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The Facts About Epididymitis

Find out how epididymitis affects your sexual health.

A doctor expressively speaks with a man in a folding chair.

Epididymitis is a condition in which the epididymis, a part of the male reproductive system, becomes inflamed. It's a condition that affects some 600,000 men in the United States every year.

To explain what epididymitis is, though, it's best to begin by explaining what the epididymis is.

What is epididymitis and what is the epididymis?

Most people know that in the male reproductive system, the testicles, located inside the man's scrotum, are what produce sperm. However, sperm's journey from the testicle to being ejaculated is a long and winding one. The sperm cells' course takes them from the testicle through the epididymis, a 20-foot-long coiled tube that is attached to the back of each testicle.

When the spermatozoa leave the testicle and enter the head of the epididymis, they aren't yet able to swim because they haven't fully matured. Over the course of 10 to 15 days, the sperm cells travel the length of the epididymis and mature along the way before finally exiting into the vas deferens during sexual arousal in anticipation of ejaculation.

Epididymitis, then, is the condition that occurs when the epididymis becomes inflamed, typically due to a bacterial infection.

What are the causes of epididymitis?

The most frequent cause of epididymitis is a bacterial infection, usually one that begins in the urethra, the prostate gland or the bladder. The most frequently affected demographic group is younger men ages 19 to 35. In that group, the most common inciting infections are chlamydia and gonorrhea.

However, it's also important to note that a urinary tract infection that isn't caused by a sexually transmitted infection (STI) is another possible root cause of epididymitis.

Whatever the original cause of the infection, when these bacteria infect the penis and the urethra, they can sometimes travel up the urinary tract and infect other parts of the man's reproductive system, including the epididymis.

Epididymitis can also affect children and older men who aren't sexually active, but those cases are typically caused by an E. coli infection. A few other bacteria can rarely cause epididymitis, including the mumps bacteria, the tuberculosis bacteria and a bacteria called ureaplasma.

Another cause of epididymitis is when urine flows backward into the epididymis as a result of straining or heavy lifting. A few other causes include the following:

  • A blockage in the urethra
  • Enlargement or infection of the prostate gland
  • Having recently used a catheter
  • Prostate, urethral or bladder surgery
  • A groin injury

A medication called amiodarone, used to prevent heart arrhythmia, can also cause epididymitis.

What are the symptoms of epididymitis?

The early symptoms of epididymitis usually present as pain or swelling in the testicle or scrotum. Other symptoms may include the following:

  • Pain that radiates from the scrotum to other parts of the groin and pelvis
  • Redness and swelling in the testicle and scrotum
  • Blood in the semen (aka hematospermia)
  • Discharge from the penis
  • Chills or fever
  • Painful urination (aka dysuria)
  • A lump near the testicle
  • Visible swelling of the epididymis
  • Pain during ejaculation
  • Pain while urinating

How is epididymitis diagnosed?

Diagnosing epididymitis usually begins with an examination of the scrotum to see if there is a painful spot or a lump. There may be redness or swelling, and a healthcare provider will ask if you feel pain or discomfort when the scrotum is touched.

You will also probably be asked to give a urine sample for analysis, as this is how a bacterial infection can be identified.

In some cases, a healthcare provider may order an ultrasound to be certain there aren't any other potential causes of the discomfort. This is especially true in adolescents and younger boys, as a relatively common condition called testicular torsion can sometimes be difficult to differentiate from epididymitis.

It's crucial that the healthcare provider makes sure it's only epididymitis because testicular torsion is an emergency condition that requires immediate surgery to repair or the patient runs the risk of losing the testicle. The ultrasound scan allows them to see if the testicle isn't getting proper blood flow to it, an indication of testicular torsion.

Management and treatment of epididymitis

Because epididymitis is most commonly caused by a bacterial infection, antibiotics are the first-line treatment. The antibiotic treatment cycle usually takes seven to 14 days, and it's important to take all the medication—even if your symptoms dissipate—to ensure the infection is cleared out.

Some of the most commonly prescribed antibiotics for epididymitis include:

  • Doxycycline
  • Ciprofloxacin
  • Levofloxacin
  • Trimethoprim-sulfamethoxazole

While waiting for the antibiotics to do their work and clear the infection, people experiencing epididymitis can help to relieve their symptoms in the following ways:

  • Rest
  • Elevate the scrotum
  • Ice the area (20 minutes on, 20 minutes off)
  • Stay hydrated
  • Take NSAIDs, such as ibuprofen

Prevention of epididymitis

One of the best ways to prevent epididymitis is to practice safe sex. Using a condom during anal sex, even in a partnered relationship, is also important in order to prevent infections that can occur due to contact with fecal matter.

Epididymitis can also be prevented by looking after your general health. Stay hydrated, control your blood sugar if you have diabetes, and don't push or strain when urinating, as this can cause urine to back up into the epididymis.

Avoid straining or heavy lifting whenever possible, reduce extended periods of sitting, and wear compression shorts or supportive underwear when participating in activities such as running or other sports that require lots of movement.

Complications caused by epididymitis

Getting epididymitis treated promptly is very important because it rarely goes away on its own. The symptoms may even subside for a time, but it's unlikely to be fully cleared without antibiotics.

One complication could be an abscess—a pus-filled sac inside your scrotum. These can even develop into what are called fistulae, or openings in the scrotal skin that occur due to swelling and infection.

Some other complications due to untreated epididymitis may include the following:

  • Long-term or chronic epididymitis
  • Death of testicular tissue due to poor blood flow (aka testicular infarction)
  • Infertility

Another complication that could stem from untreated epididymitis is the possibility of infecting sexual partners if it's caused by an STI. Be sure to act accordingly until you've taken your entire cycle of antibiotics and the infection has been fully cleared.

Outlook with epididymitis

Having epididymitis can be painful, but getting diagnosed and treated right away and getting antibiotics on board as soon as possible can relieve some of the symptoms in as little as three days. Ice packs, NSAIDs, staying hydrated to help flush out the bacteria and avoiding strenuous activity during this initial period often help.

The outlook for men who don't get epididymitis treated promptly is very different. It can mean developing chronic epididymitis, abscesses, fistulae, infertility, testicular tissue death and more. Another possible outcome of untreated epididymitis is the bacteria can travel farther into the reproductive organs and urinary tract, infecting the prostate, the bladder or other structures.

If the symptoms do recede with antibiotics but then return sometime later, it's important to see a healthcare provider to rule out other conditions or chronic epididymitis.


What is the main cause of epididymitis?

Epididymitis affects 600,000 men annually in the U.S. The most common underlying cause is an STI, such as chlamydia or gonorrhea. However, other non-STI causes are possible.

Does epididymitis go away on its own?

No. Typically, epididymitis is caused by a bacterial infection and, usually, you can only get rid of it by taking antibiotics.

Is epididymitis only caused by an STI or STD?

No. While epididymitis is most commonly caused by chlamydia or gonorrhea, you can also get it from E. coli, strenuous activity, straining when you pee, groin trauma, catheters, recent surgery, a heart medication called amiodarone, an enlarged prostate gland and other, non-STD urinary tract infections.