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Karen Boyle, MD

Baltimore, MD 21204


Epididymitis and Vasectomy

Epididymitis is an inflammation or infection of the epididymis—a long coiled tube attached to the upper part of the testicle that is used to store sperm. Epidiymitis is a rare vasectomy complication that, if it occurs, usually hits during the first year after the procedure. Occasionally, however, it can manifest years after the vasectomy was performed. Common symptoms include swelling of the testicles, mild to severe pain in the scrotum, and sometimes a low-grade fever. Other symptoms can include pain when ejaculating, pain in the groin when lifting, and pain during intercourse.

The condition may or may not be a direct complication of a vasectomy. And since the condition is often caused by bacteria, treatment often starts with a course of antibiotics to get rid of the infection, combined with conservative therapies such as reduced activity and pain management (including non-steroidal anti-inflammatories such as ibuprofen, scrotal support, and applying heat or cold). If a man is still experiencing significant discomfort after a few months of conservative pain management, additional treatments for chronic pain may be necessary. These include the use of local steroids, tricyclic antidepressants, or transcutaneous electrical nerve stimulation analgesia.

For the few remaining men whose pain isn't relieved by non-surgical approaches, surgery can offer relief. Surgical options include an epididymectomy, spermatic cord denervation, vasectomy reversal, and orchidectomy.

These days, urologists have made some modifications to the vasectomy technique to decrease a man's risk of developing post-vasectomy epididymitis. Because one potential cause of inflammation is pressure from sperm building up in the epididymis, an open-ended vasectomy procedure—in which one end of the vas deferens is left uncauterized, thereby relieving pressure and decreasing the likelihood of sperm granulomas, masses that develop in an immune reaction to sperm that have leaked from the cut vas. Another technique is pre-emptive analgesia, in which the urologist floods the vas deferens with a local anesthetic before it is cut. Early evidence suggests that both these procedures can reduce the chances of epididymitis post vasectomy, but further study is needed for conclusive results.

There is still much researchers and physicians don't yet understood about epididymitis as a post-vasectomy complication, including what causes it and how to further prevent it. Controlled studies focusing on newer vasectomy techniques, the role of sperm granuloma in the condition and the role of the immune system post-vasectomy will help build a more comprehensive understanding of epididymitus and how best to treat it.

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