Health Society of South Africa

EPIDIDYMITIS AND ORCHITIS
Common Inflammations in the Scrotum

What are Epididymitis and Orchitis?

Epididymitis is an inflammation of the epididymis. Inflammation is most often caused by bacteria in the urinary tract (a bladder infection) or by bacteria passed between partners during sex. It usually occurs in both tubes, and can be acute or chronic. When the inflammation spreads to a testicle, it is called orchitis.

Acute Inflammation
This comes on quickly. Symptoms include:

Pain and swelling in the scrotum.
An urge to urinate often.
A discharge from the penis.
Pain during ejaculation.
Fever.

Chronic Inflammation
This is most often the late phase of an acute infection. Symptoms may include:

An ache or dull pain in the scrotum, which may spread to the groin.
A heavy feeling in the scrotum.

What Inflammation Does Not Mean
If you have epididymitis or orchitis:
It does not mean you are impotent.
It does not mean you will be infertile once the infection clears up.
It does not mean you have cancer or AIDS.

Evaluation and Treatment

Your doctor diagnoses epididymitis through a physical exam and simple lab tests. Treatment includes medication to get rid of the bacteria. Resting, supporting the scrotum and using ice packs can help relieve your symptoms. If you are sexually active, any partners need to see a doctor as well.

Physical Exam and Tests
During your physical, your doctor examines your testicles for swelling. Your urethra is checked for any discharge, and you will be asked to give a urine sample. The sample is sent to the lab to find out which bacteria are causing the inflammation. Sometimes a blood test is done. If your doctor finds a mass on a testicle or if a testicle feels twisted, an ultrasound may be ordered. This imaging test uses sound waves to create a picture of the inside of your scrotum.

Treatment
Treatment may include one or more of the following:

Antibiotics: Acute epididymitis is most often treated with oral antibiotics. You may also be given an injection of antibiotics. Be sure to take all of your medication.

Anti-inflammatories: Your doctor may prescribe medication to reduce swelling and tenderness.

Rest: You will most likely need to rest for 3 to 4 days, or until the swelling and fever is gone. Lying down with a towel folded under the scrotum can help relieve discomfort.

Scrotum support: If your testicles are swollen, you may want to wear an athletic support (jockstrap) or spandex bicycle shorts. This helps relieve your discomfort until the swelling goes down.

Ice and heat: Putting an ice pack on the scrotum can help reduce any swelling. Once the swelling is gone, sitting in a warm bath increases blood flow to the affected area. This helps to bring more antibiotic to the area and speeds healing.

The Testicle and the Epididymis

The two testicles are the male sex organs that produce sperm and male hormones. The testicles lie inside the scrotum. Behind each testicle is a coiled tube called the epididymis. Sperm mature as they pass from the testicle through the epididymis.

Normal Flow of Sperm and Urine
Sperm travel from the testicle through the epididymis into a tube called the vas deferens. During ejaculation, sperm pass out of the body through the urethra. During urination, urine flows from the bladder out though the urethra.

How Inflammation Starts
The urethra contains bacteria. Bacteria can travel from the urethra into the epididymis. This causes inflammation in the epidiymis. The inflammation can also spread to the testicle. Sometimes infections, such as mumps, start elsewhere in the body and spread to the epididymis.

After Treatment

The inflammation will go away with treatment. But you may have an achy feeling in the testicle for weeks or months. This does not mean the infection has come back. The testicles just take time to heal. If you have a lump in a testicle after treatment, however, you need to see your doctor. Once the inflammation in gone, you should feel like being active again.

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