Epididymitis: It's a Real Pain in the B….

This article originally appeared online at Dr.Pullen.com, part of the HCPLive network.

The epididymis is the organ on the back side of each male testis, where the thousands of tiny tubules that the sperm travel through in the testis come together to form the epididimis which then develops into a single tube called the vas deferens (of vasectomy fame).

When the epididymis becomes inflamed it gets swollen, enlarged, and very tender. Patients usually complain of pain in the scrotum or testis, and on exam have an enlarged tender epididymis on one or both sides. Treatment of this condition is usually with antibiotics and anti-inflammatory medications.

The epididymis is a part of the body that is protected from chemicals in the bloodstream by what is called the “blood-testis barrier.” The body seems to have a way to keep chemicals in the bloodstream from getting into tissues where sperm cells live, presumably as a way to prevent injury to the sperm which could reduce fertility or lead to imperfect embryos. This makes it difficult for medications like antibiotics and anti-inflammatory medications to penetrate these tissues. Probably for this reason it is difficult to successfully treat epididymitis, and usually long courses of treatment are needed, and recurrence is common.

The cause of epididymitis is often not apparent. Occasionally it is an acute STD, with Chlamydia or gonococcus as the causative organism, but most of the time this is not the case. Recurrent minor trauma, as in bicycle riders, can sometimes be the cause. Most of the time the cause of epididymitis is not apparent. Epididymitis is a close kin to prostatitis, and sometimes both conditions are found at the same time in a patient. Epididymitis can be a complication of vasectomy, usually in the period shortly after the surgery if this is the cause. Differentiation of epididymitis from cancer of the testis is obviously very important, and even though it is usually quite apparent on examination that the painful mass is in the epididymis, many cases of testicular cancer are initially misdiagnosed as epididymitis. When in doubt a testicular ultrasound can usually separate these two conditions.

Although epididymitis is very common, I find that most of the men that I see with their first case of epididymitis have never heard of the condition, and come in worried about testicular cancer.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.