How does epididymitis come about?

Inflammation of the epididymis results in swelling and pain. What causes can be behind it and how it is treated

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Male anatomy: this is where the epididymis are located

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Epididymis - in short

Doctors refer to inflammation of the epididymis as epididymitis. The cause is usually bacteria that enter the epididymis either via the blood or, more often in the case of a urinary tract or prostate infection, via the vas deferens. Infection during unprotected sexual intercourse is possible. The main symptoms are pain and swelling, as well as redness and warming of the affected area. It is crucial that a doctor is consulted who will make the diagnosis and prescribe treatment with anti-inflammatory and pain-relieving drugs and, if necessary, antibiotics.

The epididymis lie on the testicles as independent organs within the scrotum. They mainly consist of a tightly twisted four to six meter long epididymal duct and serve to mature and store the sperm cells that are produced in the testes. The matured sperm cells then pass from the epididymis via the vas deferens and the urethra to the outside.

Symptoms of epididymis

The most common disease of the epididymis is inflammation - called epididymitis. It often manifests itself with massive swelling, severe pain, and warming and redness in the area of ​​the affected epididymis. Sometimes you also experience pain when urinating, fever, chills, and fatigue. The pain can radiate to the groin and lower abdomen. The epididymis often spreads to the neighboring testicles.

Important: See a doctor quickly

"An epididymis is not only extremely painful, if left untreated, it can lead to an occlusion of the epididymal tubules," says Professor Christian Stief, Director of the Urological Clinic and Polyclinic at the Ludwig Maximilians University in Munich. The sperm cells then no longer get out naturally. In the rare event that both epididymis are affected, it can lead to infertility.

If the acute inflammation does not heal, a chronic inflammation can develop, so that the symptoms keep reappearing. There is also a risk of an abscess forming. If this encapsulated collection of pus breaks open, there is a risk of life-threatening blood poisoning.

In the event of swelling and pain in the testicle area, those affected should therefore not hesitate long and contact a doctor directly.

What are the possible causes?

Inflammation can rise from the urethra or prostate through the vas deferens to the epididymis. The pathogens then come from a urinary tract or a prostate infection, but infection can also have occurred through unprotected sexual intercourse.

Rarely do the pathogens come from another source of infection in the body and reach the epididymis via the bloodstream.

The most common triggers are bacteria such as chlamydia, Escherichia coli, enterococci or staphylococci, and more rarely viruses. "The most common cause of an infection via the bloodstream is an infection with pathogens causing tuberculosis," says Professor Christian Stief.

More rarely, the inflammation is the result of testicular torsion - a massive injury to the epididymis caused by a kick - or a rheumatic disease. Men who wear a urinary catheter for a long time, who suffer from malformations in the area of ​​the spermatic duct or the urinary tract or who have a voiding disorder of the urinary bladder are particularly at risk.

How does the doctor make a diagnosis?

To make the diagnosis, the doctor palpates the testicles and scrotum. With epididymitis, the pain often decreases when the testicle is lifted. An examination of the inflammation values ​​in the blood shows whether there is inflammation. The pathogens involved can be determined with a urine test and the selection of a suitable antibiotic can be made easier. In some cases, a swab from the urethral opening is also necessary. With the help of an ultrasound blood flow scan, the doctor can assess the extent of the inflammation. An X-ray examination with a contrast agent makes it possible to detect flow obstructions, for example in the urethra. It is important to rule out testicular torsion as the cause, as this must be operated on within a few hours as an emergency.

How is epididymitis treated?

Against the epididymis, the doctor recommends anti-inflammatory and analgesic medication and - if a bacterial infection is the cause - antibiotics. In addition, bed rest should be maintained until the fever has subsided. The testicle can be cooled with cold compresses and raised if necessary.

Professor Dr. med. Christian Stief, specialist in urology

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Consulting expert

Professor Dr. med. Christian Stief is a specialist in urology. He completed his habilitation in 1991 at the Hannover Medical School. Since 2004 he has been Director of the Urological Clinic at the University of Munich Clinic. He is the editor of several German and English-language academic books and was co-editor of the journal from 2006 to 2012 European Urology. He has been a member of the Medical Committee of the Science Council since 2018.

Important note: This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions