Epididymitis
Epididymitis is inflammation of the epididymis, the coiled tube at the back of the testicle that stores and carries sperm. It can cause pain, swelling, and tenderness in the scrotum, sometimes accompanied by fever or urinary symptoms. Prompt diagnosis and treatment, usually with antibiotics or other medical care, can relieve symptoms and prevent complications.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
What is epididymitis?
The testicles (or testes) are two small organs located in the scrotum, responsible for producing sperm and the hormone testosterone. Behind each testicle sits a coiled tube called the epididymis, which stores and transports sperm from the testicle to the sperm-carrying tubes (vas deferens). The epididymis plays a key role in maturing and storing sperm until they are ready to be released during ejaculation.
Epididymitis is inflammation of the epididymis. When the epididymis becomes inflamed, it can cause pain, swelling, and tenderness in the testicle, sometimes accompanied by redness or warmth of the scrotum.
Understanding Epididymitis
Epididymitis is inflammation or infection of the epididymis - the tube at the back of the testicle that stores and carries sperm. Because the epididymis sits directly against the testicle, symptoms often affect the whole area of the scrotum.
Common symptoms include:
- Pain in one testicle, which may start gradually and become more intense over hours or days.
- Swelling or tenderness of the affected epididymis and testicle.
- Warmth or redness of the scrotal skin.
- Pain that spreads to the groin, lower abdomen, or flank.
- Discomfort when passing urine, such as burning, stinging, or needing to urinate more often.
- Discharge from the penis, particularly if the cause is a sexually transmitted infection (STI).
- Fever or feeling generally unwell in more severe cases.
- Pain during ejaculation or blood in the semen (less common)
These symptoms can vary from mild to severe, and in some people the onset is sudden, especially if the testicle becomes involved (a condition called epididymo-orchitis).
Common Causes
Epididymitis occurs when the epididymis becomes inflamed, usually due to infection. The cause can vary depending on age, sexual activity, and underlying health conditions. Common causes include:
| Sexually transmitted infections (STIs) | In sexually active young adults, epididymitis is most often caused by chlamydia or gonorrhoea. |
| Urinary tract infections (UTIs) | Bacteria from the bladder or prostate can travel to the epididymis, especially in older adults. |
| Prostate enlargement (BPH) | This can cause urine to flow backwards (reflux), increasing the risk of infection spreading to the epididymis. |
| Recent urinary procedures | Catheter insertion, cystoscopy, or prostate surgery can introduce bacteria into the urinary tract. |
| Viral infections (less common) | For example, mumps can occasionally cause epididymal inflammation. |
| Non-infectious inflammation | Rarely, epididymitis can be caused by trauma, heavy lifting, or autoimmune conditions. |
Diagnosing Epididymitis
If epididymitis is suspected, a healthcare professional will assess your symptoms, examine the scrotum, and carry out tests to confirm the cause. A proper diagnosis helps ensure the right treatment is given. During this assessment, you can expect:
- Medical history: You’ll be asked about your symptoms, how quickly they started, sexual history, recent infections, urinary problems, or injuries.
- Physical examination: The clinician will gently examine the testicles and epididymis to check for swelling, tenderness, or warmth. They may also assess the abdomen and groin.
Your clinician may also recommend further tests to confirm the diagnosis and check for what might be causing the inflammation. These may include:
| Urine Tests | Your doctor will look for swelling, tenderness, redness, or warmth in the affected arm or leg. |
| STI Tests | If a sexually transmitted infection is suspected, swabs or blood tests may be taken. |
| Ultrasound | A painless scan of the testes and scrotum that helps confirm inflammation of the epididymis and rules out other conditions such as testicular torsion (a surgical emergency). Ultrasound can also detect abscesses or fluid collections. |
Treatment Options
Treatment for epididymitis focuses on relieving symptoms, clearing any underlying infection, and preventing complications. The exact treatment you receive will depend on the suspected cause, your age, and any test results.
| Antibiotics | If the epididymitis is caused by a bacterial infection, antibiotics are the main treatment. The type and duration of the antibiotic will depend on whether the infection is likely to be sexually transmitted or due to urinary or prostate bacteria. It’s important to finish the full course even if symptoms improve. |
| Pain relief and anti-inflammatory medication | Medicines such as ibuprofen or paracetamol can help reduce pain and swelling. Your clinician will advise you on what is suitable for you. |
| Rest and supportive care | Limiting physical activity for a few days can help symptoms settle. Wearing supportive underwear (such as briefs rather than boxers) can reduce discomfort by easing pressure on the testicle. |
| Treatment of underlying conditions | If epididymitis is linked to another issue, such as an enlarged prostate, urinary tract problems, or repeated infections, your clinician may recommend additional treatments to address the root cause. |
Symptoms often start to improve within a few days of treatment, but full recovery can take several weeks. Follow-up may be recommended to ensure the inflammation has resolved, especially if symptoms persist or recur.
How can Lanthorn help?
Testes & Scrotum Ultrasound - only £150
We provide high-quality scrotal ultrasound scans, which are the key imaging test for assessing the epididymis and ruling out other causes of pain, such as testicular torsion, cysts, or tumours. This scan can help confirm the diagnosis or evaluate persistent symptoms.
STI Testing - £TBC
Lanthorn can arrange the tests needed to identify common infectious causes, helping guide the most appropriate treatment.
Onwards referral and follow-up planning
We can provide a clear report of your results and refer you to a GP to ensure you receive the necessary treatment, such as antibiotics or further investigations. If symptoms are severe, persistent, or linked to another underlying condition, we can also arrange referral to a urologist for specialist assessment and management.
