Funiculitis is the medical term for inflammation affecting the spermatic cord, a structure in the male groin. The cord contains the vas deferens, blood vessels, nerves, and lymphatic channels. Inflammation in this area causes pain and discomfort, often requiring medical attention.
Understanding the Causes
The inflammation of the spermatic cord most frequently results from an infection that has spread from an adjacent structure, such as the epididymis, testicle, or urethra. Funiculitis is often seen alongside acute epididymitis, where inflammation extends from the epididymis into the cord itself. Bacterial infections are the most common underlying cause.
In sexually active males, the infection is often caused by sexually transmitted organisms like Chlamydia trachomatis or Neisseria gonorrhoeae. In older men, or those with underlying urinary tract issues, the cause is typically the retrograde ascent of common urinary tract bacteria, such as Escherichia coli. Less frequent causes include viral infections, like the mumps virus, or non-infectious causes such as trauma or post-operative complications following procedures like an inguinal hernia repair.
Recognizing the Signs
Symptoms center on the spermatic cord and scrotum, where patients experience localized pain and tenderness. This discomfort can radiate into the lower abdomen or groin region. A physical examination may reveal a palpable swelling or thickening of the spermatic cord, distinct from the testicle.
Scrotal swelling is a common finding, sometimes accompanied by redness or warmth. If the inflammation is due to a systemic infection, the patient may also experience generalized symptoms like fever and chills. Painful urination (dysuria) or pain during sexual activity can also occur, especially if the inflammation is linked to a urinary tract or sexually transmitted infection. These acute symptoms require prompt medical evaluation because they closely resemble testicular torsion, a medical emergency involving the twisting of the spermatic cord.
Diagnosis and Management
A medical professional will perform a physical examination, checking for tenderness and the characteristic thickening of the spermatic cord. Blood tests are often ordered to check for markers of infection, such as an elevated white blood cell count. A urinalysis and urine culture are also routinely performed to identify the presence and specific type of bacteria causing the infection.
The primary imaging tool used to confirm the diagnosis and rule out other serious conditions is a Color Doppler ultrasound. This test provides detailed images of the spermatic cord, showing increased blood flow (hyperemia) and thickening, which is characteristic of funiculitis. The Doppler ultrasound helps differentiate funiculitis from testicular torsion, which is characterized by reduced or absent blood flow and requires emergency surgery.
Management of funiculitis is conservative and focuses on addressing the underlying cause. If a bacterial infection is confirmed or suspected, the patient is treated with a course of antibiotics, such as doxycycline or ciprofloxacin, which must be completed entirely. Supportive care includes rest, scrotal elevation, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling. While pain symptoms may subside quickly, the complete resolution of swelling can take several weeks. Surgical intervention is reserved for rare complications, such as the formation of an abscess.