Understanding the Impact of Chronic Epididymo-Orchitis and Chronic Prostatitis on Testicular Volume, Testosterone Levels, Semen Quality, and Sexual Function: A Prospective, Descriptive Study

Abstract

Introduction Chronic epididymo-orchitis (CEO) and chronic prostatitis (CP) are prevalent urological conditions that significantly impact male reproductive health. Despite their high prevalence, comprehensive studies evaluating their combined effects on testicular volume, testosterone levels, semen quality, and sexual function are limited. This study aims to bridge this gap by adopting an integrated approach to assess how these conditions influence these key parameters and their interrelationships. Methods This study was conducted at the Department of Urology, Institute of Post Graduate Medical Education & Research (IPGEMR), Kolkata, India, from February 2024 to January 2025. Male patients aged 18-60 years diagnosed with CEO and/or CP were recruited. Participants underwent baseline evaluations, including medical history, physical examination, blood tests for testosterone levels, semen analysis, and ultrasound imaging to assess testicular volume. Sexual function was assessed using a structured questionnaire developed based on established domains of male sexual function, including erectile function, sexual desire, orgasmic function, intercourse satisfaction, and overall satisfaction. Data were analyzed using descriptive and comparative statistical methods. Results The study included 153 participants, with 48 diagnosed with CEO and 105 with CP. The preliminary findings revealed several important insights. There was a significant reduction in both testicular volume and testosterone levels in men with CEO and CP, suggesting an association between these conditions and testicular atrophy and hormonal imbalances. Semen analysis showed a decrease in sperm count, motility, and morphology, indicating that CEO and CP can negatively affect fertility by impairing sperm quality. The structured questionnaire used to assess sexual function revealed that many participants experienced erectile dysfunction and painful ejaculation, which are common symptoms of these conditions. The study also found that changes in one parameter, such as testosterone levels, could influence others, like sexual function or semen quality. For example, lower testosterone levels were associated with poorer sexual function and reduced sperm quality. Conclusion This study is unique in its comprehensive approach to evaluating the multifaceted impact of CEO and CP on male reproductive health. By this integrated approach, this study contributes to a deeper understanding of the clinical manifestations and long-term consequences of these chronic urological conditions, particularly how each parameter (testicular volume, testosterone levels, semen quality, and sexual function) affects the others. The findings highlight the need for further research to explore the complex interrelationships between these parameters and their implications for male reproductive health.

Keywords: chronic epididymo-orchitis; chronic urological conditions; hormonal imbalance and male infertility; male reproductive health; questionnaire used to assess sexual function; sperm morphology; sperm motility; testicular volume testosterone levels semen quality sexual function erectile dysfunction testicular atrophy; ultrasound imaging testicular volume; urology andrology sexual health testosterone chronic prostatitis.

Figure 1. Comparison of mean values of semen volume, sperm concentration, total sperm count, motility, sperm morphology, and vitality between CP and CEO patients

CP: chronic prostatitis; CEO: chronic epididymo-orchitis

Figure 2. Relationship between sperm concentration and total sperm count in both CP and CEO patients

CP: chronic prostatitis; CEO: chronic epididymo-orchitis

Figure 3. Relationship between progressive sperm motility and total motility

Figure 4. Negative impact of antisperm antibodies on sperm vitality

Figure 5. Comparison of serum testosterone levels and antisperm antibody percentages between CP and CEO patients

The CP group (left) demonstrates lower mean serum testosterone (510 ng/dL) compared to the CEO group (600 ng/dL), while exhibiting reduced antisperm antibody positivity (80.9% vs. 89.6% in CEO). These findings highlight the distinct endocrine and immunological profiles characterizing these conditions, with CEO showing both higher androgen levels and greater autoimmune involvement. Error bars represent standard deviation. Statistical significance: p < 0.05 for testosterone; p < 0.01 for antisperm antibodies (two-tailed t-test). CP: chronic prostatitis; CEO: chronic epididymo-orchitis

Figure 6. Comparison of the mean Sexual Function Questionnaire scores (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) between CP and CEO groups

Green, solid line with circles represents the Sexual Functions Questionnaire scores for CP patients across different sexual function domains. Blue, dashed line with squares represents the Sexual Functions Questionnaire scores for CEO patients across the same domains. Sexual Function Domains (X-Axis) includes Erectile Function, Orgasmic Function, Sexual Desire, Intercourse Satisfaction, and Overall Satisfaction. Mean Score (Y-Axis) represents the average score for each domain, reflecting variations in sexual function between CP and CEO patients. Error bars represent standard deviation. Statistical analysis by independent t-test with Welch's correction for unequal variances. CP: chronic prostatitis; CEO: chronic epididymo-orchitis

Figure 7. Heatmap showing the correlation coefficients between key parameters such as testosterone levels, testicular volume, sperm parameters, and antisperm antibodies.