Facts on File Encyclopedia of Health and Medicine

and surgical, can control symptoms and improve
fertility. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS), which block the inflammatory response
as well as relieve pain, are often adequate to treat
mild symptoms in women who wish to become
pregnant. HORMONE THERAPYis highly effective to
treat moderate to significant symptoms in women
who do not desire to become pregnant. Common
hormone therapies include

• estrogen and progestin in combination, such as
  oral contraceptives (birth control pills)


• progestin alone, such as in progestin oral con-
  traceptives or DepoProvera injections


• danazol, an androgen analog (synthetic, weak
  male HORMONE) that suppresses the menstrual
  cycle


• GONADOTROPIN-RELEASING HORMONE(GNRH) antag-
  onists such as leuprolide, which shut down the
  ovaries to prevent them from producing estro-
  gen

Laparoscopic surgery to remove endometrial
implants from pelvic structures and the peritoneal
cavity may be the only treatment that effectively
mitigates symptoms in women who have severe,
disabling endometriosis. Therapeutic laparoscopy
for endometriosis can provide long-term relief.
However, it does not remove distant endometrial
implants, which often continue to produce symp-
toms. As well, endometrial implants will regrow if
a few endometrial cells remain.

Risk Factors and Preventive Measures

Factors that increase a woman’s risk for
endometriosis are unclear. Because endometriosis
tends to run in families, researchers believe it may
be the result of GENETIC PREDISPOSITIONin combina-
tion with other, undetermined factors. However,
any woman who menstruates can develop
endometriosis. There are no measures to prevent
endometriosis.
See also ANALGESIC MEDICATIONS; ENDOSCOPY;
MACROPHAGE; MONONUCLEAR PHAGOCYTE SYSTEM;
PHAGOCYTOSIS; SURGERY BENEFIT AND RISK ASSESSMENT;
UTERINE FIBROIDS.

epididymitis INFLAMMATION of the EPIDIDYMIS,
nearly always due to INFECTION. The epididymis is a

tightly coiled tubule that begins at the base of the

testicle and ends at the VAS DEFERENS. The epi-

didymis incubates newly formed SPERM, bringing

them to maturation as they migrate through its

coils on their journey to the vas deferens.

ESCHERICHIA COLIINFECTION, CHLAMYDIA, andGONOR-

RHEAare the most common causes of epididymi-

tis—E. coliin young boys and men over age 60;

chlamydia and gonorrhea in men between ages 25

and 50. Repeated infections may result in perma-

nent INFERTILITY.

Symptoms typically include scrotal PAIN and

swelling, discharge from the PENIS, and difficulty

urinating. Some men also experience FEVER, NAU-

SEA, and pain extending into the sides of the

abdomen (the flank area). The diagnostic path

includes examination to rule out TESTICULAR TOR-

SIONand culture of the discharge to identify the

responsible PATHOGEN. Treatment is a course of the

appropriate ANTIBIOTIC MEDICATIONSwhen the infec-

tion is bacterial. As with all infections, it is essen-

tial to complete the entire prescribed course of

antibiotics even when symptoms improve. Less

commonly, viruses (such as the MUMPS VIRUS) may

cause epididymitis. Viral epididymitis resolves

without treatment (antibiotic medications cannot

treat viral infections).

The doctor may recommend ANALGESIC MEDICA-

TIONSsuch as acetaminophen or NONSTEROIDAL ANTI-

INFLAMMATORY DRUGS(NSAIDS) such as ibuprofen to

relieve discomfort and fever; NSAIDs can also

relieve inflammation. Ice packs or cold cloths

applied to the SCROTUMand supporting the scro-

tum such as by wearing an athletic supporter may

also provide relief.

See also ABSCESS; HEMATOSPERMIA; ORCHITIS; SEXU-

ALLY TRANSMITTED DISEASE(STD) PREVENTION; URETHRI-

TIS.

episiotomy A surgical incision through the tis-

sues of the PERINEUMto extend the opening of the

VAGINAduring CHILDBIRTH. The most common types

of episiotomy are the midline (median) incision,

which extends from the vaginal opening toward

the ANUS, and the mediolateral incision, which

extends from the vaginal opening diagonally to

either side. The obstetrician numbs the tissues of

the perineum with an injected local anesthetic (if

the woman does not already have epidural anes-

episiotomy 277