Funiculitis

Overview

Funiculitis (say: fyoo-nik-yoo-LY-tis) means inflammation of the spermatic cord. The spermatic cord is the bundle of tubes, blood vessels, nerves and muscle that runs from the lower belly down to each testicle. It carries sperm and blood to and from the testicles. When this cord gets inflamed, it can feel sore, tender or swollen in the groin or scrotum. Funiculitis is usually caused by an infection spreading along the cord, or by irritation after an injury or an operation. It is treatable, and most people feel much better once the cause is found and looked after.

Funiculitis is not common. It is seen much less often than other causes of scrotal pain, such as epididymitis (inflammation of the tube that stores sperm) or a twisted testicle. Because it is uncommon, doctors often check for other causes first.

It can affect males of any age, but it is most often seen in adult men. It can also happen in boys, and occasionally in newborns, where inflammation of the umbilical cord is a separate but similarly named condition. People who have had recent groin surgery, a urinary infection, a sexually transmitted infection or a groin injury are more likely to get it.

Symptoms

Common symptoms

• Aching or sharp pain in the groin, scrotum or lower belly, often on one side
• Tenderness along the cord above the testicle
• Swelling or a heavy, full feeling in the scrotum
• Redness or warmth of the skin over the area
• Pain that gets worse when you move, cough or strain
• A lump or thickened area you can feel above the testicle
• Fever, chills or feeling generally unwell, especially if infection is the cause
• Discomfort when passing urine, or discharge from the penis, if an infection is behind it

Symptoms in children

• Crying or fussiness that is hard to settle
• Pulling at or touching the groin or scrotum
• Refusing to walk, or walking with a limp
• Swelling on one side of the scrotum
• Fever or generally feeling unwell
• In newborns, redness or swelling around the base of the umbilical cord should be checked quickly, as it is a different but related problem

Symptoms in older adults

• Pain that may be milder but lasts longer
• Swelling that is easy to miss if you have less feeling in the area
• Fever or confusion, which can be the main sign of infection in older people
• Symptoms linked to a urinary infection, a catheter, or prostate problems
• Symptoms after recent hernia or groin surgery

Causes

Main causes

• A bacterial infection that spreads from the tube that stores sperm (the epididymis) or from the urethra, the tube you pass urine through
• Sexually transmitted infections, which can travel along the tubes and inflame the cord
• Urinary tract infections, especially in older men
• An injury or direct blow to the groin
• Recent surgery in the groin, such as a vasectomy or hernia repair
• Irritation from a catheter or from long-term pressure on the area
• Less often, other infections or inflammatory conditions, and sometimes no clear cause is found

Risk factors

• A recent sexually transmitted infection or unprotected sex with a new partner
• A current or recent urinary infection
• Recent surgery, a catheter, or a procedure in the groin
• A groin injury or heavy strain
• An enlarged prostate or trouble emptying your bladder fully
• Diabetes or a weakened immune system
• Poor hygiene in the groin area

When to see a doctor

See a doctor urgently if:

• Sudden or severe pain in the testicle or groin — seek emergency care straight away
• Fever with a red, swollen or tender scrotum
• Vomiting along with testicular pain
• Trouble passing urine
• Symptoms that keep getting worse, or that do not settle after a few days

Book a routine appointment if:

• A mild ache or small swelling in the groin that lasts more than a few days
• Discomfort that keeps coming back
• Symptoms that appear after groin surgery once you are home
• Any new lump you can feel above or around the testicle

Diagnosis

A doctor will usually start by asking about your symptoms, your recent health, any surgery or injuries, and your sexual history. They will then examine your groin and scrotum gently, checking for tenderness, swelling and warmth, and comparing both sides. This examination is often enough to point to the likely cause, but tests are usually done to rule out more serious problems and to find out whether an infection is involved.

Tests that may be done

• A urine test to look for infection
• A swab from the urethra, or a urine sample, to check for sexually transmitted infections
• Blood tests if you are feverish or unwell
• An ultrasound scan of the scrotum, which uses sound waves and is painless, to check blood flow and rule out a twisted testicle or an abscess
• In some cases, a small sample of fluid may be taken for testing

What to expect at your appointment

The examination can feel a little uncomfortable, but it is quick. If a twisted testicle is suspected, you will be seen urgently and may go straight for a scan or to a surgical team. Most other results come back within a few days. Your doctor will explain what they find and what the next steps are.

Treatment

Treatment depends on the cause. If an infection is found, the aim is to clear it. If the cause is irritation or injury, the aim is to rest the area and let it settle. In most cases, funiculitis improves with the right care, and serious problems are rare when it is checked early.

Self-care at home

• Rest and avoid heavy lifting, cycling or strenuous exercise while it is sore
• Support the scrotum with close-fitting underwear or a soft support
• Use a cool pack wrapped in a cloth for short periods to ease swelling — never put ice directly on the skin
• Take simple pain relief as advised by your pharmacist or doctor
• Drink plenty of fluids if you have a urinary infection
• Keep the area clean and dry
• Finish any treatment your doctor prescribes, even if you feel better early

Medical treatments

If a bacterial infection is causing the problem, your doctor may prescribe a course of antibiotics. The type is chosen based on your age, test results and any allergies. If a sexually transmitted infection is found, you will be offered treatment and your partner may also need checking and treatment so the infection does not come back. Pain relief and anti-inflammatory medicines available from a pharmacy can help with discomfort. If you are feverish or very unwell, you may need to be seen in hospital for fluids and monitoring.

When is surgery considered?

Surgery is not usually needed for funiculitis itself. It may be considered if a collection of pus (an abscess) forms and needs draining, if a twisted testicle is found, or if an underlying problem such as a hernia or fluid sac around the testicle needs repair. Your doctor will explain the reasons clearly if this applies to you.

Living with this condition

Most people feel better within days to a couple of weeks once treatment starts. In the meantime, take things gently, wear supportive underwear, and give yourself permission to rest. If your work involves heavy lifting or long periods on your feet, ask your doctor when it is safe to go back.

Lifestyle tips

• Wear supportive, well-fitting underwear during recovery
• Avoid heavy lifting and vigorous exercise until the soreness has gone
• Practise safer sex, including using condoms, to lower the risk of infections
• Keep the groin area clean and dry
• Drink enough fluids, especially if you have had a urinary infection
• See your doctor if symptoms return rather than guessing at the cause

Diet and exercise

There is no special diet for funiculitis, but eating well and drinking enough fluids helps your body recover, particularly if you have had an infection. Gentle walking is fine once the pain settles. Build back up to your usual activity slowly, and avoid cycling, heavy weights or contact sports until you feel fully comfortable.

Mental health and emotional wellbeing

Pain in the testicles or groin can be worrying. Many people feel anxious about fertility, sexual function or what the pain might mean. These feelings are normal, and most causes of scrotal pain do not affect fertility. If worry is affecting your sleep, mood or daily life, it is worth telling your doctor. If you ever feel overwhelmed or in crisis, contact your local mental health crisis service or your local emergency number straight away — you deserve support.

Prevention

You cannot prevent every case, but you can lower your risk. Treating infections early, practising safer sex, keeping the groin clean, and following your surgeon's advice after groin surgery all help. Promptly checking any new groin pain means problems are picked up while they are easier to treat.

Vaccines

There is no vaccine for funiculitis itself. Routine vaccines offered in your country, such as the HPV vaccine where available, help prevent some sexually transmitted infections that can lead to inflammation in this area.

Screening programmes

There is no screening test for funiculitis. Regular sexual health checks, especially after a new partner or if you have no symptoms but are at risk, can catch infections early. If you have repeated urinary infections or prostate trouble, regular review with your doctor is worthwhile.

Complications

If left untreated

• An abscess forming in the scrotum, which may need draining
• The infection spreading to the testicle or further into the body
• Long-lasting groin or scrotal pain
• Scarring that can, in rare cases, affect fertility
• Reduced blood flow to the testicle in severe cases
• A missed twisted testicle, which is serious if not treated quickly

Long-term outlook

The outlook is good for most people. Once the cause is found and treated, funiculitis usually settles without lasting problems, and many people recover fully within a couple of weeks. Some people have discomfort that lingers a little longer, and a small number get repeat episodes. Seeing your doctor early and finishing treatment gives you the best chance of a smooth recovery.

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