A Pain in the Testicle

Epidid-a-what? Who can pronounce epididymis, let alone spell it? In fact, few of the men I see even know they have epididymides (two of them). But believe me, once an epididymis acts up, they never forget.

Located on the back of each testicle, the epididymis consists of a tube that might measure 20 feet long uncoiled. Yet the sausage-shaped compact version stretches little more than a half inch across and two inches long. Immature sperm move from the testicle through 12 to 14 tiny tubes into the epididymis, where they grow and develop their swimming ability (we doctors call it motility) for the difficult journey north up the vas deferens to the penis—and beyond. So, in it's own way, the epididymis is as important to fertility as the testicle itself.

Epididymitis—infection or inflammation of the epididymis—strikes most commonly in men between 20 and 40, though older men sometimes develop chronic problems. Symptoms include pain in the scrotum—particularly with ejaculation—fever, and other flu-like symptoms. Epididymitis can take the fun out of life—not to mention sex.

More serious, epididymal problems can lead to abscesses, scarring of the tubes, and infertility. It's the single largest preventable cause of male sterility.

Figuring out where a bout of epididymitis came from isn't always simple. The first thing we look for is a sexually transmitted disease. Chlamydia, for example, probably causes about a third of all cases. Men who lift heavy objects while straining are also prone to the disease, because urine may be forced down the vas deferens to the epididymis during exertion. Less frequently, other bacteria or viruses can settle into the epididymis from the blood stream.

Because of the risk of sterility, prompt treatment is very important. Prescription antibiotics form the front line. But there are also things you can do to help. A jock strap or tight-fitting underwear keeps the scrotum elevated and warm—easing the discomfort and speeding healing. For the first 48 hours, ice packs may help reduce swelling. After that, hot baths may provide relief.

Though most cases clear up under this treatment, some do become chronic. So prevention is your best defense: Practice safe sex and never strain while lifting, and you'll avoid the two most common causes of something you really don't want.


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