Big Ball Series: What You Need to Know About Epididymitis

Andrew Siegel MD  11/10/2018

This is a continuation of the “Big Ball” series of entries, which provide information about common maladies that affect the contents of the scrotum.

The epididymis is a comet-shaped organ located above and behind each testicle. It consists of multiple tiny twisted tubules and is the site where sperm mature, are stored and are transported.  At the time of sexual climax, sperm move from the epididymis into the vas deferens (sperm duct).


A. epididymal head, B. body, C. tail, D. vas deferens (sperm duct)                                             Attribution: By KDS444 [CC BY-SA 3.0 (, from Wikimedia Commons  

Epididymitis is an inflammation, pain, and swelling of the epididymis, a common inflammatory and/or infectious condition seen in men of all ages.  The vast majority of the time it involves only one side.  If left untreated, it can spread to the testicle in which case it is known as epidiymo-orchitis.

Epididymitis can be caused by the spread of infection from the prostate, bladder or urethra. The most common cause in young, sexually-active men is from organisms that cause urethritis, an infection or inflammation of the channel that conducts urine through the penis. This is often due to a non-bacterial organism such as chlamydia. In older men, bacterial infection caused by an obstruction in the lower urinary tract is a common cause of epididymitis.  In this older population, typical microorganisms are pathogens that normally reside in the colon such as E.Coli. In about 5% of cases, epididymitis is viral in origin, often from the spread of a viral upper respiratory tract infection.  Epididymitis can be an inflammatory as opposed to an infectious process, with no infecting organisms responsible.  For uncertain reasons, epididymitis is more commonly seen in men who do weight training or are employed in occupations that require heavy lifting.  On occasion it can be induced by certain medications, e.g., amiodarone.

Acute epididymitis can vary greatly in severity, ranging from mild to severe. Mild epididymitis causes a low-grade discomfort, swelling, and tenderness of the epididymis. In moderate epididymitis, the extent of pain, swelling, discomfort, and tenderness are appreciably increased.  In severe epididymitis, the epididymis often cannot be differentiated from the testes on exam because of the extensive infectious/inflammatory process and it is common to have fever, chills, malaise and other systemic symptoms.  The entire scrotum can be swollen and red, its contents hard, irregular and exquisitely tender.

Scrotal ultrasonography is extremely helpful to ensure making the proper diagnosis and to rule out an abscess or infarction (tissue death) that might require surgical intervention.  In acute epididymitis, the ultrasound often reveals epididymal enlargement and increased blood flow because of the inflammatory process.  Ultrasound is essential in severe epididymitis, persistent infection, or when physical exam is hampered from pain, scrotal wall inflammation or a reactive hydrocele (a collection of fluid surrounding the testes). Ultrasound can distinguish epididymitis from other processes including a twisted testes or twisted appendix testes, testes cancer, groin hernia, varicocele, trauma and scrotal abscess. In years preceding the ready availability of ultrasound it was not uncommon to have to perform scrotal surgical exploration to sort out the problem.  Urinalysis and urine culture are useful to help identify a specific bacterial source and to guide the choice of antibiotic.  Sexual transmitted infection testing is important when appropriate.

The treatment of acute epididymitis is directed at the specific organism responsible. In young men, this is often a course of a tetracycline-derivative antibiotic such as Doxycycline in conjunction with activity restriction, scrotal elevation and anti-inflammatory medication. Supportive jockey shorts are particularly useful to help elevate and immobilize the testes. Locally applied heat can be beneficial as well. In older men, an antibiotic directed at the likely source, the colonic bacteria, is appropriate.  Epididymitis may require a prolonged course of antibiotics and several weeks before it normalizes. Occasionally, after resolution, there will be an irregularly firm and sensitive epididymis as a result of scar formation and inflammation. In the case of severe epididymitis, after complete resolution of the infection it is important to undergo urological evaluation to rule out structural abnormalities that could have given rise to the process.

Occasionally, epididymitis can be so severe as to require hospitalization for intravenous antibiotics. Rarely, surgery is necessary to drain an epididymal abscess or remove the epididymis and at times, the infected testicle as well.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor




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One Response to “Big Ball Series: What You Need to Know About Epididymitis”

  1. Big Ball Series: What You Need to Know About Varicoceles | Our Greatest Wealth Is Health Says:

    […] Maximizing our health by promoting wellness; bridging the knowledge gap between physicians and the community. « Big Ball Series: What You Need to Know About Epididymitis […]

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