Definition of Epididymitis

Epididymitis is inflammation or infection of the epididymis. The epididymis a storage structure for newly formed sperm, a hollow structure that runs from the back to the top of the testicle. The epididymis is the structure that links the testicle to the vas deferens, the tube the leads up the scrotum to the prostate.

Men have an epididymis on each side; one for each testicle, and the plural of epididymis is epididymides. 

What Causes Epididymitis

Conventional medicine alleges that 80 percent of epididymitis is caused by infection. It thought that infection goes up the penis and down through the vas deferens until it settles into the epididymis, causing epididymitis. The causative germ is thought to vary with the age of the patient.

Who Gets Epididymitis

Epididymitis is most common in men aged 19 to 35, but can occur at any age.

Incidence

USA studies show the incidence of epididymitis to be less than 1 in 1,000 males per year. Epididymitis is a large problem in the military in some studies, with military men having a high level of hospitalization and treatment of epididymitis.

What are the Symptoms?

Epididymitis causes pain and swelling in the scrotum. Fever may be present. Pain with ejaculation may occur. It may be an acute condition, or a chronic problem.

Epididymitis is Serious

Pain and swelling in the scrotum can be a medical emergency. Men should treat the condition as an emergency and see a physician immediately. Torsion of the testicle, in which the testicle will die if not treated within hours, can mimic epididymitis. In addition, antibiotics are thought to be more likely to cure infectious epididymitis if they are started early in the course of therapy. A percentage of men with epididymitis have urethral discharge, which should be collected and used for culture and other tests for microbes.

Ideally, all men with epididymitis should be tested for prostatitis, with culture of the prostatic fluid and other tests for microbes being performed.

Germs and Other Causes

Males before puberty seldom get epididymitis, but when they do, some sort of anatomical problem is suspected. The common organism associated with epididymitis before puberty is E. coli.

Sexually transmitted organisms are thought to be most often responsible for epididymitis during the peak years of sexual activity from the teenage years to 35 years of age.

Chlamydia trachomatis is often cited as the most common cause of epididymitis in this age group.

Neisseria gonorrhoeae is often cited as the second most common cause of epididymitis is this age group.

After age 35, prostates enlarge and the urinary system is more obstructed than during the teenage years. A shift in the cause of epididymitis may occur, with coliform bacteria predominating. Gram-negative rods such as E. coli become more common again.

It is possible that the germs causing epididymitis are from the prostate, where prostatitis may have set in.

Men with compromised immunity may get epididymitis due to fungus.

It is also possible that epididymitis, regardless of age, is caused by the reflux of urine into the epididymitis, or the reflux of semen backwards into the epididymitis. This may cause a chemical inflammation, or may be a mechanism by which germs get into the epididymis.

Undergoing a urological procedure with instrumentation through the penis can also lead to epididymitis.

Undergoing a vasectomy may be associated with epididymitis.