The third testicle? What is the epididymis?

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  • Whenever there are medical stories on the local stations warning men to do self exams for testicle cancer, office visits to the urologist for a testicular mass increase.
  • What the male perceives to be an abnormality is in actuality the epididymis.
  • On exam it is separate from the testis proper, posterior lateral, movable and linear.
  • If sperm fluid accumulates near the head of the epididymis, a spermatocele, the patient perceives this as a “third testicle.”
  • When a male complains that his “testicle” swollen and tender…the culprit is usually the epididymis and not the testis proper.

From the Mayo Clinic-

Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Males of any age can get epididymitis.

Epididymitis is most often caused by a bacterial infection, including sexually transmitted infections (STIs), such as gonorrhea or chlamydia. Sometimes, a testicle also may become inflamed — a condition called epididymo-orchitis.

Signs and symptoms of epididymitis might include:

  • A swollen, red or warm scrotum
  • Testicle pain and tenderness, usually on one side
  • Painful urination or an urgent or frequent need to urinate
  • Discharge from the penis
  • Painful intercourse or ejaculation
  • A lump on the testicle
  • Enlarged lymph nodes in the groin
  • Pain or discomfort in the lower abdomen or pelvic area
  • Blood in the semen
  • Less commonly, fever

Chronic epididymitis

Epididymitis that lasts longer than six weeks or that recurs is considered chronic. Symptoms of chronic epididymitis might come on gradually. Sometimes the cause of chronic epididymitis is not identified.

When to see a doctor

Never ignore scrotal pain or swelling. Scrotal pain can be caused by a number of conditions, and some of them require immediate treatment to avoid permanent damage.

If scrotal pain is severe, seek emergency treatment. Also see a doctor if you have discharge from your penis or pain when you urinate.

Causes of epididymitis include:

  • STIs. Gonorrhea and chlamydia are the most common causes of epididymitis in young, sexually active men.
  • Other infections. For boys and men who aren’t sexually active, epididymitis can be caused by a nonsexually transmitted bacterial infection. In boys and men with urinary tract or prostate infections, bacteria might spread from the infected site to the epididymis.
  • Amiodarone (Pacerone). This heart medication can cause inflammation of the epididymis.
  • Urine in the epididymis (chemical epididymitis). This condition occurs when urine flows backward into the epididymis, possibly because of heavy lifting or straining.
  • Trauma. A groin injury can cause epididymitis.
  • Tuberculosis. Rarely, epididymitis can be caused by tuberculosis infection.

Certain sexual behaviors that can lead to STIs put you at risk of sexually transmitted epididymitis, including having:

  • Sex with a partner who has an STI
  • Sex without a condom
  • A personal history of STI

Risk factors for nonsexually transmitted epididymitis include:

  • History of prostate or urinary tract infections
  • History of medical procedures that affect the urinary tract, such as insertion of a urinary catheter or scope into the penis
  • An uncircumcised penis or an anatomical abnormality of the urinary tract
  • Prostate enlargement, which increases the risk of bladder infections and epididymitis

Untreated, epididymitis can become chronic. Other complications include:

  • Pus-filled infection (abscess) in the scrotum
  • Epididymo-orchitis, if the condition spreads from your epididymis to your testicle
  • Rarely, reduced fertility

You might be referred to a doctor who specializes in urinary issues (urologist).

What you can do

  • Make a list of your symptoms, including any that might seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of your key medical information, including any history of STI.
  • Make a list of all medications, vitamins or supplements that you’re currently taking.
  • Write down questions to ask your doctor.

Questions to ask your doctor

  • What’s the most likely cause of my symptoms? Are there any other possible causes?
  • What kinds of tests do I need?
  • What treatments are available for epididymitis?
  • How long will it take before I start to feel better?
  • Should my partner be tested or treated for an STI?
  • Are there any restrictions on sexual activity that I need to follow?
  • I have these other medical problems. How can I best treat them together?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them might make time to go over points you want to spend more time on. You might be asked:

  • When did you first begin experiencing symptoms, and how severe are they? Are your symptoms constant or occasional?
  • What, if anything, seems to improve or worsen your symptoms?
  • Do you have discharge from your penis or blood in your semen?
  • Do you have pain when you urinate, or a frequent or urgent need to urinate?
  • Do you have pain during intercourse or when you ejaculate?
  • Have you or has your partner had or been tested for an STI?
  • Does your work or do other physical activities involve heavy lifting?
  • Have you been diagnosed with a prostate condition or urinary tract infection?
  • Have you ever had surgery in or near your urinary tract, or surgery that required the insertion of a catheter?
  • Have you had a groin injury?

What you can do in the meantime

While you wait for your appointment, avoid sexual contact that could put your partner at risk of contracting an STI, including sexual intercourse, oral sex and any skin-to-skin contact with your genitals. Let your sex partner or partners know about your signs and symptoms, so they can also seek testing.

Your doctor is likely to start with a physical exam, to check for enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor might also do a rectal examination to check for prostate enlargement or tenderness.

After that, your doctor might recommend:

  • STI screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the laboratory for gonorrhea and chlamydia.
  • Urine and blood tests. Samples of your urine and blood are analyzed for abnormalities.
  • Ultrasound. This imaging test might be used to rule out testicular torsion. Ultrasound with color Doppler can determine if the blood flow to your testicles is lower than normal — indicating torsion — or higher than normal, which helps confirm the diagnosis of epididymitis.

Antibiotics are needed to treat bacterial epididymitis and epididymo-orchitis. If the cause of the bacterial infection is an STI, your sexual partner also needs treatment. Be sure to take the entire course of antibiotics prescribed by your doctor, even if your symptoms clear up sooner, to ensure that the infection is gone.

It might take several weeks for the tenderness to disappear. Resting, supporting the scrotum with an athletic strap, applying ice packs and taking pain medication can help relieve discomfort.

Your doctor is likely to recommend a follow-up visit to check that the infection has completely cleared up. If it hasn’t, your doctor might prescribe another antibiotic. However, for most people epididymitis clears up within three months.

Recent studies suggest that epididymitis is relatively common in preadolescent boys and might not always need treatment with antibiotics.


If an abscess has formed, you might need surgery to drain it. Sometimes, all or part of the epididymis needs to be removed surgically (epididymectomy). Surgery might also be considered if epididymitis is due to underlying physical abnormalities.

Epididymitis usually involves considerable pain. To ease your discomfort:

  • Rest in bed
  • Lie down so that your scrotum is elevated
  • Apply cold packs to your scrotum as tolerated
  • Wear an athletic supporter
  • Avoid lifting heavy objects
  • Avoid sexual intercourse until your infection has cleared

To help protect against STIs that can cause epididymitis practice safe sex.

If you have recurrent urninary tract infections or other risk factors for epididymitis, your doctor might discuss with you other ways to prevent epididymitis from recurring.


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