When It Really Hurts Down There-Epididymitis

When men experience a painful testicle, it can be frightening and a source of not only pain but anxiety as most men associate the testicles with pleasure and reproduction. This article will discuss a common cause of pain in the scrotum and what treatment options are available.
Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Pain and swelling are the most common signs and symptoms of epididymitis. Epididymitis is most common in men between the ages of 14 and 35.
Epididymitis is most often caused by a bacterial infection or by a sexually transmitted disease (STD), such as gonorrhea or chlamydia. In some cases, the testicle also may become inflamed.
Epididymitis symptoms include: Testicle pain and tenderness, usually on one side, painful urination, painful intercourse or ejaculation, chills and fever, a lump on the testicle, discharge from the penis especially if the cause is from a STD, and discoloration of the semen.

Location of the epididymis

Location of Epididymis On Top and Behind the Testicle

Causes
Epididymitis has a number of causes, including: STDs, particularly gonorrhea and chlamydia, are the most common cause of epididymitis in young, sexually active men. Boys, older men and homosexual men are more likely to have epididymitis caused by a nonsexually transmitted bacterial infection. For men and boys who’ve had urinary tract infections or prostate infections, bacteria may spread from the infected site to the epididymis. Rarely, epididymitis is caused by a fungal infection. Epididymitis may be caused by urine going backward into the epididymis. This is called chemical epididymitis and may occur with heavy lifting or straining.

Diagnosis
Your doctor will do a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.
Other tests your doctor might order include: STD testing. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.
Ultrasound imaging is a noninvasive test, which uses high-frequency sound waves to create images of structures inside your body and is used to rule out conditions, such as twisting of the spermatic cord (testicular torsion) or a testicular tumor. Your doctor may use this test if your symptoms began with sudden, severe pain.
A nuclear scan of the testicles is also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.

Treatment
Epididymitis caused by a sexually transmitted infection (STI) or other infection is treated with antibiotic medications. If you have significant pain, you will probably receive an anti-inflammatory medication. Your sexual partner will also need treatment.
When you’ve finished your medication, it’s a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up. If it hasn’t, your doctor may try another antibiotic. If the infection still doesn’t clear, your doctor may do further tests to determine whether your epididymitis is caused by something other than a bacterial infection or an STD.

To ease your symptoms, try these suggestions: Bed rest-depending on the severity of your discomfort, you may want to stay in bed one or two days. Mild relief will occur if you place a folded towel under your scrotum. Wear an athletic supporter or jockey underwear. A supporter provides better support than boxers do for the scrotum. Apply cold packs to your scrotum. Wrap the pack in a thin towel and remove the cold pack every 30 minutes. Don’t have sex until your infection has cleared up. Ask your doctor when you can have sex again.

Bottom Line: Epididymitis is a common cause of scrotal pain. Epididymitis is usually a result of an infection and can be successfully treated with antibiotics. See your doctor whenever you have scrotal pain or you find a lump or bump in your scrotum.

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