Epididymitis

Overview

Epididymitis is inflammation (swelling) of the epididymis, the tube at the back of the testicle that stores and carries sperm. It can cause pain and swelling in the scrotum (the skin sac that holds the testicles).

Epididymitis is a common condition, especially in men aged 15 to 35, and in older men with prostate issues.

It primarily affects males of any age, but is most common in sexually active young men and older men with enlarged prostate or urinary tract infections.

Symptoms

Common symptoms

• Pain or discomfort in the scrotum, often on one side
• Swelling and redness of the scrotum
• Pain that may spread to the lower abdomen or groin
• A feeling of heaviness or tenderness in the testicle area
• Pain when urinating or an urgent need to urinate
• Discharge from the penis (if caused by an STI)
• Fever or chills

Symptoms in children

• Pain in the scrotum or testicle area
• Swelling of the scrotum
• Crying or fussiness in infants
• Refusing to walk or favoring one side
• Fever

Symptoms in older adults

• Dull ache or pain in the scrotum or groin
• Swelling that may come and go
• Difficulty urinating or a weak urine stream
• Fever or confusion (in severe cases)

Causes

Main causes

• Bacterial infection from a urinary tract infection (UTI) or a sexually transmitted infection (STI) like chlamydia or gonorrhea
• Urine flowing backward into the epididymis (urine reflux), which can happen with heavy lifting or straining
• Trauma or injury to the groin area
• A fungal infection (rare)

Risk factors

• Being sexually active, especially with multiple partners or without condoms
• Having a urinary tract infection or an enlarged prostate
• Recent surgery or catheter use in the urinary tract
• Heavy lifting or straining that causes urine reflux

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe scrotal pain — go to the emergency department right away
• If you have a high fever (over 101°F/38.3°C) and scrotal pain
• If you cannot pass urine

Book a routine appointment if:

• If you have mild pain or swelling in the scrotum that does not go away in a day or two
• If you have discharge from your penis or pain when urinating
• To rule out other conditions like testicular torsion (a twisting of the testicle that is a medical emergency)

Diagnosis

Your doctor will ask about your symptoms and recent activities, and examine your scrotum, testicles, and abdomen. They may also check for tender glands in the groin.

Tests that may be done

• Urine test to check for infection or blood
• Swab from the urethra (tube that carries urine out) to test for STIs
• Ultrasound scan of the scrotum to see the blood flow and check for other problems like a twisted testicle or abscess
• Sometimes a blood test to look for signs of infection

What to expect at your appointment

The exam may be uncomfortable but is usually quick. An ultrasound is painless and uses sound waves to create images. You may be asked to provide a urine sample or have a swab taken from the tip of the penis.

Treatment

Treatment focuses on clearing the infection and relieving symptoms. Antibiotics are the main treatment if an infection is found. You should complete the full course as prescribed.

Self-care at home

• Rest in bed or limit activity to reduce pain and swelling
• Apply an ice pack wrapped in a cloth to the scrotum for 15–20 minutes every few hours
• Wear supportive underwear or an athletic supporter (jockstrap) to lift the scrotum
• Take over-the-counter pain relievers like paracetamol (acetaminophen) or ibuprofen — follow the label directions
• Avoid heavy lifting and straining until symptoms improve

Medical treatments

Your doctor will prescribe antibiotics if bacteria are the cause. They may also give you medicine to reduce inflammation and pain. If the epididymitis is due to an STI, your sexual partner(s) will also need to be treated to avoid reinfection.

When is surgery considered?

In rare cases, if an abscess (collection of pus) forms, it may need to be drained with a needle or with a small surgical procedure. If the condition does not get better with treatment, surgery to remove part or all of the epididymis (epididymectomy) may be considered.

Living with this condition

During the first few days of treatment, it is important to rest and avoid activities that cause pain. Once the infection clears, you can gradually return to normal activities. Full recovery usually takes a few weeks.

Lifestyle tips

• Use condoms during sex to prevent STIs and reinfection
• Drink plenty of fluids to help flush bacteria from your urinary tract
• Avoid heavy lifting or straining until your doctor gives you the all-clear
• Practice gentle exercises like walking once you feel better

Diet and exercise

A healthy diet with plenty of fruits, vegetables, and whole grains can support your immune system. Light exercise like walking is fine, but avoid strenuous activity until the swelling and pain are gone.

Mental health and emotional wellbeing

Dealing with scrotal pain or an STI diagnosis can be stressful or embarrassing. It is normal to feel anxious or worried. Talking to your partner, a friend, or a counsellor can help.

Prevention

You can reduce your risk by practicing safe sex (using condoms), treating UTIs promptly, and avoiding heavy lifting that could cause urine reflux.

Screening programmes

If you are sexually active and have multiple partners, regular STI testing can help catch infections early and prevent epididymitis.

Complications

If left untreated

• A pocket of pus (abscess) in the scrotum
• Long-term (chronic) pain or swelling
• Spread of infection to the testicle itself (epididymo-orchitis)
• Infertility (rare) if the infection damages the sperm tube
• Sepsis (a life-threatening response to infection)

Long-term outlook

With prompt treatment, most people recover fully within a few weeks. Even if complications occur, medical care can manage them effectively. Following your doctor’s advice and completing all prescribed treatment gives you the best chance of a good outcome.

Find support

Local organisations

• Your local health service

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