Which feature is typical of epididymitis?

• A. Sudden, severe testicular pain with a high-riding testis
• B. Absent cremasteric reflex
• C. Pain that worsens with heat
• D. Gradual onset scrotal pain with tenderness along the epididymis

Answer: (D)

Epididymitis typically presents with a gradual onset of scrotal pain and tenderness localized along the epididymis, usually felt as a posterior and posterolateral tenderness of the testis. This pattern reflects inflammation of the epididymal tail rather than an acute, generalized testicular process. In contrast, conditions like testicular torsion cause sudden, severe pain with a high-riding testis and often an absent cremasteric reflex, which help distinguish it from epididymitis. Heat itself isn’t a defining feature of epididymitis. Additional context, such as urinary symptoms or fever, can support an infectious/inflammatory etiology, but the key hallmark here is the gradual onset with focal tenderness along the epididymis.