Epididymis: Queue for sperm

Epididymis: Queue for sperm

Very few men (let alone women) know that the scrotum houses the testicles as well as the epididymis. These are particularly important for male fertility: This is where the sperm mature and wait for their “use”. What are epididymis, what diseases can affect them, and how can they be prevented?

How are the epididymis located?

The epididymis (epididymis, parorchis), together with the penis and testicles, belong to the male sex organs. Together with the testicles, they sit in the scrotum. Like a “C”, they run lengthwise down the back of the testicles from the upper end.

Each epididymis is about 5 cm long and contains a tightly coiled tube up to 6 m long, the epididymal duct (ductus epididymitis). The upper end, the head of the epididymis (caput epididymitis), is connected to the testicle via many small ducts, the testicular tubules (ductules efferents).

The middle section of the epididymis is called the body (corpus epididymitis). At the lower end follows the tail of the epididymis (Cauda epididymitis), which merges directly into the vas deferens. The vas deferens finally open into the urethra at the prostate level. The epididymis is closely connected to the testicles via connective tissue (mesepididymis).

The inside of the epididymal duct is lined with a tissue (cylindrical epithelium) that is densely covered with tiny “cilia” (stereocilia). Contractile myofibroblasts (connective tissue cells that contract) sit outside the epididymal head and body, and the tail is surrounded by smooth muscle cells. This allows the epididymal duct to contract and transport the sperm further.

 

What is the function of the epididymis?

The immature sperm cells travel from the testicles to the epididymis via the seminiferous tubules. Contact with the wall of the epididymal duct, the epididymal epithelium, is essential for later sperm mobility. The epithelium secretes glycoproteins, which are molecules of sugar and protein. The surface of the sperm cells absorbs these.

Contraction of the myofibroblasts transports the sperm from the head, through the body, to the epididymis’s tail over about 12 days, where it is eventually stored. When the smooth muscle of the caudal epididymis contracts, sperm are transported through the vas deferens to the urethra and finally expelled during ejaculation. Incidentally, the sperm cells only reach their final fertilization capacity in the female genital tract.

The so-called capacitation, triggered by estrogen in the female body, enables the sperm to penetrate the envelope of the female egg.

What diseases are related to the epididymis?

The epididymis can be affected by various diseases. For example, a palpable lump in the epididymis can indicate a cyst (spermatocele). A painless swelling of the epididymis usually accompanies the epididymal cyst. It is a benign change that only requires treatment if it causes symptoms. In addition, inflammation and other complaints can occur in connection with the epididymis, for example.

 

Inflammation of the epididymis (epididymitis)

The most common disease is epididymitis. The epididymis are painful and very swollen, and the skin of the scrotum is red. The pain often radiates to the groin area. Moderate fever is standard, rarely high. In most cases, the person affected feels generally ill and battered.

If there is a urinary tract infection simultaneously, there is also pain when urinating and a constant urge to urinate. Epididymitis is usually caused by bacteria that migrate into the epididymis from the urinary tract, the prostate or the testicles.

In younger men, it is primarily sexually transmitted germs such as chlamydia or the pathogens that cause gonorrhoea (“clap”) that trigger epididymitis. In older men with an enlarged prostate, the bladder often does not empty. Bacteria multiply quickly in the residual urine that remains in the bladder. The high pressure with which those affected empty their bladder creates excess pressure, which causes the bacteria to travel up the urethra and vas deferens into the epididymis.

The most common pathogens are Escherichia coli, enterococci, Proteus mirabilis, Klebsiella and Pseudomonas aeruginosa. Wearing a urinary catheter for an extended period also promotes epididymitis. Bacteria penetrate relatively quickly through the thin catheter tube, which leads directly into the urinary bladder and reaches the epididymis via the vas deferens.

Children and adolescents rarely have epididymitis. Twisting of the testicles (testicular torsion) is often the cause of pain and discomfort in the testicle area. If you suspect it, consult a doctor immediately; a testicular torsion must be operated on directly. Otherwise, the testicle will die due to lack of blood flow.

Although epididymitis is often bacterial, contusion or blows to the epididymis cause an inflammatory response.

Depending on the trigger, the therapy is carried out with antibiotics, which inhibit bacterial growth. The sometimes significant pain is treated with anti-inflammatory painkillers. Bed rest, elevation of the testicles, and cooling are also helpful. Wearing tight underpants is also comfortable for most of those affected. It can take up to 6 weeks for epididymitis to heal completely.

If the epididymitis is not treated consistently, it becomes chronic, possibly spreading to the other epididymis or the testicles (epidymorchitis). In the case of bilateral epididymitis, the epididymal tubules or the vas deferens can become blocked – which leads to infertility (occlusive azoospermia) and may have to be remedied in an operation if you want to have children. Very rarely, in particularly severe chronic cases, the epididymis is surgically completely removed (epididymectomy).

Von Hippel-Lindau disease

This sporadic, hereditary disease usually occurs between the ages of two and four decades. Tumours form in various organs, most commonly in the eyes and the central nervous system. But the genitals can also be affected. In men, z. B. Benign tumours, so-called cystadenomas, are possible on the epididymis. This can be felt as a firm, cherry-sized swelling above the testicles or diagnosed with an ultrasound. These benign tumours are only operated on if they B. block the vas deferens and thereby lead to infertility.

mumps

In 20 to 30% of all boys, orchitis, an inflammation of the testicles, occurs in connection with mumps disease – very rarely, this also spreads to the epididymis.

 

Prevention – protecting and supporting the epididymis

In most cases, epididymitis is mild and without permanent damage. To prevent the inflammation from spreading to the testicles or becoming chronic, those affected should consult a doctor immediately the first time symptoms appear and follow the prescribed therapy consistently. You should also take “harmless” urinary tract infections seriously and always cure them well so they do not spread to the epididymis.

By taking simple precautions when having sex – by wearing condoms – you will avoid sexually transmitted infections that can cause epididymitis. Since strong mechanical influences also promote epididymitis, you should wear a jockstrap when practising “risk sports” such as ice hockey.

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