What is epididymitis?

Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Although males of any age can develop epididymitis, it occurs most frequently between ages of 20 to 39. When it develops in children, it is usually due to inflammation caused by trauma. However, some children develop it because of bacterial infections, some of which may be due to sexual abuse.

What are epididymitis causes?

The cause of epididymitis is usually a bacterial infection. The bacteria usually get to the epididymis by moving back through (retrograde) the urethra, prostate, vas deferens into the epididymis. The responsible bacteria are usually identified in about 80% of cases.

Two main groups of organisms cause most cases of epididymitis: sexually transmitted organisms and coliforms (organisms that commonly live in the intestines).
- In men younger than about 39 years of age, the causes are usually the same organisms that cause the sexually transmitted diseases of chlamydia (responsible for nearly 50%-60% of cases) and gonorrhea. The bacterial species are Chlamydia trachomatis and Neisseria gonorrhea, respectively.

- In those older than 39 years of age, the causes are usually coliforms, which are bacteria (such as Escherichia coli) that live in the intestines. These organisms also frequently cause bladder infections. Any age of men who participate in anal intercourse are more likely to get infected with E. coli or other fecal bacteria. Epididymitis is rarely caused by fungi or Mycobacterium spp.

- Chemical epididymitis (rare) is inflammation caused by the retrograde (backward) flow of urine when exercising or having sex with a full bladder.

- Amiodarone (Nexterone), a frequently used heart medication, occasionally causes inflammation of the epididymis.

- Viral infections (including mumps), mainly in the pediatric population.

What are dpididymitis symptoms?

Epididymitis symptoms depend on the cause. They can include:

- A tender, swollen, red or warm scrotum
- Testicle pain and tenderness, usually on one side — the pain may get worse when you have a bowel movement
- Painful urination or an urgent or frequent need to urinate
- Painful intercourse or ejaculation
- Chills and a fever
- A lump on the testicle
- Enlarged lymph nodes in the groin (inguinal nodes)
- Pain or discomfort in the lower abdomen or pelvic area
- Discharge from the penis
- Blood in the semen

Chronic epididymitis

Signs and symptoms of epididymitis usually develop over a day or two and get better with treatment. In some cases, epididymitis may not clear up completely or may recur. This is known as chronic epididymitis. Symptoms of chronic epididymitis may come on gradually. Sometimes the cause of chronic epididymitis is not identified.

How is epididymitis diagnosed?

Your doctor will do a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.

Other tests your doctor might order include:

Sexually transmitted infection (STI) screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.

Ultrasound imaging. This noninvasive test uses high-frequency sound waves to create images of structures inside your body and is used to rule out conditions, such as twisting of the spermatic cord (testicular torsion) or a testicular tumor. Your doctor may use this test if your symptoms began with sudden, severe pain and other tests have not been definitive.

Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.

How is epidiymitis treated?

The health care practitioner likely will treat the individual with antibiotics through an IV, a shot, or pills orally (to be taken for 10 days or longer). Often the treatment depends on the identity of the infecting bacteria; many physicians elect to treat with at least two different antibiotics because individuals are occasionally infected with more than one organism.

For men younger than 39 years of age, Ceftriaxone, Azithromycin, and Doxycycline are often prescribed. For men older than 39 years od age or those who participate in anal intercourse, Ciprofloxacin, Ofloxacin, Sulfamethoxazole and trimethoprim are often prescribed.

The CDC guidelines recommend that for acute epididymitis most likely caused by enteric organisms or with negative gonococcal culture or PCR nucleic acid amplification test the following:
Ofloxacin (Floxin) 300 mg orally twice a day for 10 days or levofloxacin 500 mg orally once daily for 10 days.

Guidelines change frequently; most health care practitioners who treat epididymitis are aware of these guidelines, and depending on local resistance patterns of pathogens, may change the type and duration of antibiotics to best fit the patient's condition. Pediatric treatments are best administered by pediatricians and are usually based on the weight of the patient and the infecting organism's antibiotic susceptibility. If the infection is not treated early, complications may develop that require surgery.

For patients with non-infectious causes of epididymitis (for example, chemical, inflammation) anti-inflammatory medication is often prescribed; occasionally, consultation with a urologist is recommended for additional treatments.

What is endometriosis?

Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region.  It is one of the most common health problems for women.

Most often, endometriosis is found on the:

- Ovaries
- Fallopian tubes
- Tissues that hold the uterus in place
- Outer surface of the uterus
- Lining of the pelvic cavity

Other sites for growths can include the vagina, cervix, vulva, bowel, bladder, or rectum. In rare cases, endometriosis has been found in other parts of the body, such as the lungs, brain, and skin.

What are endometriosis causes?

The cause of endometriosis is unknown. One theory is that the endometrial tissue is deposited in unusual locations by the backing up of menstrual flow into the Fallopian tubes and the pelvic and abdominal cavity during menstruation (termed retrograde menstruation). The cause of retrograde menstruation is not clearly understood. But retrograde menstruation cannot be the sole cause of endometriosis. Many women have retrograde menstruation in varying degrees, yet not all of them develop endometriosis.

Another possibility is that areas lining the pelvic organs possess primitive cells that are able to grow into other forms of tissue, such as endometrial cells. (This process is termed coelomic metaplasia.)

It is also likely that direct transfer of endometrial tissues during surgery may be responsible for the endometriosis implants sometimes seen in surgical scars (for example, episiotomy or Cesarean section scars). Transfer of endometrial cells via the bloodstream or lymphatic system is the most likely explanation for the rare cases of endometriosis that develop in the brain and other organs distant from the pelvis.

Finally, there is evidence that shows alternations in the immune response in women with endometriosis, which may affect the body's natural ability to recognize and destroy any misdirected growth of endometrial tissue.

Women might be more likely to get endometriosis if she has:
- Never had children
- Menstrual periods that last more than seven days
- Short menstrual cycles (27 days or less)
- A family member (mother, aunt, sister) with endometriosis
- A health problem that prevents normal passage of menstrual blood flow
- Damage to cells in the pelvis from an infection

What are endometriosis symptoms?

Pain  

Secondary dysmenorrhea is a typical symptom, condition worsen with lesion aggravating over time. The pain often occurs in lower back and lumbosacral area, and even vagina, perineum and legs, 1-2 days before menstruation. The most desperate pain is usually on the first day of the period and abates during the following days , the pain stops after the menstruation. The amount of pain corelate poorly with the extent of lesion., with some women having little pain despite having severe adhesion, while other women may have great pain even though they have only a few small areas of endometriosis. A few women may have a constant pain in lower abdomen, worsen with the menstrual cycle.

Irregular menstruation   

15%-30% of patient have heavy menstrual flow, prolonged menstrual periods, and spotting. Irregular menstruation may relate to ovarian lesion anovulation, luteal phase deficiency, adenomyosis, and fibroids.

Infertility   

Infertility rate of Patients with endometriosis is up to 40%. The reason of which may include:
①anatomical distortion: Adhesions between tissues and organs in pelvic cavity and Fallopian tubes peristalsis abate in patient with serious endometriosis affect the act of ovulation and fertilization.
②Ovarian dysfunction: Incidence of ovarian disease is 17%-27% in patients with endometriosis. It may relate to the rising of PGs in peritoneal fluid effects follicle growth and ovulation.
③Autoimmune reaction: B-lymphocytes produce EMAb interfere with the transportation and implantation of early fertilized egg. Macrophage in abdominal cavity swallow germs and interfere with egg cell division leads to infertility.

Painful sex   

Rectouterine pouch cause local tissue edema ,adhesion or fixed retroversion of uterus. Fornix of vagina during sex intercourse, uterine contraction and elevation may give rise to the pain, most obvious before the menstruation

Ovarian endometriosis ruptured cyst   

After cyst ruptured ,stale thick dark blood would flow into abdominopelvic cavity causes sudden gnawing pain with nausea , vomiting and anus bulge. Pain occurs before and after menstruation or after sex intercourse, the symptom of which similar with rupture of tubal pregnancy.

Other special symptom   

①rectal endometriosis: cause stomachache ,diarrhea, constipation minor hemafecia ,  hemorrhage due to intestinal mucosa hyperemia.
②endometriosis of the urinary system: ectopic endometrium violates bladder wall may cause painful urination and frequent urination during periods. Ectopic endometrium violates and oppresses ureter may cause pain on side of lower back and hematuresis ,but only in rare cases.
③endometriosis to abdominal wall scar after surgery: recurrent pain on the scar and enlarging of the lump months or years after surgery..
④The reports about endometriosis of other parts of body, such as lung, brain tissues and limbs are rarely seen.The symptoms of which is the recurrent pain at lesion parts and bleeding or forming lumps, and lead to corresponding symptoms.

How is endometriosis diagnosed?

Exams for diagnosing endometriosis includes:

Pelvic exam. Your doctor will perform a pelvic exam to feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are hard to feel.

Ultrasound. Your doctor could perform an ultrasound, an imaging test to see if there are ovarian cysts from endometriosis. During a vaginal ultrasound, the doctor will insert a wand-shaped scanner into your vagina. During an ultrasound of your pelvis, a scanner is moved across your abdomen. Both tests use sound waves to make pictures of your reproductive organs. Magnetic resonance imaging (MRI) is another common imaging test that can produce a picture of the inside of your body.

Laparoscopy. The only way for your doctor to know for sure that you have endometriosis is to look inside your abdomen to see endometriosis tissue. He or she can do this through a minor surgery called laparoscopy. You will receive general anesthesia before the surgery. Then, your abdomen is expanded with a gas to make it easy to see your organs. A tiny cut is made in your abdomen and a thin tube with a light is placed inside to see growths from endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope.

If your doctor does not find signs of an ovarian cyst during an ultrasound, before doing a laparoscopy, your doctor may prescribe birth control pills to control your menstrual cycle. Sometimes this treatment helps lessen pelvic pain during your period. Some doctors may offer another treatment that blocks the menstrual cycle and lowers the amount of estrogen your body makes before doing a laparoscopy. This treatment is a medicine called a gonadotropin (go-na-doh-TRO-pen) releasing hormone (GnRH) agonist, which also may help pelvic pain. If your pain improves on this medicine, the doctor will likely think that you have endometriosis.

Laparoscopy is often recommended for diagnosis and treatment if the pelvic pain persists, even after taking birth control pills and pain medicine.

How is endometriosis treated?

Western doctors believes that there is no cure for adenomyosis, there are just some treatments for the pain and infertility that it causes. Common treatments are as follow:

Pain medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may prescribe stronger pain relievers.

Hormone treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who do not have bad pain. Hormones come in many forms including pills, shots, and nasal sprays. Common hormones used for endometriosis include:
- Birth control pills
- GnRH agonists and antagonists
- Progestins
- Danazol

Surgery. Surgery is usually the best choice for women with severe endometriosis — many growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help. Your doctor might suggest one of the following:
- Laparoscopy
- Laparotomy or major abdominal surgery
- Hysterectomy

Appropriate herbal formulas can treat endometriosis syptoms as well, some even found able to clear up the lesion.

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