FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PAINFUL TESTICLES EPIDIDYMITIS, NOT HARBINGER OF CANCER

Question: For the last five years I've had episodes of tenderness and swelling on one of my testicles. My family doctor and a urologist have diagnosed my condition as epididymitis. Each of the doctors has prescribed antibiotics that give some temporary relief, but the pain and swelling eventually return. I'm concerned about testicular and prostate cancer because my grandfather and an uncle died from prostate cancer, and another uncle had surgery for it but now is fine. The doctors I've seen don't seem very concerned about my condition. I'm at a loss for what to do next. Do I just have to live with the discomfort until it becomes cancer?

Answer: Epididymitis is a common infection of the male reproductive tract. And before I go any farther, I should briefly review the structures of the male reproductive system because they are all potentially involved in your problem.

As you know, the testicles are located in the scrotum and are responsible for two important functions: They make male hormones and produce sperm. The hormones are carried to all areas of the body by the blood stream, but the sperm have a much more limited route of travel. The sperm, while still immature, leave the testicle and collect in the epididymis. This is a "comma shaped" sack attached to the back side of the testicle.

The epididymis empties into the vas deferens. This tube which you can feel within your scrotum above the testicle carries mature sperm from the epididymis through the inguinal canal (the hernia area) and across the inner surfaces of the pelvis to the prostate gland. The prostate mixes its own fluid and that from the seminal vesicals and other sources with the sperm to produce the ejaculate of the male reproductive system.

An infection in the epididymis causes pain and swelling, just as you describe. There are several possible explanations for your repeated episodes. It is possible that each has been a new, separate infection, especially if you've had multiple sexual partners. It is also possible that you have suffered from one infection that hasn't been totally cleared by the antibiotics you've taken. This allows the symptoms to flare up from time to time. One particular microorganism C. trachomatis is commonly the culprit because it is hard to kill with antibiotics.

Another common cause of repeated epididymitis, and the most likely cause for you, is chronic infection in the prostate gland. The low-grade infection spreads down the vas deferens and causes the new episodes of epididymitis. Unfortunately, chronic prostate infections are difficult to eradicate. It often takes special antibiotics that must be taken for four or more weeks to clear up the problem.

Infections of the epididymis or the prostate do not cause cancer. Once the infection has been cleared up, your discomfort should be over. However, you still have some risk of developing prostate cancer and testicular cancer just like every man. Performing monthly testicular self-exams is your best protection against testicular cancer.

The testicles have a very smooth surface and a firm and resilient feel when lightly compressed. A cancer of the testicle feels like a hard growth as small as a grain of rice and just as hard located on or just below the surface of the testicle.

Your family history of prostate cancer imparts some increase risk to you for developing this malady. There are no "self-tests" for this condition. Therefore, you should see your doctor every year for a rectal digital exam. You see, the prostate is situation in the pelvis just forward of the rectum. The doctor can feel the prostate gland for the changes in shape and texture that suggest cancer by examining through the rectum. Your doctor will probably also recommend an additional blood test to measure the PSA, a chemical normally produced by the prostate gland but dramatically increased in prostate cancer.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.