Painful Scrotum & Epididymitis

In the past two weeks, I’ve noticed blood streaks in my ejaculate. My testicles are a bit tender because I’ve had to wear a support/crotch harness at work (to prevent a fall), and it feels pretty uncomfortable to wear. Could I be doing any damage? Is there something I should do?

This sounds like a case of epididymitis.

Most men never notice the epididymus (pronounced “ep-e-DIh-deh-mus”) unless they have a problem with it, so don’t be surprised to learn you have one behind each testicle. Sperm are manufactured in the testicles all throughout a man’s life. When the sperm are ready to mature, they wait in the epididymis. When ejaculation occurs, the epididymis and spermatic tube contract, and force the sperm up from the scrotum, through the prostate (collecting food) and urethra, on the way out of the body.

Semen, which is a combination of sperms and prostate fluid, is usually whitish or light gray, and when healthy, a man’s semen should never have blood or yellowish fluid (pus). Most ejaculate volumes are about 1 TSP or so, and it is possible not to notice a change in color.

Problems with the epididymis

There are two main reasons for problems with the epididymis.

  1. Infection
    • Bacteria infecting the bladder can travel backwards down the spermatic duct and infect the small organ. Usually the infectious agents are E. coli or Klebsiella sp, and the person might experience fever, chills, scrotal pain, painful urination and blood in semen.
    • Infections acquired during sexual activity can also travel down the spermatic duct. The most common infections are Chlamydia and/or N. gonorrhea. While many men can be infected with these agents and have no symptoms, if the epididymis is involved there is often testicular pain and swelling of the scrotum.
  2. Mechanical Trauma
    • Men who experience prolonged compression of the epididymis/scrotum, or repeated abdominal straining (lifting, or difficult bowel movements) can force otherwise normal urine back through the spermatic ducts. The urine is chemically irritating to the epididymis, and can cause inflammation even though there is no infection present.
    • Post-surgical complications involving manipulation of the spermatic duct can cause a non-infectious inflammation of the epididymis.

The blood in your semen could be due to mechanical compression and epididymal irritation/inflammation from the harness you’ve been wearing (mechanical trauma to the scrotum), since it sounds from your description that the fall-prevention harness has applied a tight pressure against your scrotum. It is also possible that if you are doing heavy lifting/straining, urine might be pressurized backwards into your epididymis, causing a chemical irritation.

You need to be evaulated by a health professional and undergo a complete examination including a scrotal and prostate exam. From there, they can determine whether there is an infection (and where) and further therapies (antibiotics, anti-inflammatories, ice packs and elevation of the pelvis above heart level–lying down on a slanted surface) need to be pursued.

Don’t put an evaluation off. It is much easier to remedy when problems are caught early, and abcess formation or infertility are possible complications if you ignore it. Also, see whether there is another type of harness available to you that can protect you from a fall and still allow less constriction of your genital area. Rock climbing harnesses, for example, can be worn all day and allow much more room and comfort for your genitals.