Your epididymis is a coiled tube around six metres long, folded neatly against the back of your testicle. Sperm ripen there for a few more weeks after the testicle is done with them. When that tube gets inflamed, it is called epididymitis.
What I find most important about this topic is not what it is, but what it is not.
It is not the condition that puts you on an operating table within six hours. That is the twist. And the difference between the two comes down mostly to the clock.
What is epididymitis?
An inflammation of the epididymis, the tube behind your testicle where sperm mature and are stored. It usually happens when bacteria travel up through your urethra. It causes pain and swelling at the back and top of your testicle, and it builds over days.
According to Thuisarts, the Dutch GP information service, you usually get epididymitis when bacteria reach your epididymis via your urethra.
Sometimes the testicle itself joins in. Doctors then call it epididymo-orchitis, which is a grand word for the same problem having moved slightly further along.
What does an inflamed testicle feel like?
Nagging and heavy, and it gets worse over a few days rather than a few minutes. The pain usually sits at the back and top of your testicle, the area is swollen and feels warm, and the skin may look red. Urinary symptoms, urgency or fever may come with it.
That building course is the most useful feature.
Many men can point reasonably precisely to when it started nagging. With a twist, they can name the minute.
It often eases a little when you support your scrotum or lie down. Thuisarts mentions support with tight underwear as a way to take the edge off the pain.
If you have sudden, severe pain, this piece is not about you. Read testicle pain and call your GP.
What causes epididymitis?
Almost always bacteria, and which bacterium it is depends heavily on your age and your sex life. In younger, sexually active men, chlamydia and gonorrhoea are the most common pathogens. In older men it is more often enteric bacteria travelling up through the urinary tract.
That age split is not trivia. In practice it shapes which treatment makes sense.
A review in American Family Physician sums it up: men between 14 and 35 are most often affected, and chlamydia and Neisseria gonorrhoeae are the most common pathogens in that age group, while in other age groups coliform bacteria are the primary pathogens (PMID 19378875).
| Age and context | Most common pathogens | What often plays a part |
|---|---|---|
| Roughly 14 to 35, sexually active | Chlamydia, gonorrhoea | Often with no prior STI symptoms |
| Older, or after urinary problems | Enteric bacteria (coliforms) | Bladder infection, prostate trouble, catheter |
| After a bladder or prostate infection | Variable | Urinary symptoms came first |
Thuisarts groups three common triggers together: a bladder infection, an inflammation of your prostate, or an STI such as chlamydia or gonorrhoea.
Which means that epididymitis in a young man often brings a conversation about STIs with it. That feels awkward, and it is simply part of working out properly where it came from.
How long does epididymitis last?
The worst symptoms usually settle within a few days to about a week, especially once treatment against bacteria has started. But a heavy, tender feeling in your scrotum can linger for weeks afterwards, and that in itself is not alarming. The swelling fades more slowly than the pain.
That difference in pace surprises almost everyone.
Men call back after three weeks because it is "still not gone", while the infection has long been under control and only the tissue is still settling.
On the other hand: symptoms that get worse after a few days of treatment, or fresh fever, do belong back with your GP. Something then does not fit the picture.
I know the urge to give up after a week and leave the course unfinished. Do not, and talk to your GP if you are unsure.
Can epididymitis harm your fertility?
It can, though it certainly does not always. An inflammation can leave scar tissue in the epididymis, and that may narrow or block the passage for sperm. With a blockage, your hormone values can be entirely normal while few or no sperm end up in your ejaculate.
This is one of the few places where hormones lead you astray.
Production in the testicle carries on, LH and FSH look perfectly fine, and yet the semen analysis does not add up. The problem is not the factory, but the outflow pipe.
Where else things can go wrong on the route from production to transport is set out in male infertility. How your testicles divide their two jobs is in testicles: how they work.
If you have had epididymitis and children are on the agenda, discuss it with your GP. Some men have their FSH and inhibin B read alongside a semen analysis, for instance via the IVF partner screening, to see whether it is a production problem or a plumbing one.
When should you see a doctor straight away?
With sudden, severe pain, especially with nausea, and especially if your testicle now sits higher or at an angle. That can be a twist of the spermatic cord, and that one counts in hours. With pain that came on over days alongside fever or urinary symptoms: see your GP quickly, but there is no need for the out-of-hours service in the middle of the night.
The honest answer is that you cannot make that distinction at home with any certainty.
A doctor can, with their hands and an ultrasound if needed, within minutes. If you are in doubt, just call.
There is no blood test that answers this question for you, and that is a fair remark on a site that sells blood tests. For a painful, swollen scrotum, the doctor is the test.
The bigger picture on having children starts with our guide to male fertility. And if something feels hard and painless rather than warm and swollen, read testicular cancer symptoms.
References
- Trojian TH, et al. Epididymitis and orchitis: an overview. American Family Physician. 2009. PMID 19378875.
- Workowski KA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recommendations and Reports. 2021. PMID 34292926.
- Thuisarts. I have epididymitis. thuisarts.nl
- Thuisarts. Pain in your scrotum: what can it be, what should you do? thuisarts.nl
Every blood test result at Caliber includes a professional assessment by a BIG-registered doctor. For treatment decisions, always discuss your results with your GP.
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