7 Common Epididymitis Symptoms You Should Never Ignore

Epididymitis is an inflammation of the epididymis, a coiled tube located at the back of the testicle that stores and carries sperm. This condition typically affects men between the ages of 14 and 35, though it can occur at any age. Understanding the symptoms of epididymitis is crucial for early detection and prompt medical intervention, as untreated cases can lead to serious complications including chronic pain, abscess formation, or fertility issues.

The condition usually develops gradually over several days, though acute cases can manifest more rapidly. Epididymitis can be caused by bacterial infections, sexually transmitted infections, or non-infectious factors. Recognizing the warning signs early can help you seek appropriate medical care and prevent long-term complications.

1. Testicular Pain and Tenderness

The most prominent symptom of epididymitis is pain in one testicle, which typically starts gradually and worsens over time. The pain usually begins in the lower abdomen or groin area and then localizes to the affected testicle.

Characteristics of the pain:

• Usually affects only one testicle, though bilateral cases can occur
• Ranges from mild discomfort to severe, debilitating pain
• May worsen during bowel movements, physical activity, or ejaculation
• Often intensifies when standing or walking
• The affected testicle becomes extremely tender to touch

The pain typically develops over several hours to a few days and may radiate to the lower abdomen, pelvis, or groin. Some men describe the sensation as a constant ache or pressure, while others experience sharp, stabbing pain. The discomfort may be relieved slightly when lying down or supporting the scrotum.

2. Scrotal Swelling and Enlargement

Swelling of the scrotum is a hallmark symptom of epididymitis and occurs as the body’s inflammatory response to infection or irritation. The swelling typically affects the side where the epididymis is inflamed.

The affected side of the scrotum may become noticeably larger than the other side, and the skin may appear stretched or shiny. In some cases, the entire scrotum swells, making it difficult to distinguish between the two testicles. The swelling develops gradually over several days and may be accompanied by a feeling of heaviness or fullness in the scrotum.

Key observations:

• The epididymis itself becomes enlarged and can be felt as a swollen, tender area behind the testicle
• The testicle on the affected side may also appear larger
• Swelling may extend to the surrounding scrotal tissue
• The scrotum may feel warm or hot to the touch due to inflammation

3. Redness and Warmth of the Scrotum

As inflammation progresses, the scrotal skin often becomes red, warm, and may feel hot to the touch. This symptom indicates an active inflammatory process and is particularly common in acute bacterial epididymitis.

The redness typically appears on the affected side of the scrotum and may range from a light pink to a deep red color. The warmth results from increased blood flow to the area as the immune system responds to the infection or inflammation. Some men notice that the affected area feels significantly warmer than the other side when touching both testicles simultaneously.

The combination of redness, warmth, and swelling creates what medical professionals call the “inflammatory triad,” which strongly suggests an infectious or inflammatory process requiring medical attention.

4. Painful or Burning Urination

Many men with epididymitis experience discomfort during urination, particularly when the condition is caused by a bacterial infection or sexually transmitted infection that also affects the urethra.

Urinary symptoms may include:

• Burning sensation while urinating (dysuria)
• Pain or discomfort that worsens at the beginning or end of urination
• Feeling of incomplete bladder emptying
• Increased urgency to urinate
• More frequent urination than usual
• Discomfort in the urethra or penis during urination

These urinary symptoms occur because the infection causing epididymitis often originates in the urinary tract or urethra and spreads to the epididymis through the vas deferens. If you notice blood in your urine along with these symptoms, seek immediate medical attention.

5. Abnormal Penile Discharge

When epididymitis is caused by a sexually transmitted infection such as chlamydia or gonorrhea, abnormal discharge from the penis is a common accompanying symptom.

The discharge may vary in appearance depending on the causative organism. It can be clear, white, yellow, or greenish in color, and may have a thick or thin consistency. Some men notice the discharge only in the morning or after prolonged periods without urination, while others experience continuous discharge throughout the day.

The presence of penile discharge along with testicular pain strongly suggests that a sexually transmitted infection is the underlying cause. This symptom requires prompt medical evaluation and testing to identify the specific pathogen and prevent transmission to sexual partners.

6. Fever and Chills

Systemic symptoms such as fever and chills indicate that the body is fighting an infection and are more common in acute bacterial epididymitis.

The fever associated with epididymitis typically ranges from low-grade (99-100°F or 37.2-37.8°C) to moderate (101-102°F or 38.3-38.9°C), though higher fevers can occur in severe cases. The fever may be accompanied by:

• Chills and shivering
• General feeling of being unwell (malaise)
• Body aches
• Fatigue and weakness
• Night sweats

The presence of fever indicates that the infection may be more serious and requires immediate medical attention. High fever combined with severe testicular pain could indicate complications such as abscess formation or testicular torsion, which are medical emergencies.

7. Groin and Lower Abdominal Pain

Pain is not always confined to the testicle itself. Many men with epididymitis experience pain that radiates to other areas of the lower body.

The referred pain occurs because the nerves supplying the testicles, groin, and lower abdomen are interconnected. The discomfort may manifest as:

• Dull aching in the groin area on the affected side
• Lower abdominal pain or cramping
• Pain in the lower back or flank area
• Discomfort in the pelvic region
• Pain that radiates down the inner thigh

This radiating pain can sometimes make it difficult to pinpoint the exact source of discomfort, which is why some men initially mistake epididymitis for a hernia, kidney stone, or muscle strain. The key distinguishing feature is that the pain worsens when the testicle is touched or moved, and there is usually visible swelling or tenderness in the scrotum.

Main Causes of Epididymitis

Understanding the causes of epididymitis can help in prevention and early identification. The condition can result from various factors:

Sexually Transmitted Infections (STIs):

In sexually active men under 35, STIs are the most common cause of epididymitis. Chlamydia trachomatis and Neisseria gonorrhoeae are the primary culprits. These bacteria are transmitted through unprotected sexual contact and first infect the urethra before spreading to the epididymis.

Bacterial Infections:

In men over 35, children, and those who engage in anal intercourse, bacterial infections from urinary tract organisms are more common causes. Escherichia coli (E. coli) and other intestinal bacteria can travel from the bladder or prostate to the epididymis. Urinary tract infections, prostate infections, and urethral infections can all lead to epididymitis.

Urinary Reflux:

Sometimes urine flows backward into the epididymis, causing chemical inflammation even without bacterial infection. This can occur due to heavy lifting, straining, or increased abdominal pressure when the bladder is full.

Tuberculosis:

In regions where tuberculosis is prevalent, the bacteria Mycobacterium tuberculosis can cause chronic epididymitis. This form develops slowly and may not present with acute symptoms.

Trauma or Injury:

Physical trauma to the groin or scrotum from sports injuries, accidents, or medical procedures can cause inflammation of the epididymis without infection.

Medications:

Certain medications, particularly amiodarone (a heart rhythm medication), can cause drug-induced epididymitis as a side effect.

Other Risk Factors:

• Recent urinary tract surgery or catheter insertion
• Anatomical abnormalities of the urinary tract
• Enlarged prostate gland
• Uncircumcised status in prepubertal boys
• Vigorous physical activity
• Prolonged sitting (such as bicycle riding)

Prevention Strategies

While not all cases of epididymitis can be prevented, several measures can significantly reduce your risk of developing this condition:

Practice Safe Sexual Behavior:

Since STIs are a leading cause of epididymitis in younger men, practicing safe sex is crucial. Use condoms consistently and correctly during all sexual encounters, limit your number of sexual partners, and ensure you and your partner are tested regularly for STIs. Open communication with partners about sexual health is essential for prevention.

Maintain Good Urinary and Genital Hygiene:

• Urinate regularly and completely empty your bladder
• Drink adequate water throughout the day to help flush bacteria from the urinary tract
• Clean the genital area daily with mild soap and water
• Urinate after sexual activity to help clear any bacteria from the urethra
• Wipe from front to back after bowel movements to prevent bacterial spread

Avoid Straining and Heavy Lifting:

When your bladder is full, avoid heavy lifting or strenuous activities that increase abdominal pressure, as this can cause urine to reflux into the epididymis. If you must lift heavy objects, empty your bladder first and use proper lifting techniques.

Seek Prompt Treatment for Urinary Issues:

Don’t ignore symptoms of urinary tract infections or prostate problems. Painful urination, frequent urination, or difficulty urinating should be evaluated by a healthcare provider promptly. Early treatment of these conditions can prevent them from spreading to the epididymis.

Protect Against Injury:

Wear appropriate protective equipment during sports and physical activities that pose a risk of groin injury. Athletic supporters or protective cups can help prevent trauma to the testicles and epididymis.

Consider Mumps Vaccination:

While rare in vaccinated populations, mumps can cause epididymitis. Ensure you’re up to date with MMR (measles, mumps, rubella) vaccination.

Frequently Asked Questions

How long do epididymitis symptoms last?

With appropriate medical treatment, symptoms typically improve within 48-72 hours, though complete resolution may take several weeks. Acute epididymitis generally resolves within 6 weeks, while chronic cases may persist for longer than 6 weeks. Without treatment, symptoms can worsen and lead to complications.

Can epididymitis go away on its own?

While mild cases caused by non-infectious factors may improve on their own, bacterial epididymitis requires medical treatment with appropriate antibiotics. Attempting to wait out the condition without medical care risks serious complications including chronic pain, abscess formation, and potential fertility problems.

Is epididymitis contagious?

Epididymitis itself is not contagious, but if it’s caused by a sexually transmitted infection, the underlying STI can be transmitted to sexual partners. It’s important to inform partners and abstain from sexual activity until you’ve completed treatment and been cleared by your healthcare provider.

Can epididymitis affect fertility?

In most cases, properly treated epididymitis does not affect fertility. However, severe, untreated, or recurrent cases can potentially cause scarring that blocks sperm passage, leading to reduced fertility. Bilateral epididymitis (affecting both sides) poses a higher risk to fertility than unilateral cases.

How is epididymitis different from testicular torsion?

Testicular torsion occurs when the testicle twists on its spermatic cord, cutting off blood supply. It causes sudden, severe pain and is a medical emergency requiring surgery within hours. Epididymitis typically develops more gradually over days. However, distinguishing between the two can be difficult, so any acute testicular pain should be evaluated immediately.

When should I see a doctor for testicular pain?

Seek medical attention promptly if you experience testicular pain accompanied by swelling, redness, fever, or discharge. Immediate emergency care is needed for sudden, severe testicular pain, as this could indicate testicular torsion. Even mild testicular pain lasting more than a few days warrants medical evaluation.

Can young boys get epididymitis?

Yes, though it’s less common, prepubertal boys can develop epididymitis. In children, it’s usually caused by urinary tract bacteria, congenital urinary abnormalities, or viral infections rather than STIs. Any scrotal pain or swelling in a child should be evaluated by a pediatrician or pediatric urologist.

Will I need to be hospitalized for epididymitis?

Most cases of epididymitis can be treated on an outpatient basis with oral medications and supportive care. Hospitalization may be necessary for severe cases with high fever, inability to tolerate oral medications, suspected abscess formation, or when outpatient treatment has failed. Immunocompromised patients may also require inpatient care.

References:

• Mayo Clinic – Epididymitis
• NHS – Epididymitis
• American Urological Association – Epididymitis
• CDC – Epididymitis Treatment Guidelines
• Healthdirect Australia – Epididymitis