness of the inflamed tissues. Diabetics and other individuals with underlying systemic illnesses are more susceptible to this type of infection.
Sexual partners should also be tested for chlamydia.