A Day in the Life of the Epididymis

[two-thirds-first]The epididymis has been on my mind recently. The Epi-WHAT-amus? What is that? Well, for one, it’s probably the shortest 5-syllable word you’ve ever heard. And, it happens to be the name of an organ that can spell the difference between being a fertile or infertile guy.
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epididymis is an 18-foot long, tightly coiled, almost microscopic, sperm-filled tubule that could fit into a pen cap. It sits on top of, and wraps behind, the testicle. Sperm pass from the testicle into the epididymis and, over about 12 days, get rubbed, shined and gassed up for the big day.
At the end of this trip, sperm are ready to fly, prepared to meet an egg, anywhere, anytime. However, until ejaculation occurs, some 200 million sperm are kept in check within the epididymis just waiting to be set free.
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Sperm Maturation

Sounds funny, but passage of sperm through the epididymis is a lot like going through puberty. A lot of serious functionality is acquired during this time that prepares sperm for the real world. Here is a short list of what happens to sperm in the epididymis:

  • Improved structural rigidity that helps with motility or movement.
  • Acquire the ability to move purposefully.
  • Learn to “smell” (chemosense) the fluid released during female ovulation. This helps them know where to go once ejaculated.
  • Acquire the ability to fertilize eggs.

The epididymis is also a “filter” that sorts out and destroys sperm that, for some biological reason, do not pass muster. This activity is increased several hundred-fold after a vasectomy when sperm fills the epididymis with nowhere else to go because of the downstream roadblock.
So, much like the inconspicuous, nerdy guy in the back of the class, the epididymis, in its own quiet way, is critical for normal male fertility. Beware though, that it can also be a problem child. Here’s how:

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102 thoughts on “A Day in the Life of the Epididymis

    1. Dear Chyke, I have many patients like you. Read, read and read. Call if you need to talk with us. But always have some hope.

  1. Hi,am from Kenya been reading your blogs and going through your website and i know your the person i need to see.i underwent a hernia operation in 2005 and a few months later i discovered i could not produce sperm which i could produce before the surgery.i have visited several doctors here in Kenya to no avail ,just wondering if you can visit Kenya for men like me and many others who really need your expertise. I Will be happy to hear from you. Regards Kanyote.

    1. Dear Peter/Kanyote: I would love to visit Kenya, but I am not licensed to practice medicine there. I have spent a good deal of time in Senegal but way back when I was training in medicine. Consider a Second Opinion consult as you may have obstructive azoospermia due to mesh hernia repair.

  2. Paul Turek, MD
    I have been suffering for too long now with epididymis and a hernia it is driving me crazy I went to a Doctor In Puerto Rico I got no treatment. I’m on Dialysis I live in the British Virgin Islands. Can’t take this pain any longer.

  3. I have been diagnosed by azoospermia. Testical biopsy done and both producing normal sperms. Specialist suspected it might be blockage and suggest for ICSI/IVF. But I’m not satisfy and I want to solve the “root cause” of this problem. Can you please advise? Thank you.

    1. Dear Krishna, I like the way that you are thinking! There are actually 2 possible solutions to your problem: IVF-ICSI with surgically retrieved sperm and potential reconstruction of the system to have kids naturally. I just did two such similar cases this past month and 1 patient already has ejaculated sperm after surgery! These are challenging microsurgical cases that I enjoy immensely. The reason why the “rebuild it” approach wasn’t discussed with you is possibly because the doctors don’t do this kind of surgery? Consider a Second Opinion with us to see what’s possible.

  4. I had Inguinal Hernia surgery about 10 days ago. Immediately after the selurgery I noticed seemed like thr Hernia but was harder and sensitive manipulation. I had a follow up with my Surgen and he explained that my hernia was pretty big (especially for a 29 yr old) and that swelling of the spermatic tube and epididymis is common post surgery. the whole area is still sensitive and the spermatic tube is swollen along with the epididymis being swollen.. Is this a normal thing post surgery? I hate the thought of this not going back to normal

    1. Dear Donnie, really hard to make a diagnosis over the web. Stay in touch with your surgeon and gives things a bit more time to settle down.

  5. I had a vasectomy performed 4 years ago. Over the past 10 months I have had recurrent bouts of epididymitis. Mainly on my left side X 4 but I have had 2 bouts on my right. The discomfort is accompanied with specific swelling of the inferior portion of the structure. It improves with antibiotics/warm baths/NSAIDS/support. There is no referred testicular pain. Do you recommend an epididymectomy or a reversal of the vasectomy? What is the success rate of both? Thank you.

    1. Dear JP, sounds like recurrent inflammation (epididymitis without infection). This should subside with time, but you have given it time. Epididymectomy will work if one is certain that the inflammation is epididymal in nature, but won’t if its not. Reversal is restorative and should eliminate it but then there’s the worry about contraceptive all over again. A trial of testosterone hormone replacement for 6 mos is another option, as it may “turn off” sperm production and reduce inflammation.

      1. Could you please indicate amount of and frequency of Testosterone injection to accomplish the shutting off of sperm? I also have been taking this 200 mg Test ananthate bi-weekly for this purpose, and had developed painful cysts on one end of each epid. 3 months-in with this regimen helps reduced the size of the cysts by about 1/2 their original size, and the pain goes away during the first 7 days, but gradually comes back during the second week of my injection cycle. By day 14, the pain is about 2/3 of baseline prior to starting T. Is there any way to stop the pain for good? Does the sperm come back after stopping T?

        1. Dear SKM, It is entirely unclear what the working dose of testosterone replacement is needed to completely turn off sperm production. If we had this answer, there would be a male oral contraceptive out there taking advantage of it. It appears that each person may have their own susceptibility levels to TRT.

  6. Since having my vasectomy 5 years ago I been having reacurring epididymitis, which my gp gives me some pills to reduce it, but it never really goes away, last year I saw a new gp explained the symptoms with some mild pain in the lower back and he thought it was gulliuns barre and gave me a drug overdose which landed my in resuss and a few nights in hospital still the epididymitis not sorted. I now suffer from seizures but still got epididymitis would a reversal at least get rid of the epididymitis?

    1. Dear Neil, Vasectomies can be associated with epididymitis which is typically “inflammatory” due to a “blowout” in the epididymis and is treated with antinflammatories. Antibiotics are unlikely to help much as this is not a true “infection.” However, usually epididymitis occurs once or twice and then stops. Another diagnosis is epididymal congestion or post-vasectomy pain syndrome, which is simpler and due to excessive pressure behind the vasectomy. It typically is not associated with swelling, unlike inflammatory epididymitis. A vasectomy reversal is more likely to help stop congestive pain more than epididymitis, but can be used for both.

  7. My husband had a vasectomy 2 months ago and has had 3 bouts of what sounds like epididymitis. Swelling of the left side and lots of pain. it has been treated each time with antibiotics- goes away and then this most recent time came back quicker and more painfully than before. On antibiotics again… is there something else he should be doing or considering? Why is this happening? So concerning.

    1. Dear Jessica, this could be discomfort due to simply “congestion” or actual inflammation from epididymitis. It is typically NOT bacterial in nature, so antibiotics might not have value. Antiinflammatories are another option and this problem should resolve.

  8. I’m 15 years old and about 6 months went to the doctors with a swollen and sore right testicle and then a swollen and sore left. He told me that I had bilateral epididymitis. He also referred me to have an ultrasound and they picked up nothing. It’s been kind of better for the last few months but has cropped up again and is really tight and sore. In really worried about it and worried that it may render me infertile. Are there any treatments/cures? Will it leave me infertile? If so is their a way I can store the sperm and is this costly? Thanks for your time.

    1. Dear Ollie, I think you should see a pediatric urologist for this issue to get a definitive diagnosis. It may represent intermittent torsion, or torsion of the testis or epididymal appendages. It may also be a varicocele or other issue. Most of these are very definable. Based on this, you can better decide whether or not to bank sperm for future use. Storing sperm is costly and you might need help with it so it should be a considered decision. Congratulations for taking such good care of your reproductive health!

  9. Sperm take 12 days in the epididymis to mature. This means we should ejaculate after 12 days of abstinence. But some research shows that after 10 days of abstinence, sperm quality decreased significantly. Somewhere I read that at the 7th day there is peak rise of testosterone. What’s the optimum ejaculation frequency?
    I am 23 years old, and I have some burning questions about sexology:
    1. Is there any relation between hormones regulating growth and reproduction?
    2. Shall we copulate yearly once like most of the species? If yes, then in spring or winter ?
    3. Are the factors of aging and senescence related to the sperm cells? Sperm cells die after period of days and regenerate. Shall we ejaculate before this period so that our body does not observe senescence.

    1. Dear Anupam, Interesting thoughts, to say the least. Why does epididymal maturation have anything to do with ejaculatory abstinence? Humans ejaculate sperm contained in a “reservoir” in the cauda epididymis, not from the transported epididymal sperm directly. The optimum ejaculatory frequency for fertility is 2 days and for a semen analysis it is 3-4 days, but for different reasons and not for reasons that you offer. Sure there is a relationship between hormones that regulate growth (testosterone and estrogens) and reproduction! You can copulate once yearly if you like, completely up to you! Pick your season. Your body gets rid of senescent sperm all the time, no need to try to help out by the way you ejaculate.

  10. My husband recently had his first bout of epididymitis, and orchitis (his right testicle was about 5-6 times as big as the other side!). He went on antibiotics and it seems to have mostly cleared up, though he does still feel a bit tender on that right testicle. We have noticed, though, that he is not ejaculating the same amount of fluid as before the infection. What could be going on? Could that one side be blocked? And if so, by what, and how would that have happened? What is the cure?

    1. Dear Feather, epididymitis may or may not cause epididymal obstruction. If it does cause obstruction, the ejaculate volume would not change. However, if the epididymitis was a result of “descending” infection that started, say, in the urine (ie. UTI) then it could cause ejaculatory duct obstruction which WOULD lower the ejaculate volume. A urethral stricture could also cause a low ejaculate volume and epididymitis. The cure depends on the cause.

  11. Dear Anupam, i had a vasectomy around 4 weeks ago. Unfortunately after a week, it got infected quite badly. All seemed not too bad for the 1st week. Was due to go back to work, but infection and immense pain kicked in in the middle of the night. Worst pain ever! My right testicle and epididymis were around the size of a medium pineapple. My right vas daf was swollen and hard. It seemed like it was travelling up into my abdomen as the swelling was traveling up into my abdomen. The upper front of my right thigh was also getting very warm. Not great times.
    Went to my gp, they got me on a 7 day course of antibiotics and anti inflammatorys. I returned twice within this week to the gp as it seemed to be getting worse. Luckily the infection (my gp tells me) has subsided. I still however have a swollen epididymis, not quite as swollen as it was, its currently around the size of my normal testicle. Vas Davis still ever so slightly swollen. The pain is nowhere near where it was, very manageable without pain relief.
    Now I’m done waffling on,my question is…
    Am i safe to engage in intercourse? I have attempted masturbation which I had to abandon due to intense pain and pressure build up in my testicle. As you can imagine this makes me quite apprehensive of a repeat performance. Whats your professional opinion?

  12. Can I simply say what a reduction to search out someone who actually knows what theyre talking about on the internet. You positively know tips on how to deliver a difficulty to gentle and make it important. More individuals have to learn this and understand this side of the story. I cant consider youre not more in style because you undoubtedly have the gift.

  13. Hello doctor,
    I am 32 and have azoospermia, but normal FSH, LH and T. My testes are normal size. My left epididymis is very hard and tubular about 0.5cm in diameter and I can’t feel my right one.
    I had undescended testicles and inguinal hernias when young.
    If I refrain from ejaculation, then my testes feel as though they are getting ‘fuller’.
    Am I likely to be able to father children?
    Thanks for your time

    1. Dear Alan, If you are azoospermic than fathering children becomes…more difficult. It should be determined whether your condition is OBSTRUCTIVE or NONOBSTRUCTIVE in nature. Blockages or obstruction can often be fixed and allow for fatherhood naturally. If there is no obstruction, fatherhood is possible if sperm are being made, but this gets a little complex. FNA mapping is a great way to learn which one of these you are.

      1. I saw a fertility specialist today at St. Mary’s Hospital in Manchester and he has put me on a 14 day course of antibiotics for epididymo-orchitis before further treatment. I am azoospermic – could an infection cause zero sperm in the ejaculate? My semen volume was 3ml. If the infection clears up, what are the chances of natural conception?

  14. Dear Dr Turek,
    Thanks for your reply. I have a consultation in 2 weeks time. My wife is only 25 and doesn’t have any fertility issues. Is it normal for the epididymis to be enlarged and hard. Could this be contributing? After sex, my left epididymis feels uncomfortable. However, my right one feels fine, so you’d think there would be some sperm in my semen. Could there be an issue due to my inguinal hernia operations when I was a child?

    1. Dear Dr. Turek
      Had a vasectomy 3 months ago, recovery went well but roughly a month post vasectomy started to have dull aching pain on left testie about 3/10. The pain hasn’t subsided nor has it gotten worse just constant dull pain with sharp bouts every so often, also pain doesn’t worsen during intercourse. Pain feels like it resides behind the testicle. No issue on right side. 2 ultrasounds, 1st was done onset of pain found no issues except small amount of scotal fluid. 2nd ultrasound done 3 month mark stated left epididymis is enlarged suggested epididymitis. Dr. gave me Cipro for 7 days as 1st treatment option and see from there. Saw urologist and he said sperm granuloma and with some watchful waiting and advil should resolve. Any suggestions or thoughts is it epdidymitis or granuloma or both or something else? What could be the result of the pain and any suggestions on how to treat and resolve the pain? Hot baths seem to help with pain while soaking in the tube, scrotal support and advil have little affect on the pain.

      1. Dear Nick, see my response to your query in another post (The Truth About Vasectomy and Pain)

  15. Congestive epididymitis after vasectomy
    My symptoms:
    – Testicle pain and tenderness, on one side
    – Enlarged lymph nodes in the groin
    – Pain or discomfort in the lower abdomen or pelvic area
    – The epididymis swell to twice normal size
    My testicle blew up to about 3-4 times!
    How is it treated? Antibiotics do not help

    1. Dear Andrey, Hopefully you have been well evaluated medically and are being followed for this. Consider adding non steroidal antiinflammatories (NSAIDS) for 1-2 mos.

  16. Dr Turek,
    We (M33, F34) are going to move to California in 2 months and going to visit your clinic first thing, but is there anything else you would recommend doing before that for the following male factor infertility results:
    – First semen test: 1.3ml, 2.5M/ml, 7% motile, 1% normal forms
    – 2nd: 1.4ml, 27M/ml, 38M overall, 45% motile, 6% normal forms
    – 3rd – 1ml, rest as 1st
    – 4th: 0.8ml, 0.8M/ml, 0% motile
    My doctor has ordered tests such as endocrine/hormonal, abdomen ultrasound, scrotal ultrasound, TRUS, y-chromosome microdeletions/cytogenetics, virology all of which came back normal. Scrotal ultrasound showed minor epididymital cyst and small hydrocele on different sides, but doctor said they are very small and are norm. I am about to have another semen test with urine analysis to rule out retrograde ejaculation as per my doctor. He suspected obstruction, but after normal TRUS they are looking to refer me to a specialist, so I found your website.
    Overall, I feel normal and live healthy lifestyle. My semen volume was low like that for 10 years I am with my wife, she has been evaluated for fertility as well and all is good.
    Thank you!

    1. Dear Yvone, Your semen quality is all over the map in terms of count and motility but what is very consistent in it is that the ejaculate volume is low. (<2 mL). This could mean retrograde ejaculation or, more likely, partial ejaculatory duct obstruction. That second semen sample is really quite good, showing me that you can, at times, get good sperm counts out of the system. Be happy to help.

      1. I wanted to post an update and thank Dr Turek for successfully diagnosing and treating my obstruction as he correctly suggested in his first response. My local specialists were unable to diagnose this, missed some evident (to Dr Turek) signs on the ultrasound and recommended IVF as the only option left. After his procedure my counts went up 50x as well as volume 4x and my wife is 7 weeks pregnant. If you are reading this you probably have read enough of research and done your homework. Schedule a call and make an appointment with his clinic, even if you have to travel far.

  17. Dr Turek,
    Thank you for your reply. Partial obstruction is suspected even when TRUS does not show any anatomical signs of obstruction? It was done in urology center by a doctor who read my case and told me this right away.

  18. I had a bout with epididymitis and orchitis last year. All cleared up nicely, but before and after semen analysis show a drastic reduction in volume. Before: volume – 5.5 Concentration – 53 Motility – 59% Total Motile – 172 mil. After: volume – 2.9 Concentration – 62 Motility – 49% Total Motile – 88.1 mil. A cystoscopy and transrectal ultrasound showed no blockages and perfectly normal seminal vesicles and prostate. Urine sample was clear. Doctor has never heard of volume going down after epididymitis (not comforting). What in the world could this be? Can it be fixed, or am I rendered useless on one side? I’ve had no other complications (tenderness, swelling, etc).

    1. Dear Astew, unlike the epididymitis was caused by an infection that also scarred off of the ejaculatory ducts, your urologist is right that epididymitis does not lead to lowering of ejaculate volumes. Either way, before or after your epididymitis, the ejaculate volumes are normal.

      1. Dr. Turek,
        I realize that my after level is within the “normal” range, but the fact remains it is half of what it was before the epididymitis, and my wife can’t get pregnant, as we were always able to do pretty easily (we’ve tried for 7 months now). After talking with a few other eurologists here, I’m a little frustrated that no one will take this seriously because it’s within “normal”. However, it is not MY normal. 3-4 semen analysis before show levels anywhere from 5.0-5.4, and now I’m at 2.9. Facts don’t lie. Everything to me seems to point to an obstruction, possibly in the epididymis. Transrectal ultrasound and cystocopy showed everything normal. I’d like to come out to see you (we’re in another state) as I see you’ve helped many people, and my wife and I desperately want more children. However, if I’m only going to hear that I’m within “normal” and be disregarded, then I’d rather not spend the money or time. I hope this makes sense. I’d love your thoughts.

  19. Hi Doc
    My story began about 5-6 months ago.
    I had been doing stupid penile enlargement exercises (jelqing).
    I also bought a hydropump that fits around the penis and covers the spermatic cord.
    The device requires you to push down toward the pelvis to create suction.
    I realised after doing this that I lost my morning erections and could no longer
    achieve erections by thought as I usually could. I allowed myself a week of rest
    and seemed to recover, however whenever I masturbated, it returned to it’s weakened state.
    I could only gain an erection through manual stimulation now.
    I also noticed my left testicle would pull up much higher whenever I had an erection. In the last week or two I began feeling mild pain and discomfort. I went to a urologist and he said I bruised the sperm cord and had mild epididimytis.
    i was put on anti-biotics and anti inflammatories.
    My morning erections returned but still can’t achieve an erection by thought and my libido
    is practically non existant. It’s been 5 days since my dr visit and I had been put on the meds.
    I masturbated yesterday to check if all is working. I seem to gain stronger erections lying down but struggle standing up. My ejaculation seems fine. The pain and discomfort have also subsided but since masturbating my morning erection has gone again and my libido is still not there.
    Could it be the inflammation that’s blocking something? Is masturbation and sex agrravating the inflammation?
    Please help, the anxiety is destroying me, I can’t work or sleep.

    1. Dear Sphinx, I agree with your statement that “the anxiety is destroying me.” You sound normal, but anxious.

    2. I feel like something similar is happening to me. Did you ever confirm what the cause was? Did it go away after stopping use of the pump and jelqing?

  20. Thank you. What do you mean by scarring off of the ejaculatory ducts? The cystoscopy and transrectal ultrasound showed everything to be normal. Yes, volume is still within “normal” range, but it is half of my normal – seems strange that the epididymitis was the point at which it was cut in half. Thanks!

    1. Hi Dr
      Thanks for your response. I have noticed a great deal of improvement since typing this mail, hence my anxiety has been relieved as well. I tried massages with Arnica oil to reduce inflammation and added a lot of turmeric to my diet and drinks, which I read had amazing anti inflammatory benefits. I’ve also been supplementing with omega 3, B-Vitamins and L-Argnine. Also decided to refrain from any sexual activity for a month at least to allow for healing and have been applying mild heat packs to the area. All this seems to help a lot for anyone else seeming to suffer from something similar. And for the love of god guys, please stay away from dangerous, penis enlargement excercises.

  21. Dr Turek,
    I had a vasectomy 10 years ago. For as long as I can remember 7-8 years my right testicle feels like there is a large grape attached to the top. I’m confident this is my epiddymis. It is tender but not painful. It never seems to change size. It makes my right testicle look twice as large.
    I don’t want a reversal so is there anything else I can do to get the grape to reduce in size?

    1. Dear Chris, you write with such clarity! You might have a spermatocele, a benign, cyst-like lesion that develops after vasectomy because the system is under “pressure,” you continue to make sperm and fluid and it backs up and causes cyst formation. Or maybe not. So, the first thing is to see a specialist to have this looked at this to make sure it is not something bad. If not, spermatoceles can be drained, but recur. They are benign and can enlarge. When they reach the size of the testis, men typically want them removed, as we have published.

  22. Dr. Turek,.
    My left testicle seems to be larger than my right testicle. Not crazy big, but noticeably larger by feel and sight. Maybe feels 10-20% larger??? I have never performed testicle self-checks, but in trying to determine if some hip/groin area pain (which has resolved) was muscular/skeletal or coming from my testicles I noticed the size discrepancy. My testicles do not hurt, but the left testicle might be a bit tender. No night sweats or unintended weight loss (dieting and lost about 8 lbs in past few months to improve cholesterol and A1C levels).
    I recently reported to my urologist / surgeon (at a large teaching/university hospital) who performed a physical exam. The physical exam indicated that there were no palpable testicular masses. The urologist suggested that I get an ultrasound to be safe. The ultrasounds showed that both testicles are normal in size, shape, and echogenicity. The “flow” is normal as well. Both testicles are about the same size (L xW x AP = 4.4 x 3 x 2.3 cm ). Both epididymis’ were reported to be normal (head, body, tail, size, and flow). Great news all around I suppose. The only thing that the ultrasound results noted was bilateral prominent epididymal bodies consistent with history of vasectomy. Otherwise normal grayscale scrotum ultrasound and color Doppler exam.
    I did, indeed, have a traditional vasectomy (piece of vas def removed, electocauterization, with the Vas Def ends buried in different tissue planes). The same urologist performed my vasectomy.
    As for the vasectomy, I was told that the procedure went well and was relatively easy since my vas deferens were close to the skin. I received the normal antibiotics after the procedure. I went home, was much more sore and swollen than the urologist / surgeon advertised. About a week later I reported back to the surgeon for left side pain and swelling. I was diagnosed with a case of mild epididymitis. I took another course of antibiotic and the pain ceased and the swelling decreased dramatically. About 3 weeks post vasectomy, I still had some minor scrotum swelling as noted by the surgeon. I also brought the swelling to his attention. He said to take some ibuprofen and move on. All semen analysis showed no sperm after 4 months.
    I took some ibuprofen and things seemed to normalize or maybe I just adjusted to my new normal. Since the vasectomy 9 months ago, I have always felt that my scrotum (on the left side) feels saggy and loose. I would complain to my wife about my saggy, old man balls. Prior to my vasectomy, my scrotum was definitely different with tighter feeling skin.
    Any thoughts? Might I be experiencing some post vasectomy issues? What causes a prominent epididymal body?
    I wouldn’t even be writing about this issue if I hadn’t noticed the original size discrepancy. I have just accepted my post vasectomy results for what they are…you know, just move on with life.

    1. Dear J.B. I like the way you write so reasonably and clearly. The “prominent” epididymis on the ultrasound is probably just a normal epididymal response to vasectomy. It tends to bloat a bit as it is handling all of the sperm output from the testicle in the presence of the vasectomy. Entirely normal. The initial discomfort is likely to have been post-vasectomy “congestion,” also of the epididymis. Lastly the scrotal tends to fall with age but I have not heard of this being related to vasectomy. You are in good shape.

  23. Greetings Dr Turek,
    Thank you for the informative website.
    I’ve experienced testicular, epididymal and pelvic pain on my left side after a vasectomy performed two months ago. Two weeks after the procedure I reached almost normal function and felt well. However, I soon developed the above mentioned pain on my left side, such that I cannot be physically active. Quality of life is highly affected, as is my ability to work.
    I’ve run a 14 day course of antibiotics without improvement. I understand it is likely not bacterial. (Why is it that most treatment regimes suggest antibiotics for PVPS, given studies do not indicate bacterial infection as a likely cause of pain?) NSAIDs help temporarily, but do not eliminate the symptoms. My left epididymis is painful to the touch, as is my spermatic cord.
    What is the most conservative course of action, given two months have passed with minor to no improvement? A reversal would be my last consideration.
    Thanks very much!

    1. Dear JJ, there are 4 kinds of pain after vasectomy. Given this story, its sounds like either inflammatory pain or congestive pain. Conservatively a 1-2 mos course of nonsteroidal antiinflammatorties should help with inflammation. If discomfort persists at a low level after 6 mos or so, then congestion may be an issues. Most cases of congestion resolve with time. A few need to be reversed.

  24. Hi, had vasectomy 6months ago .I have this throbbing pain along the bottom of penis for a week and then goes away and then comes back a few weeks later.help

    1. Dear John, recurrent pain in the same spot after a vasectomy certainly warrants an evaluation and a repeat exam by the vasectomist. Could be inflammation (granuloma) related to the vasectomy or not.

  25. Dr. Turek, given your experience with PVPS and it’s victims, if I am considering a vasectomy, would you advise against it?

    1. Dear Rob, great question. Honestly, I just don’t see much pain after vasectomy…Really cannot remember the last patient with any sort of chronic pain. Highly recommended. And, stay tuned for the gel vasectomy (Contraline, Inc) currently under investigation that will allow fluid but not sperm to pass into the ejaculate. Kinda no more blockage.

  26. I read that vasectomies performed with the latest technique (cut, bury, & electrocautery) have a failure or reversal rate = to 1:2000.
    Is this valid?
    What about after two zero sperm test 4 months post-vasectomy?
    Are those “at-home” test from the pharmacy a reliable option?

    1. Dear JFB, Those numbers are right. I do not have a vasectomy failure (defined as a persistent sperm count or unintended pregnancy) in over 2000 cases. However, I not a big fan of “burying” the vas as it disturbs too much tissue around the vas that may contain nerves. In my lab, a single zero semen sample 3 mos after the procedure is what I use to “clear” men of further contraception. I am not a big fan of “at home” tests as they may miss low numbers of sperm in the ejaculate.

  27. Hi Dr,
    I had a vasectomy 6 weeks ago using the “traditional” two slit scalpel method. The procedure appeared to go well but pain afterwards was quite intense. I went and saw my GP who diagnosed a small hematoma on the right side of my scrotum on top of my testicle. I went and had an ultrasound and the diagnosis was a two small bilateral hematomas. I am at the stage where I can complete day to day activities ok but there is still a mild dull ache and tenderness to the testicles. Is this normal? My GP has said to continue giving it time but this is a bit concerning.

    1. Dear Josh, hematomas after vasectomy aren’t quite normal but can occur. Depending on how big they are, they can take weeks to resolve. If too big, they are better served being surgically drained. Small hematomas typically resolve, but it takes some time. Keep your vasectomist apprised about how you are doing.

  28. I have a very large hard left epididymis, all the way from the tail upwards. It has been like this for as long as I can remember. Ultrasound shows damage to the efferent ducts and I have azoospermia.
    Can any of this be reversed without surgery?

    1. Dear Craig, really can say over the internet whether it can be reversed at all. However, most likely it would require microsurgery. You can always get sperm out from the system using needle aspiration and use it with IVF to have kids..that’s not “real” surgery but it is expensive.

  29. Hi Doc,
    I had a vasectomy approx. 6 months ago and have had consistent pain on my left side from the coils at the top of the testicle upwards into my abdomen and across my hip. The pain seems to increase with sexual activity. I have seen my urologist a number of times since and he now has me in physical therapy where I do nerve slide exercises and crush bottles of Aleve. However, the pain continues and is so strong that it makes me nauseous (basically like getting kicked down there). The coils feel much larger than on my right side and I continually have to shift around in my chair at work. After 6 months, I’m not sure how much longer I can continue living with this pain. Any thoughts would be greatly appreciated.

    1. Dear Dan, I am not sure what the “coils” are present at the top of the left testicle but did you discuss the possibility of having a left varicocele with your urologist? If not and if it is related to the vasectomy it could be any one of 4 kinds of pain, most of which are imminently treatable.

  30. Hi Doc,
    Had my V done april 2017, recovery was good, epididymitis started in oktober 2017, had Ofloxacine, never did fully resolve, still comes and goes. Is this congestive? Not much pain, big grape on top of epididymis though…Urologist only wants to talk about pain blockage. Can ibuprofen be of some assistance or would reversal be the only cure?

    1. Dear RB, Scrotal pain developing 6 mos after vasectomy could be inflammatory/epididymitis or congestive in nature. Typically antibiotics don’t help as this is inflammation not infection. Nonsteroidal anti-inflammatories have a role in some cases. My advice would be for you to check in with the vasectomist.

      1. Just found out through ultrasound that I have spermatoceles on both sides. I think that’s what causing my pressure pains. Is it true that when you remove these cysts that they can return (because of the still existent congestive pressure)? I am opting for reversal plus removal of cysts…

        1. Dear RB, spermatoceles are not uncommon after vasectomy as the system is pressurized. I typically resect/remove the spermatoceles (all visible ones) and do not do the reversal and have not seen recurrences.

          1. thank you for always commenting about questions. Will removing spermatoceles cause any other obstruction in the epididymis? If I decide to do a reversal, can you tell me how big the chance of scarring is? Would an epididymectomy be a better plan?

          2. Dear RB, Yes it is possible that removing spermatoceles can interrupt the flow of sperm from the testicle to the epididymis on that side. However the other side should be fine. When we studied the sperm counts of men before and after spermatocele repair using an operating microscope to increase surgical precision, we preserved the counts in all cases. Reversal surgery may “deflate” a spermatocele as the blockage is relieved, but it may not. I am not a big fan of epididymectomy as it is a bigger procedure with the potential for more obstructive pain than a vasectomy. In cases of vasectomy-related spermatoceles, I resect ALL visible cysts so that the smaller ones do not enlarge in the future.

  31. Hi Doc, I had a case of epididymitis where my left testicle was in pain, dropped lower than my right one, was swollen, and I noticed I had completely dry orgasms. I was treated with a shot in the arm/antibiotics for 10 days, pain left days afterwards. It is now a month later everything is normal accept there are only couple of sperm when I ejaculate. Not too sure what should I do from here…

    1. Dear Joshua, If you’re not sure what to do, then reconnect with the doctor who is caring for you. You can always get a semen analysis to check on what you think is going on with what is considered normal.

  32. Had a vasectomy in 1992 by an Army doctor. Never had any pain or problems until I had a bike fall in 1995. Had all the tests. No torsion, no infection, just swelling. Ever since then, I’ve had epididymis on and off, especially when my left testicle hits something hard, like sitting down quickly on a chair. Only have pain on the left side. I’m now 53 and tired of it. I’ve tried heat and cold; I wear special underwear, but I continue to have pain. I’m now considering surgery, but I’ve read that only few men have relief even after surgery. It’s not painful during sex, but the constant pain is messing with my daily life. Thoughts or advice?

    1. Dear Steve, Nagging pain and discomfort years after a vasectomy in the absence of anatomical issues could definitely be either congestion or inflammation. Vasectomy reversal is one approach to solving this problem. Temporary nerve blocks followed by microdenervation of the spermatic cord (another surgery) is another. In men with older vasectomies, I have had great success using testosterone replacement to “turn off” sperm production, decrease congestion and eliminate the congestive pain. You might consider this…

  33. Dr, i was experiencing pain in mainly my right testicle so i was advised to do an ultrasound of my testicles and it was found that the head of the epididymis was swollen, meet an urologist and ciprofloxacin and nimesulide was prescribed i got betterafter the dossge, but now again the pain has return especially on my right side and every time i sit or some how get the testicles in contact with each other, i feel the urgeto urinate, in the past 3 days i have been urinating more than normal. Im confused

    1. Dear Mike, I know nothing about you, your age, your medical history, but epididymitis can be due to a urinary tract infection and therefore be associated with urinary issues. It can even be due to tuberculosis! Please see your doctor and continue to get care!

  34. Hello doc, question I’m curious about and have seen zero about online.
    I got a vasectomy in Feb. Experiencing first symptoms of Epididymitis 6 months later. Urologist prescribed antibiotics and anti-inflammatories. They said it was probably congestion.
    My question is:
    does masterbation or intercourse make the inflammation worse?
    Does the mind-body connection say he is having an orgasm we need to make more sperm, in turn creating more sperm and creating a bigger backlog?
    Or does the body just make sperm at a steady constant pace no matter what the body is doing??

    1. Dear Jason Klopp, Great questions! In fact, ejaculation by masterbation or with sex can make congestive pain after vasectomy worse as the vas deferens tubes contract at high pressures behind and beyond the vasectomy site and increase luminal pressures inside the vas. This is how the sperm normally gets pumped through the system to the prostate before ejaculation and this process continues after the vasectomy. With a vasectomy though there is a blockage and so we imagine that the pressure just builds up behind it blockage and causes increased congestive pain. Sperm production is a constant process and does not respond to ejaculation.

      1. So just to clarify, ejaculation can exacerbate congestive pain, but how long might this condition last? I ask because I had a vasectomy back in April, and in July I started having the classic PVPS symptoms. Based on what I’ve read on others’ experiences, my guess is that I have congestive pain. I think I’ve noticed that ejaculation does make it worse the next day. I’m fine holding off for a while to alleviate the pain, but assuming the pain goes away in time, will ejaculation cause it to come roaring back?

  35. Hi, I hope you can shed some light on my predicament ..I had a vasectomy about 6 years ago .Afterwards i experienced a lot of pain ,swelling ,strange looking semen and complete loss of orgasm .. Had a reversal one year later ,which helped and although orgasm weaker it was there.Now my orgasm has disappeared again ..Help .

    1. Dear Rob, typically a vasectomy will not alter either orgasm or ejaculate volume. Having said this, I have had patients with altered orgasm and altered ejaculate volume. Recall that age, medications, low T, prostate hypertrophy can all alter ejaculate volume. I would investigate other causes of low volume and weak orgasm.

  36. Hi, thanks for the reply but i can assure you i had no problems pre vasectomy and i am sure i had Epididimitis after the op.The volume is fine ,i dont drink or smoke and i am very athletic.I am at a loss at no orgasm when ejaculation .

  37. My scan suggest chronic epididymi orchitis,as a result I have low sperm count. Is there any hope of fathering a child naturally.

    1. Dear CK Butros, as long as there is ejaculated sperm, there is a chance of fathering children naturally. Low sperm counts make things harder, but not impossible. Your diagnosis is VERY unusual and should be treatable!

  38. Dr. Turek,
    I was seen by a urologist one month ago for testicular pain on my right testicle that radiated to both of them as well as my lower abdomen and occasionally my lower back, though there has been no swelling. The urologist did an ultrasound, bloodwork, and a urinalysis, and didn’t find anything unusual. He said it sounded like epidymitis and prescribed me 2 weeks worth of doxocycline and naproxen. After I finished the doxocycline I was no better so I was switched to Bactrim for 3 weeks. I am now approaching the end of my Bactrim antibiotic course and have still found no relief. Does this sound like epididymitis to you? And if this becomes a chronic issue is there any sort of treatment or cure?

    1. Dear Jordan, testicular or scrotal pain can be primary in nature (i.e. due to something in the scrotum) or secondary in nature (i.e. pain that is “referred” to the scrotum from elsewhere. Some thought and treatment has been given to primary issues; now it’s time to consider secondary issues (hernia, hip issue, back issue etc).

  39. I am having epididymo orchitis and I have checked it with a doctor and taking the prescribed medication. But I wanna ask that is masturbating safe during the treatment ?

  40. Hi,
    My husband is azoosmpermic due to amiodarone induced epididymitis. We have 1 child from before this occurred. My question is, is it possible to reverse the epididymitis without reducing amiodarone? And is it possible with a biopsy we could still have another child via IVF?

    1. Dear Tracy, fascinating! Have to say that I have never seen this. So, my answer is: it depends! If the epididymitis is inflammatory and scar tissue has blocked it off, then it may be reconstructable with microsurgery. If it is a “chemical” and not physical effect, then it may not be reconstructable. Seems likely that if not reconstructable that testicular sperm could be found and a pregnancy attempted with IVF. Consider a visit Love to help!

  41. Hi Dr. Turek,

    Thanks for your generosity sharing your knowledge answering questions.

    I had vasectomy reversal surgery a month ago and looks like experiencing epididymitis on the left side. My Dr says it will go away or he will prescribe antibiotics. I don’t want to take antibiotics and concerned about prolonged effects of not treating it. Should I do turmeric and other natural anti inflammatory supplements? Should I be concerned about this low pain and swelling left untreated for a long time? What should I do to heal? Thanks and blessings!

    1. Dear Paul, pain early on after vasectomy reversal could be a blood clot or a leak causing inflammation. I guess, rarely it could be an infection. Usually, epididymitis occurs after a vasectomy and not a reversal (which relieves pressure). Anti-inflammatories are a first good choice of treatment unless a fever develops, and then antibiotics are appropriate.

  42. Dear Dr. Turek,
    My husband suddenly got a swollen testicle and tenderness/pain. He says it’s about a 3 on the pain scale. He seems to always be somewhat distracted by it. . He went in and was given antibiotics (2 rounds). They did nothing. The ultrasound showed that the epididymis was “lit up”/inflamed. Another doctor said it was epididymitis and said to take NSAIDs for 2-3 months. He is on week 6 and the pain hasn’t changed a bit. My question is, could this be related to the vasectomy he got a little less than 2 years ago? He was also on an 18 hour flight a week before he develped this. Could that have anything to do with it? Also, how likely is it that it will actually go away in 2-3 months? How often do men presenting with these symptoms have to end up getting a reversal to stop the pain? We’re both pretty nervous this will be chronic…
    Thank you so, so much for your thoughts!

    1. Dear Keri, Sudden onset of testis pain anytime after a vasectomy is typical for epididymitis. The system may have “blown out” with sperm spillage and inflammation and granuloma. This is not typically bacterial in nature, so antibiotics don’t help. NSAIDs and steroidal antinflammatories do the best with this and it should resolve with time.

  43. Dr turek I got hit in football game roughly 13 years ago am 28 now my left testicle was damaged badly i didn’t undergo any immediate surgery nor antibiotics I used to feel pain for years after which I finally stopped feeling pain now if experience atrophy in the left testicle in ultrasound the the size Is 21cm the epididymis head is ok blood flow is good too but is small in size compared to the right testicle I had seminal analysis since to know my fertility
    My lab results were as follows
    Volume 1ml
    Ph 7
    Fluidification normal
    Color creamy whitish
    Viscosity normal
    N⁰ of sperm cells per cm 242500
    %of sperm cell motility in two hours 08%
    % of morphologically abnormal sperm cells 5%
    Leukocytes 2-3 per camp
    on the other hand right testicle is 31cm and these days became firmer than before specially in cold times I was suspicious about testicular cancer but after googling I don’t have other symptoms only firmer such that you can’t squeeze at times

    1. Dear Geedi, Sounds like your testis are uneven in size and your sperm count is low. This could be hormonal, genetic, post-traumatic, varicocele or a number of other things. Get thee to a urologist to know more! Give us a shout!

  44. Dear Dr. Turek,
    4 months ago I had a vasectomy. About a week after I developed a painful pea sized lump inside my scrotum on the right side and the testicle aches. It has since gotten smaller and the pain from it has lessened as well as testicle sensitivity but my question is how long does this normally take to go away? And is there anything I can do to help it go away?

    1. Dear Jesse, this sounds like inflammation or reaction to sperm spillage at vasectomy. Typically it will pass with time. Antiinflammatory medications can help it along.

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