Infection of the testis and epididymis (the coiled tube that stores and transports sperm away from the testis) can lead to inflammation called epididymo-orchitis. This condition usually causes painful swelling of one testis and may be accompanied by fever.

What are the causes?

Epididymo-orchitis is usually caused by bacteria that have traveled from the urinary tract along the spermatic duct (vas deferens) to the epididymis. In men under 35 years of age, a common cause of the condition is a sexually transmitted infection (STI), such as nongonococcal urethritis. In older men, a urinary tract infection, prostatitis, or recently having had a catheter inserted to drain urine are possible causes. In rare cases, an infection that is transmitted through the bloodstream, such as tuberculosis, leads to the development of epididymo-orchitis.

In boys and young men, the most common cause of the condition used to be inflammation due to mumps, but this has become less common since the introduction of immunization.

What are the symptoms?

The symptoms of epididymo-orchitis usually develop over a period of several hours and may include:
- Swelling, redness, and tenderness of the scrotum on the affected side.
- In severe cases, extreme pain in the scrotum, with fever and chills.

You may also have some symptoms of the underlying disorder, such as painful and frequent passage of urine in the case of a urinary tract infection.

The symptoms of epididymo-orchitis are similar to those of a more serious condition called torsion of the testis (right). For this reason, you should consult your doctor immediately if you have any of the symptoms listed above.

What may be done?

Your doctor will ask you to provide a urine sample to be tested for infection. If the doctor suspects an STI, he or she will take a swab from your urethra (the tube from the bladder to the outside of the body) to check for infection. If the diagnosis is unclear, you will need to go to hospital as an emergency for tests to rule out torsion of the testis. In some cases, exploratory surgery is necessary.

Your doctor will probably prescribe antibiotics unless the inflammation is caused by infection with the mumps virus, in which case antibiotics are ineffective. You may be advised to rest in bed and drink plenty of fluids. Taking painkillers may help to ease the discomfort, and using an ice pack may reduce the swelling and pain in the scrotum. An athletic support can be worn to support the scrotum.

Pain is usually relieved in 1-2 days, but the swelling of the scrotum may take several weeks to subside.

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Epididymal cysts, or spermatoceles, are harmless fluidfilled sacs that form in the epididymis, which stores and transports sperm away from the testis. Small epididymal cysts are common, particularly in men over the age of 40. The cysts develop slowly and are usually painless.

In many cases, there are multiple cysts, which can be felt as distinct, painless swellings like a tiny bunch of grapes on top of and behind the testis. The epididymal tubes in both testes may be affected by cysts at the same time.

If you detect a swelling on one or both sides of your scrotum, you should consult your doctor to rule out a serious condition, such as cancer of the testis. He or she will probably be able to make a diagnosis from a physical examination, but further tests such as ultrasound scanning may be necessary.

Epididymal cysts normally remain small and do not need treatment. Rarely, they become large and cause discomfort, in which case they can be removed.

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Men reach their sexual peak between the ages of 16 and 18, shortly after puberty. Since they are able to produce sperm continuously from puberty onwards, men remain fertile for a longer period than women; some man can become fathers at the age of 70 or older. Sperm are produced in the testes, and during sexual intercourse, the penis delivers them into the female reproductive system. The male reproductive system also manufactures sex hormones that are essential for sperm production and for sexual development during puberty.

The male reproductive system begins to develop before a male baby is even born. The only visible parts of the male reproductive system are the penis and the scrotum, but inside the body there is a complicated network of ducts, glands, and other tissues that work together to make the production and transport of sperm possible.

Sperm production

Once puberty is reached, sperm are manufactured continuously in the two testes at a rate of about 125 million each day. Since sperm production is not efficient at body temperature, the testes are kept cool by being suspended outside the body in a sac of skin called scrotum. Mature sperm leave each testis through an epididymis, a long coiled tube that lies above and behind each testis. The sperm are stored in the epididymis and mature there before going to the vas deferens, the tube that connects an epididymis to an ejaculatory duct. During sexual activity, each vas deferens contracts and pushes sperm towards the urethra (the tube that connects the bladder to the outside of the body). The sperm are ejaculated during sexual activity or are reabsorbed into the body. Some dribble through the upper end of the vas deferens into the urethra and are later washed away in the urine.

The sperm are carried in a fluid consisting of secretions from various glands. Most of these secretions are produced by glands called seminal vesicles as the sperm leave the vas deferens. Fluid is also added by the prostate gland. In addition to acting as a vehicle for the sperm to help them to swim, the fluid provides nutrients that keep the sperm healthy. Together, these secretions and sperm form semen, containing about 50 million sperm per millilitre.

In order for reproduction to take place, sperm must enter the female reproductive system. During arousal, the penis becomes enlarged and firm. Muscular contractions at the base of the penis then force sperm through the male urethra and into the vagina during male orgasm.

Male hormones

The principal male sex hormone, testosterone, is produced throughout life. Testosterone plays an important part in the development of the genitals and other male sexual characteristics. During puberty, there is a dramatic increase in the level of testosterone. This increase triggers the growth of the genitals and the development of secondary male sexual characteristics, such as body and facial hair, deepening of the voice, and muscle development.

Puberty

Puberty is the process of sexual development. In boys, puberty usually occurs between the ages of 12 and 15 and lasts 3-4 years. Hormones secreted by the pituitary gland cause levels of the male sex hormone testosterone to rise, stimulating changes such as genital growth and the development of secondary sexual characteristics.
Physical development: during puberty, the penis, scrotum and testes enlarge, and pubic hair grows. Hair also appears on the face and other parts of the body. Rapid growth occurs, the muscles develop, and the voice deepens.

Male reproductive system

The male genitals consist of the penis, scrotum, and the two testes, which are suspended in the scrotum. Above and behind each testis is an epididymis, a coiled tube that leads to another tube called the vas deferens. The upper end of each vas deferens is joined by a duct draining from a gland called the seminal vesicle. This duct and a vas deferens together form an ejaculatory duct. The two ejaculatory ducts then join the urethra where it is surrounded by the prostate gland, and the urethra passes through the penis to the outside.

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