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Epididymitis – the cost of genital hygiene failure

Epididymitis – the cost of genital hygiene failure

If the cause is a sexually transmitted infection, the sexual partner should also be tested and treated for infection


While overall personal hygiene is a must for healthy living, genital hygiene is one of the areas of humans that should not be ignored.

Across gender, everyone should practice cleanliness in every environment possible. The recent black swan event of Covid-19 has only increased our focus on personal hygiene and sanitation, including while attending to nature’s call.

Restrooms are one of the areas housing the highest number of germs and bacteria. The risk of contracting infections too often lingers, including urinary tract infections among others.


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“Epididymis is a small organ sitting above the testes. You can imagine the testes as the factory. The epididymis is the storage area and connects and transports the sperms. Any infection to the epididymis is called epididymitis and there are two possibilities of getting infected — in a retrograde fashion (for example, if the main road is blocked, you turn your vehicle into a side road) or through the bloodstream due to tuberculosis,” said Dr Mohan Keshav Murthy, director of urology, uro-oncology, andrology, transplant and robotic surgery, Fortis Hospitals, Bengaluru.

Under the condition of having epididymitis, the tube or epididymis behind the testicles becomes swollen and painful. If the testicles are inflamed, it’s called epididymo-orchitis.

“The tube is a very fine and convoluted one. The size of the tube is 0.3 to 0.5mm, which is very small,” said Bengaluru-based Dr Dilip C Dhanpal, a urologist with over four decades of practice.

How does epididymitis occur?

As per a 2009 study by Thomas H Trojian, Timothy S Lishnak and Diana Heiman, published by the US-based National Library of Medicine, “Epididymitis and orchitis are commonly seen in the outpatient setting. Men between 14 and 35 years of age are most often affected.”

The problem persists in the age group beyond 35 years as well, but the primary cause differs as men age.

A recent paper published in MSD Manual by Patrick J. Shenot, managing director, Thomas Jefferson University Hospital, Philadelphia, said that in those below 35 years, maximum cases are due to sexually transmitted pathogen, as compared to urologic abnormalities, catheter-related or due to urologic procedure or mumps or tuberculosis in men above 35 years.

If the cause is a sexually transmitted infection, the sexual partner should be tested and treated for infection as well. Experts in India say in the recent past, there haven’t been as many cases as there used to be earlier. This is primarily due to the spread of awareness. With an increasing number of people using protection during sexual acts, cases too have gone down drastically.

Diabetes is also one of the risk factors for epididymitis.

“Among those affected by diabetes, urinary tract infection is very common, due to high sugar content in their urine. Diabetes is also known to infect other parts of the body, including the epididymis,” said Dr Kiran KV, chief radiologist, Sagar Hospitals, Bengaluru.

Symptoms of epididymitis

Depending on the severity of epididymitis, the following symptoms are looked for during diagnosis, according to the Mayo Clinic.

  • A swollen, red, or warm scrotum
  • Testicle pain and tenderness, usually on one side, that usually comes on gradually
  • Painful urination or an urgent or frequent need to urinate
  • Discharge from the penis
  • Pain or discomfort in the lower abdomen or pelvic area
  • Blood in the semen
  • Less commonly, fever

In cases where epididymitis is severe or chronic, it will last for more than six months. Sometimes the cause of chronic epididymitis isn’t identified.

Effects on health

Dr Kiran said if there is a formation of pus or abscess it means it is developing into severe epididymitis. If the condition is ignored and left untreated, it will certainly worsen and complicate the problem in and around the genitalia.

The long-term effects of epididymitis include the development of persistent chronic epididymitis, inflammation not healing easily, recurrence, testicles getting highly infected, abscess accumulation inside epididymis which damages it and the testicles resulting in infertility, blocking sperm movement from testicles into the epididymis, shrinkage of testicles with possibly death of testicular tissue and chances of infection spreading from scrotum to other parts of the body, according to a paper published on Epainassist by Florida-based anesthesiologist and pain management specialist Dr Pramod Kerkar.


Experts recommend always maintaining hygienic practices.

Another preventive approach is not opting for unprotected sexual contact, as the infection will spread in the backward direction, affecting the epididymis. This is particularly possible if the partner has urinary tract infection.

Also, those with high sugar levels should ensure they don’t go beyond normal levels routinely.


“The correct way to go about it is to check for a good clinical history followed by a thorough physical examination of the affected part, and then a urine routine, if it is a case of epididymo-orchitis, to locate the kind of organism that is causing the infection. Also, a urine culture test to know which antibiotic to use for treatment and an ultrasound doppler of the scrotum to make sure that something else is not masquerading as epididymitis. Along with this, if it is only an epididymitis, you might do a urine analysis,” said Dr Mohan.

Dr Kiran said an ultrasound scan is also done to diagnose the extent of the infection and how swollen the epididymis is. In ultrasound, the increased blood supply in the affected area can be seen. Before treatment commences, an ultrasound report is always sought to ascertain the line of treatment or which level of antibiotics is to be prescribed.

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