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Award-winning urologist - and pioneer in Men's Health - Dr. Paul Turek blogs weekly about issues such as infertility, vasectomy and vasectomy reversal, sexual and hormonal dysfunction and more. Keep up with the latest on this fascinating field of medicine.

A Day in the Life of the Epididymis



epididymal anatomy in the human
Epididymis: most of the colored section of the figure (A-C) and one of the most important tubes in your body. (Courtesy: Wikipedia.org)

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.

Anatomy First

The 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.

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:

Epididymis as Elephant

Here’s why I have been thinking epididymal thoughts. Based on my recently published research on how ejaculated sperm recovers following reversal of vasectomy, I am now convinced that the epididymis plays a key role. Although sperm counts are similar after reversal of younger and older (>15 years) vasectomies, sperm motility is significantly lower after reversal of older vasectomies. And lower motility means longer time to pregnancy or even frank infertility after reversal. Given what you now know about how the normal epididymis influences sperm, you may surmise that it is the elephant in the room when it comes to impaired sperm movement after vasectomy reversal.  If I can now figure out a way to help the epididymis get its mojo back after reversal, then I am pretty sure that natural fertility rates will improve as well. After all, if more sperm were given directions, maybe fewer would be needed to get the job done!

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31 Responses to “A Day in the Life of the Epididymis”

    • Paul Turek, MD Paul Turek, MD

      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.

      Reply
  1. Peter

    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.

    Reply
    • Paul Turek, MD Paul Turek, MD

      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.

      Reply
  2. Derick L Corea

    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.

    Reply
  3. Krishna

    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.

    Reply
    • Paul Turek, MD Paul Turek, MD

      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.

      Reply
  4. Donnie

    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

    Reply
    • Paul Turek, MD Paul Turek, MD

      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.

      Reply
  5. JP

    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.

    Reply
    • Paul Turek, MD Paul Turek, MD

      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.

      Reply
  6. Neil

    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?

    Reply
    • Paul Turek, MD Paul Turek, MD

      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.

      Reply
  7. Jessica Stone

    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.

    Reply
    • Paul Turek, MD Paul Turek, MD

      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.

      Reply
  8. Amanda

    Hello,
    My husband was diagnosed with epidydimitis seven years ago when we were trying to get pregnant with our first child. The discomfort went away after treatment with NSAID’s and was gone for years. Last year it returned with a vengeance and got to the point where he was experiencing shooting pains in his abdomen, lower back, and down his legs. In August he had an surgery to remove the epidydimitis. The pain he was experiencing was gone immediately. He has been doing great until a week ago. Now the pain has returned and is starting to affect his back again. He has an appointment with his urologist next week. Do you have any recommendations or an explanation as to why this is occurring again? Thank you!

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Amanda, this is not so simple. Pain down there can start from “down there” or start from the back (i.e. be referred “down there”). I would check out his back really well and see if that is the source of scrotal pain.

      Reply
  9. Jeff O

    Dr Turek,

    I am a 54 year old male. I had a vasectomy some 20 years ago. Up until 4 weeks ago I never had any issue with my testicles. I did have a bout with Prostatitus in 2009. About 5 weeks ago I was having increasing right flank pain when sitting for a period. Then when driving the car and sitting, I would have testicle discomfort and some pain. The right testicle is the most involved with pain in the upper outside right edge and on the bottom. I went to my urologist and was diagnosed with Epididmitis and a slightly inflamed prostate. I was prescribed cipro and then Bactrim, NSAIDS, warm baths, and best rest. I was checked for kidney stones and had an ultrasound of the scrotum…all negative. It has not improved much. Are there any other options, such as surgery? I see my urologist for a follow up next week.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Jeff, it is not uncommon in men with older vasectomies to get a “blowout” and have epididymitis like you have had. I am a big fan of 4-6 weeks of NSAIDs for this.

      Reply
  10. Norbert

    I am Norbert 27yr from kenya. three months ago I was diagonist with epididymitis and currently I was curious to know more about me and I went for sperm count and it was nil. want is the best prescription for this problem.. I want atleast a kid.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Norbert, Having no sperm could be due to scar tissue from epididymitis or it could have preceded the epididymitis. A thorough male factor evaluation with a history, physical exam and blood tests and repeat semen analysis should be quite directional and informative here to help answer your question.

      Reply
  11. Jay

    I had a visectomy about a week ago the tubes seem to be extremely swollen and hard I’m still in some pain and extremely sensitive to pain when it comes to that area can you please ease my mind on what it can be.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Jay, this can be normal or maybe not. The key is whether the pain and swelling are improving or not. They should be. It can take several weeks for the area to feel “normal” after vasectomy. Talk to your doctor too, and see what is typical for his/her experience.

      Reply
  12. Clint

    Hi Dr. Turek,

    I had a vasectomy about two years ago, and have had no problems. Then, last week, I started noticing a marked reduction in the emount of my ejaculate. I thought it odd, but thought little of it. Now, this week, I am experiencing all the symptoms of inflammation epididymitis. I took some NSAIDs anti-inflammatories which helped greatly, but I was concerned about the great reduction in my ejaculate of late. I do have the trademark swelling of the epididimis on my left testicle, but could that cause the reduction in ejaculate, or should I be concerned about another factor? I am planning to see my physician tomorrow. Thank you.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Clint, a vasectomy does not typically cause any noticeable reduction in semen volume as semen volume is driven by the accessory sex glands (seminal vesicle and prostate). The lowered ejaculate volume could be age-related (occurs with prostate enlargement) or due to ejaculatory frequency (more sex means lower volumes, temporarily). It sounds like you may have inflammatory (not infectious) epididymitis which typically responds to non steroidal antinflammatories as you have experienced. It typically gets better and may never recur.

      Reply
  13. Zablon

    Hello sir. Am zablon from kenya. My right testicle’s epididymitis have swolen and i have been diagnosed with orchitis 5 years back, treated with some injection, then i was ok untill 1 year ago, the same orchitis return with much power. Now am under testicle pain and swolen epidymitis. Am stranded. Help me sir.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Zablon, recurrent epididymoorchitis is uncommon. Get thee to a urologist or emergency room ASAP!

      Reply
  14. Colin

    Hey Dr Turek

    I had a V done about 2.5 months ago and have had issues ever since. Started with ED issues closely after the surgery. Probably day 4 or so. That has improved, though not back to normal by any means. Just don’t get the same strength, girth and rigidness like I used to.

    I’ve had a very tender nodule at the vas site on the left side as far back as the first week as well. Sometimes this nodule is very painful and tender.

    I had one bout of prostatis about 3 weeks after which just went away on its own after a few days but has continued to resurface a few times since and has been pretty consistent lately.

    Most recently, about two weeks ago, I had some swelling and very tender left testicle area. This lasted about 2-3 days and was after a couple hard days of working out. Then, resolved, but came back about 2-3 days later, which was a week ago now, full force. I ended up coming down with a fever, shakes/chills, etc and went to ER. Did ultrasound which they said was Epididymo-orchitis. My testicle was hard as a rock and really tender and my whole scrotum area was huge, tennis ball size, and really tender.

    They gave me IM antibiotics and sent me out with doxy. I’m about 7 days into the doxy now and feel a lot better. Swelling is better and pain is now a 2-3 instead of 8 or so.

    One weird thing is my testicle that was inflamed now seems very squishy, not as firm as right side.

    Do you think this treatment is appropriate. Do you think this is something that could reoccur.

    Since I’ve had this surgery done, I’ve read about all the complications that seem to exist and, not gonna lie, I’ve regretted and I’ve wondered if I should look into doing something else – reversal, TRT, etc. look forward to your thoughts Doc.

    Reply
    • Paul Turek, MD Paul Turek, MD

      Dear Colin, sexual issues after vasectomy (ED, low sex drive) are not uncommon in the setting of lingering pain and issues. I’ve seen the sexual issues resolve after the “concern” is lifted that things are fine with the vasectomy. So, I would work on the pain. Typically, pain after vasectomy (several months after) is not an infection, but inflammation. Antibiotics do not work as well as NSAIDs. Please followup with your vasectomist or another MD interested in this issue.

      Reply

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