Epididymal and Semen Abnormalities: Diagnosis and Treatment of Inflammation and Tumors and Analysis of Semen Quality

The epididymis is located in the scrotum, attached to the upper end and posterior border of the testis. It is composed of many convoluted tubules that converge at the end to form the epididymal duct, which is continuous with the vas deferens. In addition to temporarily storing sperm, the epididymis also secretes fluid to provide nutrients for sperm and promote sperm development. Once the epididymis is infected by bacteria, it will develop into epididymitis. (1) Clinical manifestations ① Acute epididymitis. The scrotum suddenly experiences severe pain that spreads to the lower back. The epididymis swells rapidly, up to twice its normal size. The skin of the scrotum is also red and swollen, making it difficult to even walk. At the same time, the patient will experience chills and general malaise. ② Chronic epididymitis. It usually develops into a chronic process because the acute process was not completely cured. There will still be a dull pain and discomfort in the local area. A hard lump can be felt when touching the epididymis. The vas deferens and spermatic cord are also slightly thickened. (2) Treatment: Whether it is acute or chronic epididymitis, it should be treated thoroughly. ① Choose effective antibiotics: Erythromycin, ampicillin, doxycycline, and cephalosporins are generally effective, but the dosage must be sufficient. It is best to continue medication for 3-4 days after symptoms disappear. ② Bed rest is recommended. If walking is necessary, use a cloth scrotum support to elevate the vulva to prevent aggravation of local inflammation. ③ Avoid smoking, alcohol, and spicy foods to prevent local congestion. ④ Abstain from sexual intercourse to avoid congestion of the sexual organs and promote recovery. With timely and thorough treatment of epididymitis, most patients will not experience infertility due to blockage of the vas deferens in the epididymis.

Epididymal tumors are relatively rare, occurring most frequently in sexually active young patients aged 20-40. Benign tumors account for about four-fifths, while malignant tumors account for one-fifth. They are mostly unilateral, with the left side more common than the right (approximately 3:2). Lesions often occur in the tail of the epididymis, but can also occur simultaneously in the testis and epididymis. Most lesions are less than 2 cm in size. Benign tumors have a smooth surface, are round or oval, have a firm, elastic texture, clear borders, are not adherent to surrounding tissues, grow slowly, and are not tender. Malignant tumors have an uneven surface, are nodular, hard, and gradually enlarge. Epididymal tumors generally cause no discomfort, making them difficult to detect. Most patients present with a scrotal mass. As the tumor enlarges, a feeling of heaviness or mild pain may occur in the groin and lower abdomen, which is exacerbated by prolonged standing or exertion. If a malignant tumor metastasizes to the retroperitoneal lymph nodes and compresses adjacent tissues, it can cause abdominal pain or lower back pain, and sometimes gastrointestinal obstruction; metastasis to the lungs can cause cough and hemoptysis; metastasis to the kidneys can cause hematuria. This disease should be differentiated from epididymal tuberculosis, chronic epididymal inflammation, and seminal vesicle cysts. Epididymal tumors should be surgically removed early, and frozen section examination can be performed if necessary. Benign tumors can be simply removed, while malignant tumors require orchiectomy with high spermatic cord transection at the internal inguinal ring, followed by retroperitoneal lymph node dissection or radiotherapy. Surgical outcomes for benign epididymal tumors are good, while the prognosis for malignant tumors is poor.

Standards for judging whether semen is normal: Normal semen volume (per ejaculation): 1.5–6 ml. Liquefaction time: 5–45 minutes. pH value: 7–8. Viscosity: After liquefaction, it may form droplets. Agglutination: No obvious agglutination. Sperm density: Greater than 20 million/ml. Total sperm count: Greater than 40 million. Motility: Greater than 60%. Motility: Grade III, most motile sperm move forward in a straight line. Normal sperm morphology: Greater than 70%. White blood cells: Less than 10 per high-power field under a microscope. Semen, as the carrier medium for transporting sperm, must be a neutral or slightly alkaline liquid with a certain volume to buffer the acidic environment of the female vagina. Ejaculatory duct obstruction or severe accessory gland inflammation can cause insufficient semen volume. Accessory gland inflammation can alter pH and liquefaction time. The presence of antisperm antibodies can cause obvious agglutination of semen.

Under normal circumstances, a man ejaculates 2-6 ml of semen during each sexual intercourse. The amount of semen ejaculated is related to age and frequency of sexual activity. Generally, men aged 20-35 ejaculate slightly more semen during intercourse, while men over 40, especially over 50, ejaculate less semen per intercourse. The first intercourse after a long separation (with no history of nocturnal emission within one week prior to intercourse) will result in a particularly large amount of semen ejaculated, sometimes exceeding 6 ml. Shorter intervals between sexual encounters result in a smaller amount of semen ejaculated, and with age, the amount of semen ejaculated will be even smaller. Sometimes, it takes considerable effort to ejaculate even a small amount.

Semen is a mixture of sperm produced by the testes and fluids secreted by the prostate gland and bulbourethral glands. Secretions from the prostate gland, bulbourethral glands, and seminal vesicles account for more than 90% of semen volume. These fluids protect the sperm and assist them in entering the cervix. Under normal physiological conditions, the amount of semen ejaculated each time remains relatively constant. However, when the prostate gland, seminal vesicles, or bulbourethral glands become inflamed, the amount of semen may temporarily increase due to the exudation of inflammatory secretions. As the inflammation progresses, the secretory function of the prostate gland and other glands is impaired, and the amount of semen actually decreases. Patients often experience penile pain during intercourse or urethral pain after intercourse, continuous dribbling of semen, and some may also experience hematospermia, pyospermia, increased or decreased libido, and nocturnal emission. If a large amount of semen is ejaculated, inflammation of the prostate gland, seminal vesicles, or bulbourethral glands is highly likely, and prompt medical attention is necessary. If the inflammation has not progressed to a severe stage, adequate antibiotics (used under the guidance of a doctor) can lead to a relatively quick recovery. If left untreated, the inflammation can develop into a chronic condition, which will not only make treatment more difficult, but may also cause the patient to lose their fertility if the condition progresses to a certain stage.

Oligospermia is defined as ejaculating less than 1 ml of semen each time, and it is one of the causes of infertility. In Traditional Chinese Medicine, it falls under the categories of "low sperm count" or "low sperm motility." The key diagnostic points for oligospermia are: less than 1 ml of semen ejaculated each time during intercourse; congenital factors often involve low sperm count or azoospermia; acquired factors often involve low sperm quality; physical examination may reveal testicular and seminal vesicle hypoplasia, and inflammation of the prostate and seminal vesicles.