Epididymitis

Overview

Epididymitis is inflammation of the epididymis, a small coiled tube located at the back of each testicle. The epididymis stores and carries sperm. When it becomes inflamed, it can cause pain, swelling and tenderness in the scrotum. The condition may affect one side or, less commonly, both sides.

Epididymitis can occur at any age after puberty, but the causes may differ depending on a person’s age, sexual activity, urinary health and medical history. In many cases, it is related to an infection, but irritation, urine flow problems or recent procedures involving the urinary tract may also contribute.

Although the symptoms can be uncomfortable and worrying, epididymitis is a recognized urological condition and can often be managed effectively when assessed early. It is important to seek medical evaluation because scrotal pain can have several causes, some of which require urgent care.

Symptoms

Symptoms of epididymitis may develop gradually over one or more days, although some people notice discomfort more suddenly. The symptoms can range from mild to severe.

• Pain or tenderness in one testicle or the surrounding scrotal area
• Swelling, warmth or redness of the scrotum
• A feeling of heaviness in the testicle
• Pain that may spread to the groin or lower abdomen
• Discomfort during urination
• Frequent or urgent need to urinate
• Discharge from the penis in some cases
• Pain during ejaculation in some people
• Fever, chills or general feeling of being unwell
• Blood in the semen, which may occasionally occur

Because symptoms can overlap with other conditions, including testicular torsion, a medical assessment is needed to identify the cause and decide on appropriate care.

Causes and Risk Factors

Epididymitis is commonly caused by infection. In sexually active men, infections transmitted through sexual contact can be a cause. In other cases, bacteria from the urinary tract may spread to the epididymis, especially when there are urinary symptoms or prostate-related issues.

Non-infectious inflammation may also occur. This can be related to urine flowing backward toward the epididymis, injury, heavy physical strain or irritation after certain urinary tract procedures.

Factors that may increase the risk of epididymitis include:

• Recent or recurrent urinary tract infections
• Sexual activity without barrier protection
• History of sexually transmitted infections
• Enlarged prostate or difficulty emptying the bladder
• Recent catheter use or urinary tract instrumentation
• Structural urinary tract problems
• Previous episodes of epididymitis
• Trauma or strain affecting the groin or scrotal area

Risk factors vary from person to person. A urologist may ask about urinary symptoms, sexual history, recent procedures and general health to help understand the likely cause.

Diagnosis

Diagnosis begins with a medical consultation and physical examination. The doctor may examine the scrotum, testicles, groin and abdomen, and may ask about the onset of pain, fever, urinary symptoms, sexual activity and previous medical conditions.

Tests may be recommended to help confirm inflammation and identify possible infection. These may include urine testing, swabs or laboratory tests to check for sexually transmitted infections, and blood tests if there are signs of more widespread infection.

Scrotal ultrasound may be used to assess blood flow to the testicle and to look for other causes of pain or swelling. This is especially important when symptoms are sudden or severe, because testicular torsion must be ruled out quickly. Testicular torsion is a medical emergency and needs urgent treatment.

In some cases, further evaluation of the urinary tract or prostate may be considered, particularly in men with recurrent symptoms, urinary blockage or older age.

Treatment Options

Treatment depends on the suspected cause, symptom severity and overall health. If an infection is likely, a doctor may prescribe appropriate medication based on the type of infection suspected or confirmed by testing. It is important to complete any prescribed treatment as directed by the clinician.

Supportive care may also be recommended to reduce discomfort while recovery takes place. This can include rest, scrotal support and measures to help manage swelling and pain. A healthcare professional can advise what is safe and suitable for the individual patient.

If a sexually transmitted infection is suspected, sexual partners may also need evaluation and treatment to reduce the risk of reinfection and further spread. Patients are usually advised to avoid sexual contact until a clinician confirms it is safe to resume.

When epididymitis is related to urinary tract problems, treatment may also focus on addressing the underlying issue, such as bladder emptying difficulties or prostate-related symptoms. Recurrent or long-lasting epididymitis may require further urological assessment.

Surgery is not commonly needed for epididymitis, but may be considered in rare situations, such as an abscess or complications that do not improve with standard care.

When to See a Doctor

Seek medical care promptly if you have scrotal pain, swelling or tenderness, especially if symptoms are new, worsening or associated with fever or urinary problems. Early assessment helps distinguish epididymitis from other conditions and supports timely treatment.

Emergency medical attention is needed for sudden, severe testicular pain, pain with nausea or vomiting, a high-riding testicle, or rapid swelling. These symptoms may suggest testicular torsion, which requires urgent care.

You should also see a doctor if symptoms return after treatment, do not improve as expected, or if you notice penile discharge, blood in urine or semen, or ongoing urinary difficulties. A urologist can evaluate the cause and recommend the most appropriate next steps.