Travel Reference
In-Depth Information
Fewmalegenitalproblemsappearwithsufficientspeedoratanageyoungenoughtocause
problems in mountaineering situations. Two exceptions are acute epididymitis and torsion
of the testes, two entirely different disorders that have similar features and may be difficult
to distinguish, even for a physician.
Epididymitis and Testicular Torsion
Epididymitis is an inflammatory disorder of the epididymis, an organ adjacent to the
testisinwhichspermcollectbeforepassingthroughthevasdeferenstotheseminalvesicle.
Epididymitis sometimes is the result of gonorrheal infection, but cultures are rarely taken
from the inflamed tissues. Most epididymitis probably has no relation to sexually transmit-
ted infection; many cases may not result from infection.
Torsion refers to twisting of the testis within the scrotum. The spermatic cord, which
containsthevasdeferensandthearteriesandveinssupplyingthetestis,alsoistwisted,and
lieved, which usually requires surgery, the testis is deprived of its blood supply and “dies”
within a few hours.
Figure 21-2. Testicular disorders
Both of these disorders are quite painful. The scrotum is often distended and may be in-
flamed, particularly with epididymitis. The testis is usually swollen and quite tender. The
pain of testicular torsion may appear rapidly; epididymitis usually develops more slowly.
Anenlarged,firm,nodularepididymismaybefeltwithepididymitis.Elevationofthescro-
tum is frequently helpful with epididymitis; elevation of the scrotum usually does not help
relieve the pain of testicular torsion. With testicular torsion, the testis may be higher in the
scrotum than the opposite testis because twisting shortens the cord.
Bothdisordersaretoopainfulforvigorousactivity.Hotbathsarehelpfulforepididymit-
is but would usually be impossible in a wilderness situation. Ciprofloxacin (Cipro®) or le-
vofloxacin (Levaquin®) should be administered to individuals older than thirty-five years
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