The epididymus is a hollow tube located at the back of the testicles through which semen passes. In some cases, this tube can become irritated and inflamed causing a condition called epididymitis. This inflammation can result in extreme pain in the scrotum, and it may be misdiagnosed as a testicular torsion. Treatments for the two conditions are quite different, so appropriate diagnosis is necessary to determine appropriate care.
Some other conditions may also result in pain in this region. Medical professionals evaluating patients for epididymitis will usually wish to rule out testicular cancer, the presence of benign cysts, and hernias. Regular testicular self-examination may make diagnosis easier, since men are likely to notice the presence of cysts or lumps on the testicles.
Usually, this inflammation is caused by a bacterial infection. Most commonly, urinary tract infections may result in spread of bacteria to the epididymus. Other causes of this condition include the sexually transmitted diseases gonorrhea and chlamydia. When someone sees a medical professional for this problem, it is important to disclose recent sexual history, particularly where safer sex has not been practiced or when the person has had multiple sexual partners.
Since the usual cause is bacterial, treatment almost always includes antibiotics. Men may also be asked to use cold compresses on the scrotum and elevate the pelvis to reduce swelling. Patients are usually seen again by a healthcare professional after antibiotic treatment to be certain that the swelling is no longer present.
In some cases, pain becomes very severe and may extend to pain in the lower abdomen. When epididymitis is not caused by infection but is caused by conditions that cause nerves to swell, treatment may be more complex and difficult. Some cases may require the use of injected steroids to quickly bring down significant swelling.
On some occasions, patients might require hospitalization to administer a pain-blocking agent, which can offer long-term pain relief. This medication is called a cord block and can often prevent the person from feeling pain for a couple of months, usually long enough for the condition to clear. Sometimes, oral pain medications like codeine or hydrocodone are effective in pain relief as well. Anti-inflammatories like ibuprofen may often be helpful in the temporary relief of symptoms.
Those affected with bacterial epididymitis usually do not have recurrence of symptoms, unless they have another causal bacterial infection. Those with non-infectious cases may find that the condition can recur. Though this condition can often be cured completely, some find that it remains acute and opt to have the epididymus removed. This is usually a method of last resort, since it results in infertility. For some men, however, the sacrifice is well worth the resulting relief from pain.