Pain in the scrotum with a sudden onset and which is often intense can also be caused by epididymitis, or inflammation of the epididymis. This kind of caused is produced by a bacterium that has spread from the urinary tracts to the seminal duct and from there to the epididymis. Nowadays in younger people this is almost always chlamydia tracho­matis, which is transmitted through sex. In the case of an inflammation of the epididymis, an extremely painful swelling develops at the back of the testicle, and soon afterwards the scrotum becomes hard and swollen. Anyone continuing to suffer in silence runs the risk of the testicle itself and hence fertility being affected. Inflammation of the epi­didymis is easy to treat with antibiotics, but if there is any doubt about the cause the gp will generally send his or her patient along for a urine culture to check what micro-organism has caused the inflammation of the urinary tracts. Experience shows that many men with an inflamma­tion of the epididymis are not treated in time, or for long enough or with the wrong antibiotic, with the result that the infection may spread to the testicle itself, causing epididymo-orchitis. Complications include abcesses and the risk that after ‘recovery’ one is left with a ‘shrivelled testicle’. It is also important that the patient rest as far as possible, and it is sen­sible to support the scrotum with a flannel containing ice, or an ice-pack.