Definition This condition describes chronic or long-standing inflammation in the epididymis. The epididymis is a coiled, tubular structure on the back of the testicle.
What is going on in the body? Unlike the sudden form of this condition known as acute epididymitis, chronic epididymitis is not caused by infection. Therefore, antibiotics do not cure it. The exact cause of the inflammation is not usually known. Overly sensitive muscles or nerves may cause it.
What are the signs and symptoms of the condition? Symptoms of the condition include:
pain in the scrotum or testicle. Pain may occur on one or both sides. Pain may be constant or only occasional.
history of unsuccessful treatment of the condition with antibiotics.
What are the causes and risks of the condition? Often, the cause of chronic testicular pain cannot be identified. Therefore it is hard to identify the risk factors. Possible risks include:
repeated bouts of acute epididymitis. This precedes chronic pain in some men. However, the bacteria that cause infection do not remain in the tissue after the acute episode is over.
history of scrotal or groin surgery. This is a factor for many men. The exact cause has not been identified.
anxiety about the condition. This is thought to make symptoms worse.
What can be done to prevent the condition? Because the exact cause is not known, prevention is difficult. Preventing episodes of acute epididymitis may reduce the risk. Acute epididymitis is often sexually transmitted. Abstaining from sex or using condoms during sexual intercourse helps prevent sexually transmitted diseases. Avoidance of scrotal and groin surgery may also reduce the risk of chronic epididymitis. Unfortunately, some men get chronic epididymitis without having these risk factors.
How is the condition diagnosed? The doctor will examine the scrotum carefully. This is to rule out other problems that might be causing the pain. These may include:
an abnormal fluid collection surrounding a testicle, known as a hydrocoele
a collection of abnormally enlarged veins in the scrotum, known as a varicocoele
an abnormal cyst in the epididymis that contains sperm
When examined, the epididymis may be hard and irregular. The tenderness may be located anywhere along the epididymis or testicle. Scrotal ultrasonography, a special x-ray test, is often done to rule out other medical conditions. A careful examination of the area of the body between the scrotum and the anus is often performed. This is to check for nerve damage from groin surgery that may be causing the problem.
What are the long-term effects of the condition? Except for continuing pain, there are no serious long-term effects of chronic epididymitis.
What are the risks to others? Chronic epididymitis is not infectious. It cannot be passed to others.
What are the treatments for the condition? Treatments include:
non-steroidal anti-inflammatory drugs
warm baths once or twice a day. This helps reduce inflammation and increases blood flow to the area.
neuromodulating agents, used to correct abnormal nerve function in the groin area
muscle relaxing agents, to reduce muscle tension in the area between the scrotum and anus
removal of the epididymis. This surgery is performed if scrotal ultrasonography shows cysts in the epididymis. If the ultrasound is normal, this surgery is often not effective.
injections of steroids or local anaesthetics along a nerve. This may be effective if a nerve injury has been identified.
What are the side effects of the treatments? The medications used may cause stomach upset. Rarely, they can cause allergic reactions. Any surgery carries a risk of reaction to anaesthesia, bleeding and infection.
How is the condition monitored? Often, symptoms return a few months after treatment. Chronic testicular pain can be a frustrating problem for the man and his doctor. Often, the pain cannot be well controlled. Tests and examinations can reassure the individual that no serious disease is causing the problem.
Author: Stuart Wolf, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
