Testicular Self-Examination – A Matter of Great Importance

Note: This article uses the term “male” to refer to the anatomy of cisgender men. However, it is important to remember that genitalia do not define gender (which is primarily true for intersex and transgender people—both binary and nonbinary). This text may be useful to people other than cisgender men, but it may increase gender dysphoria.

Testicle structure

Before we move on to more pleasant matters, namely the actual testicular examination, I will first take you on a trip to junior high school (for younger readers, it will probably be elementary school) so that we can refresh our memory of the intricacies of the anatomical structure of the male reproductive organs. So let's start with the basics: the male reproductive system is divided into internal and external genitalia. The former consist of: the testicles (the heroes of today's episode of We'll Explain ), the epididymis, the seminal vas, the seminal vesicles, the bulbourethral glands, and the prostate. The external genitalia are the penis and the scrotum (equally important from the point of view of taking care of the health of the testicles).

The testicles themselves, whose primary task is to produce sperm and testosterone (the male sex hormone), are located in the scrotum. It is located outside the body cavity, allowing our heroes to do their job. The positioning of the testicles in the scrotum results from the fact that they need a temperature 3 to 5 degrees lower than body temperature to produce male gametes. Sperm are produced in the seminiferous tubules, which are the main components of the testicles, and then migrate to the epididymis, where they mature and wait for a call to action. The prostate and seminal vesicles, responsible for producing other substances that make up sperm, also play important roles.

Why is it worth examining your testicles yourself?

Asking questions is not a bad idea – and this is quite an important question. Regular self-examination of the testicles will allow you to familiarize yourself with their structure, which will be extremely helpful in detecting any disturbing pathological changes or swelling. Self-examination of the testicles increases the chances of early detection of neoplastic changes leading to the development of testicular cancer, the treatment of which is most effective in its early stages.

Also read our article about male hormonal changes: Andropause – the hormone is not your servant .

How to Examine Testicles? Step by Step

This painless test should be done every 4 weeks (pick a date that's easy to remember, like the 1st of each month), and it's best to start when you're a teenager. It involves a close look and touching of the scrotum, so there's nothing to be afraid of! The timing of the test is also important. The skin of the scrotum relaxes during or right after a warm bath or shower. This makes it easier to feel and locate any potential lumps or bumps. So jump in the tub or shower, relax, and check, check!

• Examine one testicle at a time, preferably in a standing position.
• Grab the scrotal sac at the base of the penis with your fingers. You will feel the spermatic cord between your index finger and thumb – don't worry, it should be there. :) Squeeze lightly so that the testicles don't move too much during the examination.
• With your free hand, gently roll your testicle between your fingers to look for any irregularities or lumps. Examine it from all sides. You may feel a small lump at the top – don’t worry, it’s just your epididymis, which should be there.
• Repeat the test with the other testicle.

The lumps come in various sizes – they can be as big as a grain of rice or a green pea. As I mentioned, the test itself is painless, but if you feel discomfort or pain during the test, notice swelling in the scrotum or feel the lumps or thickenings, see your doctor immediately.

Testicular Examination – Which Doctor?

A urologist is responsible for diagnosing and treating testicular diseases, as well as other parts of the male reproductive organs. Therefore, if we notice any worrying changes in ourselves, we should go to this specialist. Some people shudder at the thought of such a visit, but there is really nothing to be afraid of!

What does the examination and the visit itself look like? At the beginning, the doctor will ask about the reason for the visit, so it is good to remember or even write down all the ailments that prompted us to go to the urologist. If you are taking any medications, prepare a list of them, and in the case of previous surgeries - take your medical history with you.

Testicular examination

The rest of the visit depends on what condition the urologist diagnoses. The basic form of diagnostics is a testicular ultrasound. What does it look like? It is usually performed in a lying position. The doctor then applies a special gel to the scrotum, allowing him to efficiently move the head of the device in search of irregularities. The scrotal ultrasound device emits ultrasonic waves that bounce off the internal organs and are then converted into an image displayed in real time on the device's screen. First, the doctor will examine a healthy testicle, and then move on to assess the testicle in which the examination found some worrying changes.

Testicular ultrasound, which is also extremely helpful in diagnosing infertility, takes very little time, and the gel used during the examination does not leave marks on clothing. However, some people take spare underwear with them in case of contact with a lubricant. We receive the results immediately, and the doctor discusses them with us immediately after the examination and answers any questions related to the health of our reproductive system. He may then recommend repeating the testicular ultrasound or suggest extending the diagnostics, for example with an ultrasound of the lymph nodes.

Healthy Testicles – Hygiene and Prevention

Before we move on to the less positive effects of visiting a urologist, let's first look at ways to keep our "jewels" in good condition :) Healthy testicles are similar in size, and one of them may be located slightly higher in the scrotum. Unfortunately, there are no magic pills that we can take to prevent the development of testicular cancer. The only thing we can do to detect it as early as possible is to examine our testicles. However, studies conducted on the prevention of testicular cancer show that only 1 in 10 men regularly perform self-examinations.

There are many different factors that affect the health of your testicles. Here are some of the negative ones:

• High temperature – the testicles do not like to overheat, and they function best, as I mentioned above, at a temperature about 4 degrees lower than body temperature.
• Tight underwear or pants – tightness also causes the testicles to overheat, which significantly reduces their productivity.
• Sedentary lifestyle – people with sedentary jobs are advised to take regular breaks to stretch their legs and give their testicles some freedom ;)
• Lack of proper hygiene.
• Alcohol, stimulants, fast food – I guess I don't need to remind anyone that these substances have a negative impact on our entire body ;)

Testicular cancer

Testicular cancer, especially its malignant variety, accounts for 1% of all cancers in men, but its incidence has been steadily increasing over the past decades. In Poland, it is diagnosed in about 800 people of all ages each year. The group most at risk is between 20 and 39 years of age, but an increased susceptibility to developing malignant testicular cancer is observed in 15-year-olds.

Testicular Cancer - Risk Factors

The exact cause of testicular cancer is not fully understood, but there are many factors that increase the likelihood of developing the disease. Here are some of them:

• a history of cancer in the other testicle,
• cryptorchidism – a congenital defect in which the testicles do not descend into the scrotum,
• prolonged contact with certain chemical substances,
• genetic load,
• Klinefelter syndrome – extra X chromosome,
• microcalcifications,
• hypospadias,
• fertility disorders.

Testicular Cancer - Symptoms

Symptoms of testicular cancer increase with the progression of the disease. The cancerous testicle is usually enlarged, hard, and seems heavier. However, there is no pain. You can observe a slight redness of the scrotal sac, and in the later stages - also swelling of the scrotum. Palpable lumps sometimes appear on the testicles, and the scrotum itself significantly enlarges. Ignoring these symptoms can lead to dangerous metastases, which result in many complications, such as chronic cough, shortness of breath or hemoptysis (lung metastases) or neurological problems (brain metastases).

Testicular Cancer – Treatment

As I mentioned earlier, testicular cancer has a relatively high cure rate, provided it is detected early enough. Depending on the stage of the disease, both surgical procedures and radiotherapy and chemotherapy are used, but the most common first stage of treatment is orchidectomy, which involves removing the testicle affected by the cancer. Don't worry - one testicle will be perfectly capable of producing sperm and testosterone. Before the procedure, however, it is worth considering the possibility of freezing your sperm in case it metastasizes to the other testicle. The next steps taken by specialists depend on the type of cancer itself and its stage of advancement.

Other Testicular Diseases

As if cancer wasn't enough, our sensitive testicles are susceptible to many other ailments:

• Acute testicular torsion – this is the common name for an acute twist of the spermatic cord, which happens to physically active men between the ages of 14 and 18. The testicle then rotates around its own axis, which causes sudden, sharp pain and a cut-off of blood supply (this is sometimes called testicular infarction), which can ultimately lead to amputation of this organ. Thanks to a sufficiently quick reaction and surgical rotation of the testicle (ideally within 6 hours), it is usually possible to save it.
• Development of varicocele – blood vessels responsible for draining blood from the spermatic cords sometimes lose their patency, which results in slower blood flow and the formation of varicoceles. The consequences of this condition are overheating of the testicles and disorders in sperm composition and hormonal balance, and over time also severe pain in the groin.
• Testicular inflammation – usually develops as a result of bacterial inflammation of the epididymis. Typical symptoms of this disease include: testicular pain, redness and swelling of the scrotum, as well as those characteristic of urinary tract infections (for example, painful urination).
• Inguinal hernia – this is not a disease of the testicle itself, but a condition in which the hernia moves towards the scrotum, creating a so-called hernia sac – then we talk about a scrotal hernia; in other words – fragments of internal organs are in places where they should not be. With an inguinal hernia, we can experience pain radiating to the testicle when lifting weights, coughing or standing for a long time. The only way to treat a hernia is surgery.

It is impossible to express the importance of such a mundane yet incredibly important activity as a self-examination, but I would like to emphasize once again that your health is in your hands – literally! So from now on, pay attention to your gems a little more often. :)