Most men probably couldn’t tell you where their epididymides are, but they may become uncomfortably aware of this bit of anatomy when they develop a painful condition called epididymitis—inflammation of coiled microscopic tubes that lie at the back of each testicle, inside the scrotum. Each tube, or epididymis, stores sperm as it matures and then transports it to its next destination in the male reproductive tract. In older men, it’s most commonly caused by prostate problems, infections in the bladder or kidneys that spread to the epididymis, or a sexually transmitted infection (STI). (See sidebar.)

If you have swelling and pain at the back of one of your testicles, it’s important to see a doctor to get a definite diagnosis and the fastest possible relief. Here are a few things to know.

Getting a diagnosis

A typical man with pain and swelling in his scrotum doesn’t show up at a doctor’s office saying, “I think I have epididymitis.” The doctor won’t immediately jump to that conclusion either. That’s because such symptoms can have many different causes and the exact location of the discomfort can be hard to pinpoint:

Sudden, severe pain in the scrotum could be caused by testicular torsion, a twisted testicle that can quickly lose its blood supply. Delayed treatment can lead to loss of the testicle.

Pain and a lump in a testicle might raise concerns about testicular cancer, but most testicular cancers don’t cause pain.

Men who have recently had vasectomies often develop a feeling of fullness or congestion in the testes and epididymides, but this usually is temporary, not painful, and does not involve inflammation.

The doctor will strongly consider epididymitis if pain and swelling radiating from the back of one testicle have developed over the course of a few days. The testicle itself may or may not be swollen. A man with suspected epididymitis also might have a fever, painful urination, or other urinary symptoms, such as needing to urinate frequently or having trouble getting a stream of urine started. Some will also have discharge from the urethra.

If you have possible symptoms of epididymitis, expect your health-care provider to conduct a physical exam that will include checking to see if the area around the epididymis is swollen and tender to the touch. You should also expect a digital rectal exam, in which the doctor inserts a lubricated gloved finger in the rectum to check the prostate.

Different treatments for different causes

The exam and initial tests usually give the doctor a good idea of what’s causing the epididymitis. If a bacterial infection seems likely, the doctor may prescribe antibiotics right away while awaiting results to confirm the infection. You might be asked to take antibiotic pills for as long as two to four weeks, longer than is usual for many common infections. That’s because the medication can take some extra time to work on hard-to-reach tissues.

If the doctor sees no clear signs of infection, you might start your treatment with anti-inflammatory medications, such as ibuprofen or naproxen. Those should help soothe inflamed tissues and relieve pain. You also might be advised to rest with your scrotum raised and to apply ice to the area for short periods. If those treatments don’t work, the doctor may prescribe an antibiotic after all, in case a hidden infection is at work.

If an enlarged prostate is thought to be the underlying cause of the epididymitis, treatment of that problem will also be part of the plan.

Treating chronic epididymitis

While most men get better after a few weeks of treatment, others develop chronic or recurring pain. When symptoms persist for more than three months, your doctor may suggest a test called a diagnostic spermatic cord block. In this test, a doctor injects a local anesthetic into the spermatic cord, the bundle of nerves, ducts, and blood vessels that connects the testicles to the abdominal cavity. If the numbing medicine does not stop the pain, it’s likely that the epididymis is not the source after all. The medical team will then look for other possible causes that might range from a pinched nerve in your back to a kidney stone.

If the cord block does temporarily relieve your pain and nothing else is working, your doctor might offer you a surgery called microscopic denervation of the spermatic cord. In that procedure, a surgeon makes a small incision and uses a microscope to locate and permanently cut the nerves causing the pain. Another surgical option is the removal of the epididymis. Like any surgery, these procedures carry small risks of infection and other complications, so they should be considered only as last resorts after less invasive treatments have failed.

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