How To Do a Self-Exam & When To See a Doctor

What Is a Testicular Exam?

A testicular exam is a check of the look and feel of your testicles, to see if there may be any problems. You or your doctor can do it.

The testicles are part of a man’s sex organs. They’re in a pouch called the scrotum, located behind and below the penis. They make sperm and the male hormone testosterone.

Who Needs a Testicular Exam and How Often?

Every man should have a testicular exam. There is no recommendation that a testicular exam should be part of your annual physical exam. But your doctor may suggest that you do a self-exam on a regular basis. Some doctors recommend checking your testicles once a month. Others say it’s fine to have your doctor check once a year.

If you are having problems, or notice a lump or other changes in how your testicles feel or look, tell your doctor.

Exams can be a good way to find lumps that could be cancer or another problem.

How to Do a Testicular Exam

There’s no harm in a self-exam, and doctors say it’s good to know how your testicles look and feel so you can notice any changes.

A self-exam is quick and painless. It takes only a few simple steps:

1. Take a warm shower or bath to allow the heat to relax the skin of your scrotum.
2. Hold your penis out of the way.
3. Examine one testicle at a time using both hands. Roll it between your thumb and fingers.
4. Feel for a pea-sized lump. If you see or feel something like that, contact your doctor. It’s probably nothing to worry about, but it’s important you make note of it.
5. Check for any changes in the size, shape, or feel of your testicles. One might be of a different shape or size than the other. That’s OK, but the shapes and sizes shouldn’t change. One might hang lower than the other. That’s normal, too.

Don’t worry if you feel a cordlike structure behind each testicle. It’s a normal part of the part of the scrotum that stores and moves sperm. It’s not a lump.

Is It Testicular Cancer?

If there is a suspicious lump, your doctor might run a painless ultrasound to get a better look for signs of cancer. They might do a blood test to see if there’s an indication of cancer. If the doctor thinks it may be cancerous, they may decide to do surgery to remove the testicle and check for cancer. If it is cancerous, they can determine what kind.

Removing one testicle shouldn’t impact your sex life or your fertility, but having testicular cancer or its treatment could impact fertility. If you think you may want to have children, talk to your doctor about preserving sperm before treatment.

Here are some facts to know about testicular cancer:

It’s rare: Your chance of getting it is about 1 in 250.

It most often affects men ages 15 to 34: It’s the most common cancer in this group.

It’s highly curable: The risk of dying from it is 1 in 5,000.

Early identification is key: It’s more likely to be treated and cured if it’s found early.

Some things increase your risk: Testicular cancer generally can’t be prevented, but some things increase risk. Your risk is higher if you’re white and non-Hispanic or have an undescended testicle or a family history of testicular cancer.

Other symptoms of testicular cancer

A lump is the most common symptom, but others include:

• Firm testicle
• Swelling or fluid buildup in the scrotum
• Feeling of scrotal heaviness
• Achiness in the lower belly, groin, or scrotum
• Breast tenderness or growth
• Pain or uncomfortable feelings in the testicle or scrotum
• Back pain
• Early puberty in boys

A lump or other symptom doesn’t mean you have cancer or any other problem.

Doctor’s Orders: Have the Balls to Visit a Urologist

Wikimedia.

As men get older, some of the most common health problems they develop are related to their bladder and prostate. There are a number of symptoms men may develop and not understand what they mean or why they are having them. Therefore, it is important to be on the lookout for some of the most common conditions and get checked to see if they need further treatment. Many men go on living with symptoms that may be underlying problems to larger conditions that require treatment.

1. Hematuria (aka blood in the urine)

Blood in the urine is not normal. It may be an early warning sign of a number of serious health conditions, such as a bladder or kidney infection, kidney stones, kidney cancer, or bladder cancer. If you see blood in your urine, the urologist will start by doing a simple urine test called a urinalysis to test for the presence and amount of microscopic blood in the urine. They may also do a cystoscopy to look inside your bladder, or refer you for an x-ray or CT scan. Do not wait to see a urologist if you see blood in your urine. It usually means something is wrong and in that case, will not go away on its own.

2. Prostate exam (PSA test and DRE)

Check your PSA. PSA, or prostate-specific antigen, is a protein produced in the prostate. A PSA test, which is a simple blood test, can measure the level of PSA in the blood. A PSA that rises or is elevated, such as above 4.0 ng/mL, may indicate prostate cancer. However, the PSA test is not specific for prostate cancer. An elevated PSA could also mean an enlarged prostate or prostatitis (a prostate infection). Most doctors don’t test the PSA, except for urologists.

When should you start checking your PSA? Men should have a baseline PSA test starting at age 40 and check it annually. The risk for prostate cancer goes significantly up after 50, however men can develop it younger than 50. It’s especially important for men who are at a higher risk for prostate cancer to check their PSA. Men who have a higher risk for prostate cancer include African-American men, men over 50, and men who have a family history of prostate cancer. African-American men are often diagnosed with more aggressive prostate cancers, so it’s important to check it early and keep track of any changes in the PSA level. With early detection, prostate cancer is highly treatable and curable.

A DRE, or digital rectal exam, can detect growths or enlargement of the prostate. Any abnormalities, such as firmness, nodules, or other irregularities, may indicate prostate cancer. Men should have an annual DRE starting at age 40 to check for any changes in the prostate from the previous prostate exam. Again, men who have a higher risk for prostate cancer, such as African-American men and men with a family history of prostate cancer, should get tested annually.

While I stress that men should have an annual prostate exam starting at age 40, this does not mean you should worry if you are older. The risk of prostate cancer does go up after 50, but due to the possibility that men can be diagnosed and have been diagnosed earlier than 50, I think all men should start checking at 40.

3. Testicular pain or lump

Testicular pain occurs in or around one or both testicles. The pain felt in your testicles does not always mean the source is in your testicles; it could be pain caused by another area of the body such as in the abdomen or groin. Testicular pain may be caused by a number of different things including inflammation, hydrocele, kidney stones, inguinal hernia, scrotal mass, urinary tract infection, varicocele, or even testicular cancer.

A testicular lump is an abnormal mass in the testicles, and are actually pretty common. They can occur in both adult men and teenage boys. A testicular lump should not be ignored because while it may not always be serious, it is a sign that there is something wrong with the testicle. While most testicular lumps are caused by an injury, they can also indicate a varicocele, hydrocele, epididymal cyst, testicular torsion, or testicular cancer. If it is testicular cancer, do not panic. With detected early, testicular cancer is highly treatable and curable.

So, if you are experiencing mild testicular pain that lasts longer than a few days, or you feel a lump or swelling in or around a testicle, see a urologist.

4. Kidney pain or mass

If you are experiencing abdominal pain, your primary care doctor may refer you to have a CT scan or an ultrasound. While the scan may or may not show what is causing the pain, it can identify if there is a mass on the kidney. If a mass has been found in your kidney, do not let anyone do a biopsy the mass until you have seen a urologist. While it is assumed that the mass could be kidney cancer, it can also mean a cyst (fluid-filled sac), an infection, or hydronephrosis (partial blockage of kidney). It’s important to see a urologist before having your kidney biopsied in order to rule out other causes of the mass. A urologist may do a urine cytology, a cystoscopy, additional blood work, or order additional scans to check what could be causing the mass.

5. If you and your partner are having trouble conceiving

In order to get your partner pregnant, you must be able to produce healthy sperm (which is produced in the testicles), sperm have to be carried into the semen, there must be a good sperm count (higher than 15 million sperm per milliliter), and your sperm must be well-functioning and have good motility. So if you and your partner are having trouble conceiving, it could mean that you are infertile. Checking for male infertility is also important because it could mean other serious health conditions too, such as a varicocele, infection, hormone imbalance, or testicular cancer. These conditions can often be missed by primary care doctors who will then refer men to a fertility doctor, who may also miss them.

Make sure you talk to your doctor about checking for any of the other health conditions so that you can determine what else might be causing the male infertility.

Dr. David B. Samadi is the chairman of urology and chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel’s Medical A-Team and the chief medical correspondent for AM-970 in New York City. Visit Dr. Samadi’s blog at SamadiMD.com

Testicular torsion – Diagnosis and treatment

Diagnosis

Your doctor will ask you questions to verify whether your signs and symptoms are caused by testicular torsion or something else. Doctors often diagnose testicular torsion with a physical exam of the scrotum, testicles, abdomen and groin.

Your doctor might also test your reflexes by lightly rubbing or pinching the inside of your thigh on the affected side. Normally, this causes the testicle to contract. This reflex might not occur if you have testicular torsion.

Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for your symptoms. For example:

• Urine test. This test is used to check for infection.
• Scrotal ultrasound. This type of ultrasound is used to check blood flow. Decreased blood flow to the testicle is a sign of testicular torsion. But ultrasound doesn’t always detect the reduced blood flow, so the test might not rule out testicular torsion.
• Surgery. Surgery might be necessary to determine whether your symptoms are caused by testicular torsion or another condition.

If you’ve had pain for several hours and your physical exam suggests testicular torsion, you might be taken directly to surgery without any additional testing. Delaying surgery might result in loss of the testicle.

Treatment

Surgery is required to correct testicular torsion. In some instances, the doctor might be able to untwist the testicle by pushing on the scrotum (manual detorsion). But you’ll still need surgery to prevent torsion from occurring again.

Surgery for testicular torsion is usually done under general anesthesia. During surgery, your doctor will make a small cut in your scrotum, untwist your spermatic cord, if necessary, and stitch one or both testicles to the inside of the scrotum.

The sooner the testicle is untwisted, the greater the chance it can be saved. After six hours from the start of pain, the chances of needing testicle removal are greatly increased. If treatment is delayed more than 12 hours from the start of pain, there is at least a 75 percent chance of needing testicle removal.

Testicular torsion in newborns and infants

Testicular torsion can occur in newborns and infants, though it’s rare. The infant’s testicle might be hard, swollen or a darker color. Ultrasound might not detect reduced blood flow to the infant’s scrotum, so surgery might be needed to confirm testicular torsion.

Treatment for testicular torsion in infants is controversial. If a boy is born with signs and symptoms of testicular torsion, it might be too late for emergency surgery to help and there are risks associated with general anesthesia. But emergency surgery can sometimes save all or part of the testicle and can prevent torsion in the other testicle. Treating testicular torsion in infants might prevent future problems with male hormone production and fertility.

Preparing for your appointment

Testicular torsion will likely occur as an emergency, leaving you little time to prepare. You’ll probably first be seen in the emergency room or by your family doctor. However, you’ll probably then be seen by a doctor who specializes in urinary tract problems and disorders affecting male genitals (urologist).

If you have some advance warning before you see the urologist, here’s some information to help you prepare, and what to expect from your doctor.

What you can do

• Write down any symptoms you’re experiencing, including any that might seem unrelated to the reason why you’re seeking treatment.
• Write down questions to ask your doctor.

Don’t hesitate to ask questions during your appointment. Some questions to ask your doctor include:

• Why did this happen?
• Are there other possible causes for my symptoms?
• What happens if I don’t have surgery?
• What are the possible complications of surgery?
• Are there any restrictions on activity that I’ll need to follow after surgery?
• How long after surgery will I have to wait to be sexually active?
• Will I be able to father children?
• How can I prevent this from happening again?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them might give you more time to go over your concerns. You might be asked:

• When did you first begin experiencing symptoms?
• What were you doing when you first started experiencing symptoms?
• Have your symptoms been continuous, or did they go away for a time?
• How severe are your symptoms?
• Does anything seem to improve or worsen your symptoms?
• Has anyone in your family ever had testicular torsion?
• Has this ever happened to you before?

Common “Testis” queries answered by top doctors

Recently Answered Questions

All the answers published in this website are written by Verified medical doctors, therapists and health experts. The Content has been moderated by iCliniq medical review team before publication. Post your medical clarifications on iCliniq by choosing the right specialty and get them answered. Your medical queries will be answered 24/7 by top doctors from iCliniq.

Are there any medicines to treat epididymal cysts?

Query:
Hello doctor,
I was operated for cryptorchidism when I was nine years. My left testicle is 3.5 by 2.5 cm. I feel this is too small.
Please suggest tablets to increase its size. I have epididymal cysts 7 cm long in both testicles. I have burning sensation and numbness and pain. Suggest tablets for …  Read Full »

Dr. Rakesh Kumar Bahunuthula

Answer:
Hello,
Welcome to icliniq.com.
The normal size of an adult testis is 3 by 4 cm with an approximate volume of 12 to 19 cc. Patients with a history of cryptorchidism may have a slightly smaller size of the testis at adult stage.
However, the size of the testis does not matter as long as the semen f…  Read Full »

Kindly explain about the benefits of Kegel exercise in sexual health.

Query:
Hi doctor,
I have these questions. Can you please help me to clarify?
1) Does pausing and resuming urine while flowing, improves sexual performance in men? Please tell me the procedure of this. And does this cause any side effects to urinary system?
2) What is the kegel exercise? I read some…  Read Full »

Dr. Seikhoo Bishnoi

Answer:
Hello,
Welcome to icliniq.com.
Please find following answers for your questions:
1) Pausing and resuming urine would only cause problems. This will not cause any improvement in sexual functioning. Better to avoid this completely. This could cause development of diverticula in bladder or urethra…  Read Full »

Will undescended testis descend on their own in babies?

Query:
Hi doctor,
My baby boy was born after full term pregnancy by surgery. His birth weight is 3.75 kg.  But, his both testicles are undescended. What are the chances that his testicles will descend on its own? For how long should I wait before further treatment?  Read Full »

Dr. Vijaykumar Mundeshi

Answer:
Hi,
Welcome to icliniq.com.
Most of the time in 98% cases, the testes will descend by 6 to 9 months of age.
But, I want you to get an ultrasound done to check the presence of testes and its position.
Revert back with the report to a paediatric surgeon online –> https://www.icliniq.com/ask-a-do…  Read Full »

Why do I have seminal leak and testis pain on excitement?

Query:
Hi doctor,
I am experiencing seminal leak and pain in left testis on excitement without sex. Situation worsens when excited after exercising. This seminal discharge is causing anxiety and pain. I am having this problem since last 10 years. Please help.  Read Full »

Dr. Purushottam Sah

Answer:
Hi,
Welcome to icliniq.com.
I have read and understood your problem.
It may be due to infection of epididymis or prostate.
You should do ultrasound of scrotum, prostate and also bacterial culture along with drug sensitivity of prostatic massage fluid, after which a course of suitable antib…  Read Full »

Why is my left testicle lower than the right?

Query:
Hi doctor,
I observed that my left testicle is lower than the right. I examined myself but found no lump. I am not experiencing any pain either. Is this normal?  Read Full »

Dr. Vivekanandan G

Answer:
Hi,
Welcome to icliniq.com.
You need not worry since this condition is quite normal.
Because of the late descent of left testis into the scrotum, the left testis is generally placed at a lower level compared to the right. This is totally normal and not harmful.
This, by no means, will affect you…  Read Full »

Why do I have testicular pain after lifting a heavy object?

Query:
Hello doctor,I am a 28 year old male. I have a dull pain in my right testicle leading to my abdomen. I believe it started when I lifted something heavy. At the moment, it is a dull pain but, if I feel it, then it is worse. I am currently out of my home country on work and do not want to go to a loc…  Read Full »

Dr. Pratyush Kumar

Answer:
Hello,
Welcome to icliniq.com.
I understand your concern regarding a pain in the right testicle after lifting a heavy object.
It would be helpful to know some more details. Does lifting the scrotum relieve you of the pain? Is there a history of fever?
In the case of an acute onset pain, it is advis…  Read Full »

Can a herniated disc cause testicular pain?

Query:
Hello doctor,
I am a 48 year old male. Ten days back, I noticed that my testicles has moved up and are receding into my groin. I also have a dull pain in the testicles. This pain is not always there, but it happens on and off. I am worried that this may be a serious condition. Could you please l…  Read Full »

Dr. Jeremy David O’kennedy

Answer:
Hi,
Welcome to icliniq.com.
Sorry to hear about your pain.
The most important condition to exclude when a testicle becomes high-riding with associated pain would be testicular torsion (twisting and occlusion of blood supply to testicle). Torsion is however incredibly rare in older males and occ…  Read Full »

I would like a feedback on my semen analysis report.

Query:
Hello doctor,I would like to get a feedback on the semen analysis report.  Read Full »

Dr. Purushottam Sah

Answer:
Hello,
Welcome to icliniq.com.
I have gone through your reports (attachment removed to protect patient identity).
Your sperm count is normal, but the motility and normal forms are low. If you are taking any medicine or nutritional supplements on a regular basis, then it may be due to its side effe…  Read Full »

How difficult is it to remove a cyst from a testicle?

Query:
Hi doctor,
I am a 33 year old healthy male. I have had cyst in my testicle as long as I can remember. It just aggravates me and bothers me. But, I am too embarrassed to go in person to get it looked at. They say basically you will have to live with it. There is really nothing much to do about it. W…  Read Full »

Dr. Raguram Ganesamoni

Answer:
Hello,
Welcome to icliniq.com.
I am sorry to hear about your problem.
Cyst inside the testis is relatively rare and is usually not removed since it can damage the testis. However, it is not at all difficult to remove. If required, it can be removed even under local anesthesia or regional anesthesia….  Read Full »

How can I increase the length of my penis?

Query:
Hello doctor,
The length of my penis is 5 and 1/2 inches and I am 38 years old. How can I increase my penis length? Is there any medicine, cream, lotion, oil or gel?  Read Full »

Dr. Pankaj Mittal

Answer:
Hi,
Welcome to icliniq.com.
You have given very little information here. For me, as a clinician much information is needed about your sociocultural background too.
You have not mentioned your marital status, duration of married life, number of children, education, profession and ethnic background.
Y…  Read Full »

Undescended Testes | Diagnosis & Treatments

How are undescended testicles diagnosed?

A primary care doctor will first perform a full genital examination and will try to locate the testicle if it is not in the scrotum. If one can’t be felt, your son may be referred to a pediatric urologist or pediatric surgeon for a more complete examination and to rule out two related conditions — etopic testicles and retractile testicles.

Ectopic testicles

If the scrotum is empty, the doctor may first try to determine if your child has ectopic testicles, a related condition in which the testicle is somehow diverted from its normal pathway of descent. As a result, the testicle lies in an abnormal location outside this pathway. To check for this, the physician will feel the areas where ectopic testicles are sometimes located.

Retractile testicles

Retractile testicles move in and out of the scrotum. Your doctor may try to rule out this condition by trying to bring the testicle downward. If the testicle can be brought all the way into the scrotum, no treatment is required.
If your doctor determines that the testicle is not ectopic or retractile, the diagnosis is usually an undescended testicle. Your child will then be referred to a pediatric surgeon or urologist for further evaluation.

What are the treatment options for undescended testicles?

If your son’s testicle does not descend on its own before his first birthday, his surgeon will most likely recommend a type of surgery called orchiopexy to move the testicle down into the scrotum.

If the testicle can be felt in the groin, orchiopexy will probably be done through a small incision in the groin. The surgeon will free the testicle from its location in the abdomen and maneuver it into the scrotum. Children often go home later that day or the next morning.

If the testicle cannot be felt in the groin (this occurs in one out of five boys with an undescended testicle), the testicle may be in the abdomen or may simply be absent. Further exploration is necessary to make sure a testicle is not left in the abdomen in order to permit the testicle to function properly and to reduce the risk of cancer developing undetected in that testicle.

Surgery is highly recommended in order to reduce the risk of cancer or infertility, to improve your son’s body image through adolescence and adulthood, and to reduce long-term effects and the risk of cancer or infertility. In most cases, doctors are able to repair an undescended testicle with a single, simple operation at around 12 months of age.

What are the complications associated with surgery?

Complications from surgery are relatively rare, but in some cases can include bleeding and infection. The most common complication — which is still quite rare — is when the moved testicle goes back up into the groin. In this case, doctors will need to perform another surgery. In very rare cases, a testicle can lose its blood supply, which will render it nonviable. It will then become scar tissue. But again, this is very rare.

Your son may feel some discomfort after his operation, but most boys feel better after about a day. Your doctor will probably recommend that your son avoid sitting on riding toys for about two weeks in order to prevent injury to the testicle. You can expect annual follow-up examinations so the doctor can check that the testicle is growing normally.

What is the long-term outlook for children with undescended testicles?

Undescended testicles may increase the risk of infertility, especially if both testicles are affected. However, boys who have one undescended testicle tend to father children at the same rate as those who are not affected by the condition at all. 

Boys who have two undescended testicles — a much lower percentage of patients — do have a significantly lower fertility rate.
A child with undescended testicles is slightly more prone to develop testicular cancer, even after corrective surgery. However, surgery performed before puberty may reduce the risk of developing cancer. 

Parents should know that cases of cancer related to undescended testicles are rare.
Having the surgery is important in that the testicle is located where a young man can palpate a mass if it should develop.

Common Signs of Testicular Cancer and When to See a Doctor

January 21,2020 |

Testicular cancer is a type of cancer that affects the testicles or testes. It’s a rare form of cancer, but it still occurs in some males. Luckily, testicular cancer survival rates are high, especially when found early. That’s why it’s so important to know the most common symptoms of testicular cancer and when to see a doctor. Learning the signs and keeping an eye out for them are the best ways to ensure that you get the appropriate treatment in a timely manner.

Symptoms of Testicular Cancer

If you have testicular cancer, there are a number of different signs or symptoms that may present themselves. Other times, the cancer could be asymptomatic. Regular screenings with your doctor will help you stay safe and catch problems early on. Symptoms of testicular cancer include:

• A lump or enlargement in either testicle.¹
• A feeling of heaviness in the scrotom¹
• Change in the general feel or firmness of the scrotum⁴
• A dull aching in your abdomen or groin area¹
• A sudden collection of fluid in the scrotum¹
• Pain or discomfort in the testicles or scrotom¹ either with or without swelling
• Enlargement or tenderness of the breasts¹ due to hormonal fluctuations—a condition called gynecomastia⁴
• Swelling of one or both legs⁴

Advanced Testicular Cancer Symptoms

In addition to some general signs and symptoms of testicular cancer, there are a few signs of advanced cancer. If you experience lower back pain or belly pain consistently, the cancer may have spread to the lymph nodes.⁵ If testicular cancer spreads to the lungs, you’ll experience shortness of breath, chest pain, or a cough that may or may not include phlegm and/or blood.⁵ Finally, if you have be regularly occurring headaches or experience sudden bouts of confusion, it could be a sign that cancer has spread to the brain.⁵

While these symptoms rarely present themselves without first showing some of the earlier signs, advanced testicular cancer is harder to treat and more serious. Talk to your doctor immediately if you’re experiencing any signs or symptoms.

While all of these symptoms could indicate testicular cancer, having them is not a definitive diagnosis of testicular cancer. Talk to your doctor to receive the proper diagnosis.

Causes of Testicular Cancer

As with a lot of cancers, there isn’t enough information to definitively say what causes testicular cancer.¹ Cancer occurs in your body when cells undergo unhealthy mutations that create abnormalities and start to reproduce.¹ When the cellular abnormalities start to rapidly accelerate in growth, a mass is formed.¹ Sometimes these masses are benign and other times they’re malignant—a medical diagnosis is the only way to be sure of the presence of cancer.

In over 90% of testicular cancers, the growth starts as germ cells—the cells that make sperm.² There are other origins of testicular cancer, but they’re rare. There are two different main types of germ cell tumors (GCTs) called seminomas or non-seminomas.² 

• Seminomas – this is the most common type of testicular cancer.² Seminomas have a slower growth rate and tend to respond well to chemotherapy and radiation treatments, especially when caught early.²
• Non-seminomas – there are a couple different types of non-seminomas, all of which grow more rapidly and tend to be more aggressive forms of testicular cancer.² Surgery may be recommend to increase survival rates and reduce the spread of the cancer.

Risk Factors of Testicular Cancer

Unfortunately, there is no direct way to prevent testicular cancer.¹ To keep your body as healthy as possible, it’s important to eat a nutritious diet, avoid high amounts of processed food, get regular exercise, manage your stress levels, don’t smoke, and know your risk factors.

If you have any of the following risk factors, you’re more likely to develop testicular cancer. Talk to your doctor today and make sure that you undergoing regular self-examinations and urologist visits.

• Klinefelter syndrome, which is a condition that causes the testicles to develop abnormally¹
• Cryptorchidism, or an undescended testicle.¹
• Family history of testicular cancer
• Men between the ages of 15 and 35 are more at risk, but testicular cancer can occur at any age¹
• Race—white men are more at risk than other races.¹ 

Detecting Testicular Cancer

The first sign of testicular cancer tends to be a lump on the testicle or general swelling and changes in size.⁵ For this reason, it’s a good idea to make sure and perform self-examinations. If you find anything during self-examination, medical examinations will help confirm the underlying problem. Detecting testicular cancer early helps increase the chances of making a full recovery.

Self-Examinations

The best time to perform self-examinations is after a warm bath or shower when the scrotum is relaxed and you’re standing upright.² Be sure to perform your self-examinations under the same conditions every month for consistency.

Check each testicle thoroughly by gently, but firmly, rolling it between your thumb and forefingers.² A slight variation in size between the two is normal, but they should be similar in firmness. Check your epididymis and vas deferens and look for anything that doesn’t feel normal.

If you catch a tumor early, it will be the size of a small marble or pea, but as the cancer progresses the tumor can grow much larger.⁴ Remember that simply feeling a lump doesn’t indicate cancer. Lumps can form due to cysts, enlarged blood vessels, a buildup of fluid, or hernias.⁴ Always call your doctor to schedule a consultation if you feel any lumps or changes in the size of your testicles. 

Medical Examinations

Medical exams will start with a physical examination, so make sure to tell your doctor of any family history or risk factors you have. A testicular ultrasound is then done to see inside the scrotum and analyze any lumps.² If there are any chances that cancer has spread, your urologist will likely order further imaging tests. Finally, your urologist will do a blood test to check for tumor markers such as AFP, HCG, and LDH levels.

When to See a Doctor

While some doctors consider regular, monthly testicle self-examinations enough, it isn’t a failsafe way to ensure that you’re cancer-free. If you have any concerns whatsoever, don’t rely on in-home tests. Instead, schedule an appointment with your urologist to discuss your concerns and undergo the necessary tests.

The best time to see a doctor is as soon as you notice any changes in your body or if you begin to experience any of the symptoms listed above that last for longer than two weeks. If you notice physical changes, the sooner you see a doctor the better. The earlier that testicular cancer is caught and treated, the better you’ll be able to fight it. When you find late stage testicular cancer, the survival rates drop. So it’s better to talk to your doctor sooner rather than later.

It’s important to remember that many symptoms of testicular cancer can also symptoms of other, less serious issues. However, seeing a doctor is essential to getting a proper diagnosis.

Treatment of Testicular Cancer

If you’ve been diagnosed with testicular cancer, it’s important to work with a trusted team of doctors to create a treatment plan that works for you. Different stages of testicular cancer will require different treatment plans. Luckily, testicular cancer tends to have a higher survival rate than other types of cancers, especially when caught early.³

Stages of Testicular Cancer

Treatment will depend on the stage of the testicular cancer. Early stages are much easier to treat, as they haven’t yet spread to other areas in your body. Below are the basics of each stage of testicular cancer.

• Stage 0 – this is a warning that cancer could eventually grow and is commonly referred to as Germ Cell Neoplasia In Situ (GCNIS).²
• Stage I – cancer is localized in the testicle.²
• Stage II – cancer has spread to one or more lymph nodes in the abdomen.²
• Stage III – cancer has spread beyond the abdominal lymph nodes; far from the testes.² There are different classifications of stage III testicular cancer, which depend on where the cancer has spread.

Conclusion

Knowing what to look for is essential in catching any signs or symptoms of testicular cancer early. If you notice anything strange, schedule an appointment with your urologist to get a proper diagnosis. If you need any urological supplies or educational resources, visit our educational support page or our product selection guide. Byram Healthcare is proud to offer full-service urological care and we have all the high quality urological supplies that you need. If you need to order any urological supplies, all of your orders can be discreetly delivered to your home, at any time of the day. If you have any urological questions or need personalized, confidential services, our teams of knowledgeable urological customer service specialists are here to help. 

Sources:

1https://www.mayoclinic.org/diseases-conditions/testicular-cancer-care/symptoms-causes/syc-20352986

2https://www.urologyhealth.org/urologic-conditions/testicular-cancer

3https://www.webmd.com/cancer/do-i-have-testicular-cancer#1

4https://www.cancer.net/cancer-types/testicular-cancer/symptoms-and-signs

5https://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/signs-and-symptoms.html

Torsion of the Testis; Torsion of the Spermatic Cord

Torsion of the testis may more accurately be called torsion of the spermatic cord. It causes occlusion of testicular blood vessels and, unless prompt action is taken, rapidly leads to ischaemia, resulting in loss of the testis (germ cells are the most susceptible cell line to ischaemia).

Epidemiology

• Torsion occurs in boys of any age. It can occur in the first year of life but most commonly in those aged 12-18 years, with peak incidence between 13-16 years^[1].
• Annual incidence in the USA is 1 per 4,000 males younger than 25 years of age.
• There were 3,304 episodes of torsion of the testis in England in 2013/14, of which 2,501 were in children.
• 4-8% of torsions are caused by trauma.
• Some boys and men give a history of previous episodes of severe, self-limiting scrotal pain and swelling, which is assumed to be spontaneous torsion and resolution.

Risk factors

Two types of testicular torsion may occur: intravaginal and extravaginal.

Intravaginal torsion is secondary to the lack of normal fixation of the posterior lateral aspect of the testes to the tunica vaginalis. This results in the testis being free to swing and rotate within the tunica vaginalis of the scrotum. This defect is referred to as the ‘bell-clapper deformity’ which is the most common predisposing factor for torsion^[1]. This occurs in 12% of all males and is bilateral in around 40% of cases. A high insertion of the tunica vaginalis produces a ‘bell-clapper testis’ with a horizontal lie rather high in the scrotum. This lie, with the long axis in the horizontal rather than the vertical plain, is usually bilateral.

Extravaginal torsion occurs more often in neonates and occurs in utero or around the time of birth before the testis is fixed in the scrotum by the gubernaculum. Consequently, both the spermatic cord and the tunica vaginalis undergo torsion together, typically in or just below the inguinal canal.

There may be a genetic factor in some cases of torsion.

Presentation

The sensible clinician should have a very low threshold for suspecting testicular torsion in a boy or man presenting with acute, painful scrotal swelling, particularly if he is younger than 25 years of age.

History

• There is typically sudden, severe pain in one testis.
• There may be lower abdominal pain and, in any boy presenting with abdominal pain, the testes should be checked^[2].
• It often comes on during sport or physical activity.
• There is quite often a history of previous, brief episodes of similar pain. This is presumably torsion that corrected itself.
• Nausea and vomiting often occur.
• Occasionally, the symptoms are milder and less acute.
• Easing pain is not necessarily a good sign of spontaneous resolution. Pain also eases as necrosis sets in.
• A history of recurrent attacks of severe pain that resolved spontaneously might suggest intermittent testicular torsion and de-torsion.

Examination

Examination is often helpful but normal findings should not preclude further investigation if clinical suspicion is high.

• There is usually reddening of the scrotal skin.
• There is a swollen, tender testis retracted upwards.
• Lifting the testis up over the symphysis increases pain, whereas in epididymitis this usually relieves pain.
• In the early stages, the epididymis may be felt in an abnormal anterior rather than typical posterior position but this depends upon the degree of torsion that may be from 180-720°. Later, gross swelling prevents this finding.
• The testes on both sides are characteristically in the ‘bell-clapper position’ with a horizontal long axis.
• Looking for absence of the cremasteric reflex is a simple method with 100% sensitivity and 66% specificity for testicular torsion.
• The cremasteric reflex (L1/L2 spinal nerves) is elicited by gentle pinching or stroking of the inner thigh while observing the scrotal contents.
• If the torsion occurs prenatally, the baby is born with a firm, hard, non-transilluminable scrotal mass. There are no symptoms. The scrotal skin is usually fixed to the underlying necrotic testis.

Differential diagnosis

• Torsion of testicular or epididymal appendage:
  • This usually occurs in boys aged between 7 and 12 years.
  • Systemic symptoms are rare.
  • There is usually localised tenderness but only in the upper pole of the testis.
  • Occasionally, the ‘blue dot sign’ is present in light-skinned boys (ie a tender nodule with blue discolouration on the upper pole of the testis).
• Epididymitis, orchitis, epididymo-orchitis:
  • These conditions most commonly occur from the reflux of infected urine or from sexually acquired disease caused by gonococcus and Chlamydia spp. Hence, they tend to affect an older age group.
  • NB: patients with acute epididymitis usually experience a tender epididymis, whereas patients with testicular torsion are more likely to have a tender testicle.
• Hydrocele:
  • Swelling is usually painless.
  • The scrotum will transilluminate.
• Incarcerated hernia:
  • This may be diagnosed by careful examination of the inguinal canal.
• Testicular tumour:
  • Scrotal enlargement occurs more slowly.
  • It is only rarely accompanied by pain. Typically, the normal slightly delicate sensation of the testis is absent.
• Mumps:
  • There is swelling of the parotid glands in mumps.
  • Mumps orchitis is rare before puberty.

Investigations

European Association of Urology (EAU) guidelines state that Doppler ultrasound is useful to evaluate acute scrotum, with 63.6-100% sensitivity and 97-100% specificity, a positive predictive value of 100% and negative predictive value of 97.5%^[3]. A positive ‘whirlpool sign’ is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography and has 99% specificity for the presence of testicular torsion^[4].The use of Doppler ultrasound may reduce the number of patients with acute scrotum undergoing scrotal exploration, but it is operator-dependent and can be difficult to perform in pre-pubertal patients. It may also show a misleading arterial flow in the early phases of torsion and in partial or intermittent torsion. Additionally, persistent arterial flow does not exclude testicular torsion. A comparison with the other side should always be done.

However, UK guidelines from the Royal College of Surgeons state that ‘in patients with a history and physical examination suggestive of torsion, imaging studies should NOT be performed as they may delay treatment, therefore prolonging the ischaemic time’^[5]. Negative surgical exploration is preferable to a missed diagnosis as all imaging studies have a false-negative rate.The literature suggests a high degree of sensitivity and specificity can be attained with Doppler ultrasound. Doppler ultrasound may nevertheless be falsely reassuring in the early phase of torsion and in partial or intermittent torsion: present arterial flow does not exclude testicular torsion. Imaging may be considered for a small number of children under the guidance of a senior clinician in late presenters or in those with atypical features.

Management

• All cases of acute testicular pain are due to torsion until proved otherwise. If torsion is suspected after a prompt clinical assessment, a scrotal exploration should be carried out without delay.
• An immediate referral must be made to the emergency urology or surgical team^[1]. Before further assessment, food should be withheld and patients provided with adequate analgesia.
• It may be possible to reduce the torsion manually. It should initially be done by outwards rotation of the testis unless the pain increases or if there is obvious resistance^[3]. Success is defined as the immediate relief of all symptoms and normal findings at physical examination. If unsuccessful, further manual de-torsion may be attempted as the testicle can twist 180°^[6].
• Bilateral orchiopexy is still required after successful de-torsion. This should not be done as an elective procedure but rather immediately following de-torsion.
• Testicular torsion is an urgent condition, which requires prompt surgical treatment. The two most important determinants of early salvage rate of the testis are the time between onset of symptoms and de-torsion, and the degree of cord twisting.
• After 24 hours there is controversy as to whether the testis should be removed or fixed, even if it shows some viability, as there is some evidence that orchiectomy is more likely to preserve the function and fertility of the ipsilateral testis. About 20-40% of cases of testicular torsion result in an orchiectomy^[6]. The risk of losing a testis is much higher among African Americans and younger males.
• If the testis is viable then orchidopexy is usually performed to prevent recurrence, although there is no consensus about this, as the evidence base is small.
• Whether the affected testis is removed or conserved, the contralateral one should undergo orchidopexy, as the risk of recurrence on the other side is otherwise high.
• A baby born with testicular torsion should have the affected testis removed (because it is always non-viable) and orchidopexy of the other side (because bilateral torsion is common).

Complications

• Complications of an untreated or delayed torsion include infarction of the testicle with subsequent atrophy, infection and cosmetic deformity.
• Patients require follow-up mainly for fertility issues and hormonal consequences. Despite timely and adequate detorsion and fixation of the testicle, up to half of the patients may develop testicular atrophy, even when intraoperatively assessed as viable, and should be counselled accordingly.
• Fertility results vary. Unilateral torsion of the testis seriously impaired subsequent spermatogenesis in about 50% of the patients and produced borderline impairment in another 20%^[3].
• Subfertility is found in 36-39% of patients after torsion^[3]. Semen analysis may be normal in only 5-50% in long-term follow-up. Early surgical intervention (mean torsion time less than thirteen hours) with de-torsion was found to preserve fertility, but a prolonged torsion period (mean 70 hours) followed by orchiectomy jeopardised fertility.

Prognosis

• The extent and duration of torsion have a major influence on both the immediate salvage rate and late testicular atrophy.
• Testicular salvage rates are 90-100% with surgical correction within six hours of onset of testicular torsion, whereas salvage rates are 10% at 12-24 hours^[7].
• One study reported successful harvesting of semen from a subjectively dead testicle, indicating that salvage and cryopreservation of semen should be attempted in all but the most hopeless cases^[8].
• The absence of a testis may still have a significant psychological effect and so it is usual to implant a prosthesis if orchidectomy is required. This is usually delayed for six months to let inflammation subside and it is usually inserted via an inguinal incision.

Prevention

• Recurrent, intermittent pain, with a ‘bell-clapper’ testis, requires orchidopexy.
• Chronic intermittent torsion can result in segmental ischaemia of the testis^[1].
• Delay has a considerable adverse effect on survival of the testis and late presentation is a substantial problem.

90,000 Which doctor should I go to in case of testicular inflammation – doctors treating the disease

Urologists of Moscow – latest reviews

Nice welcome. There were no complaints. Elena Mikhailovna is a sweet, sociable woman. I’ll go for a second appointment. I turned to this specialist because he was closest to me.In general, I was satisfied with the quality of the reception.

Dmitriy,

September 20, 2021

At the reception, the doctor conducted an examination, told the possible causes of the problem and sent for tests.The doctor is attentive, tactful, explains everything clearly and easily. I can recommend this specialist to my friends, if necessary, and if necessary, I can apply again. I was pleased with the quality of the reception.

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September 22, 2021

Rinaz Enesovich is a very good and helpful doctor.The specialist advised me. The doctor helped me with my question. Treatment has not yet been prescribed by the doctor, as I am undergoing examination. I liked it all very much.

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September 27, 2021

Everything went well, wonderful, detailed and interesting.Oleg Leonidovich gave detailed advice, gave useful advice and answered all my questions. A pleasant, polite, experienced doctor.

Stepan,

September 23, 2021

From this doctor, I learned everything that interested me.As a result, I was satisfied. I liked the appeal of Kirill Albertovich to me, the detailed story and how he conducted the reception in general. I give a solid five out of five points. Now, with the doctor’s recommendations, I will solve my problem.

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September 21, 2021

The doctor is friendly, professional, knowledgeable in his area.Everything went well. I really liked it. At the reception, Baktybek Shaimbetovich made a consultation and examination. Prescribed a medicine that needs to be used for some time. Would reapply, made a good impression.

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September 23, 2021

Everything is great.An excellent doctor, kind, I liked everything. The doctor conducted an examination, gave advice, explained everything clearly and interestingly. The reception lasted about 15 minutes, which was enough for me.

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September 21, 2021

The reception went well.Polite, attentive, good and professional doctor. It is immediately evident that the specialist approaches the patient individually. Alexander Sergeevich listened to me. And the doctor explained everything to me and suggested it in an intelligible language. I was satisfied.

Alexander,

September 21, 2021

I found this specialist from reviews.Nice, polite doctor. The reception went well, without any complaints. Dmitry Sergeevich conducted a survey, explained everything clearly, did everything necessary. I was pleased with the reception.

Sergey,

September 23, 2021

Everything went well.The doctor consulted me. An attentive doctor. The specialist carried out an inspection. Roza Petrovna solved my problem and answered my questions. For myself, as a result of admission, I received a positive result. The doctor gave me all her recommendations. I can’t say anything about the result, since I haven’t prescribed treatment yet.

Alexandra,

September 23, 2021

Show 10 reviews of 14,200 90,000 Which doctor should I contact for pain in the testicles

Moscow surgeons – latest reviews

I was very pleased with the doctor’s appointment.The doctor is very competent, it was a pleasure to see this specialist. As a result of the admission, Anastasia Orestovan wrote out recommendations, prescribed appropriate treatment, and carried out diagnostics. I would gladly recommend this doctor to my friends. I will definitely contact you if necessary.

Svetlana,

September 22, 2021

I liked the doctor very much, only a positive opinion.Anna Grigorievna carried out the necessary diagnostics, gave useful recommendations, answered all my questions and drew up a treatment plan, was attentive to the child. We were satisfied with the reception and would have turned to this specialist again, if necessary.

Anastasia,

September 20, 2021

Good doctor, he arranged for me.After taking it, I consulted with my mother and felt that I would not drink some of the medications that he prescribed, because they are not the best and I will continue to take the medications that another doctor advised me. Dmitry Gennadievich prescribed something very good and I will take it, I will pass the necessary tests and I will refer to this specialist again in 2 weeks.

Lydia,

September 22, 2021

The doctor is good.Andrei Ilyich examined and consulted, prescribed the necessary treatment. The doctor of the highest category and corresponds to this, adequately and quickly diagnosed. The reception went well, there were no unnecessary words. I will contact this specialist again.

Gennady,

September 23, 2021

At the reception, the doctor explained everything to me, wrote the appointment and treatment.She solved my problem. After this technique for myself, I got peace of mind for my health. The doctor is attentive, pleasant in communication, explains everything clearly and easily. I can recommend this specialist to my friends, if necessary, and if necessary, I can apply again. I was pleased with the quality of the reception.

Anna,

September 21, 2021

A very kind, friendly specialist who is interested in the patient.It was pleasant for me to communicate with Anna Valerievna. The appointment went quickly for about 10 minutes, but after all. This time was enough for me. The doctor questioned all the complaints and made a treatment plan.

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September 23, 2021

The doctor is very correct.She told me everything in great detail and described about my problem, tactfully and very carefully carried out the examination. Ekaterina Vladimirovna gave me enough time, was attentive to me. If necessary, I will contact this specialist.

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September 22, 2021

Elena Vladimirovna is a good doctor and a good professional.She paid attention to my problem and explained the necessary information in detail. I addressed another doctor with my questions, but I also received the necessary help from this specialist. I liked the specialist!

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September 21, 2021

I was satisfied with everything, I liked the doctor! Coming back soon! This doctor has an individual approach to the patient, interest and attentiveness.Andrei Ilyich analyzed my problem, calmed me down, diagnosed and prescribed treatment. It has already become easier for me!

Moderation,

September 25, 2021

I liked the doctor very much, attentive, good specialist.Anna Valerievna performed an operation on my mother’s leg, removed her nail. I asked her about the dark nails on the other leg, she recommended an ultrasound of the arteries of the lower extremities. As a result of the examination, a serious pathology was revealed and the doctor sent her for a consultation to the appropriate surgeon, thank her very much.

Olga,

September 22, 2021

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Testicular pain / Your doctor, Kremenchug, Ukraine

Testicular pain can occur in both an adult man and a teenager, and even a child.Testicular pain is one of the most thrilling sensations a man can endure in his life. Even if the pain is not associated with an immediate threat to health and life, it weakens the man, causes fear of death, accompanied by profuse sweating, nausea and vomiting.

Causes of testicular pain:

The causes of pain in the testicle can be infectious and inflammatory diseases of the testicle (orchitis) or epididymis (epididymitis), chronic prostatitis, STDs (ureoplasmosis, chlamydia, mycoplasmosis), surgery, trauma and tumors of the testicles, inguinal hernia, testicular torsion, varicocele, hydrocele or spermatocele.Basically, these diseases are easily diagnosed and treated. Sometimes testicular pain becomes chronic, even after the appropriate course of treatment. According to statistics, in 25% of patients, the cause of chronic testicular pain cannot be found.

• for acute trauma to the scrotum 90 100. Violation of the integrity of the testicles is extremely rare, but an ordinary blow to the testicles can lead to instant loss of consciousness. If you experience unexpected and excruciating testicular pain caused by injury, seek medical attention.If the injury to the testicles is accompanied by damage from a sharp object, a doctor should be consulted immediately to avoid the development of severe complications (loss of a testicle, infertility).

• for testicular torsion . The testicle is suspended from the spermatic cord, which contains the blood vessels and the vas deferens. Sometimes the testicle changes its position, twisting around the longitudinal axis. This leads to a torsion of the spermatic cord 360 degrees, interruption of blood circulation in the testicle, compression of the vas deferens.If urgent medical attention has not been provided (up to surgery), then the testicle may die off. The cause of testicular torsion is unknown; physical activity here, apparently, has nothing to do with it, since torsion often occurs in a dream. For some reason, cold weather increases the risk, which means that the contraction of local muscles can play a certain role here.

• with epididymitis (inflammation of the epididymis) 90 100. In this case, the man himself can feel the scrotum and determine that the testicle is enlarged, painful when touched.Epididymitis is usually caused by bacteria, usually gonococci or chlamydia, which also cause urethritis (inflammation of the urethra). Inflammation of the epididymis is almost always observed on one side only. The pain increases gradually over one to three days. A man may also notice other symptoms of urinary tract infection – fever, spontaneous urination, or burning sensation in the canal. Seeing a doctor is mandatory – inflammation can lead to infertility and impotence.

• for orchitis (inflammation of the testicles) is a fairly rare disease, with the exception of complications from mumps. The cause of testicular inflammation is the mumps virus (mumps) usually affects the salivary glands of children, forming severe swelling behind the lower jaw and causing fever and general pain that lasts about a week. The virus infects other organs, among them the testicles most often (for unknown reasons).But this almost never happens before puberty. The usual course of the disease. Mumps in adults is not more severe than in children, and orchitis affects only 20 to 30% of cases. In only 10% of these cases, both testicles are affected. Symptoms of mumps appear suddenly, on the third or fourth day after swelling of the salivary glands: the temperature rises sharply, and the testicles swell and become painful – with varicocele, as the cause of acute pain in the testicles, it is quite rare.Usually, if varicocele is accompanied by pain, then it builds up gradually, although it can have a strong and unbearable character.

• with inguinal hernia pain in the testicles may occur if a large volume of intestine has descended into the scrotum, which exerts physical pressure on the testicles.

• pain in the testicles happens as a reflection of pain sensitivity in urolithiasis / services / urolog / disease, cysts and kidney tumors.

• One of the common causes of testicular pain in young men is unsatisfied sexual arousal. With sexual arousal, blood accumulates both in the penis and in the testicles. If sexual arousal does not receive discharge in the form of ejaculation for a long time, the swollen testicles may hurt.

What symptoms are dangerous and require a visit to a urologist?

1. You feel pain when you touch one or both testicles.

2. One testicle became larger than the other, softer, changed shape.

3. You feel a sudden severe pain in the testicle.

4. You felt pain in the scrotum, which gradually increases.

5. You feel pain in the scrotum, which is accompanied by nausea, lightheadedness, vomiting, and fever.

6. The pain arose after an injury to the scrotum and did not subside within an hour.

7. During the control palpation of the testicles, you identified a tuberosity or bulge (painful or painless) on one of the testicles, which was not there before.

Make an appointment

90,000 Doctors: testicular pain may be a symptom of coronavirus

Swelling and pain in the testicles may indicate a coronavirus infection, according to doctors in Turkey. Moreover, it may be the only symptom of the disease.

Testicular pain may be the only symptom of COVID-19, Turkish doctors from Acibadem University warn. This was faced by a man who turned to them with a similar complaint. His case was described by doctors in an article in the journal Urology Case Reports .

COVID-19 is a disease that affects different organ systems, and the male reproductive system can also be affected, the authors of the work note. However, data on the effects of SARS-CoV-2 on male genitalia are still very limited.

A 49-year-old Turk came to the doctor with complaints of swelling and pain in the testicles and left groin that appeared earlier in the day. At first, the pain was intermittent, but after a few hours it became pronounced and constant. The man did not have a fever, cough, or any other symptoms of COVID-19, but doctors still took a swab from him – a few days ago the patient came into contact with a man who later tested positive for SARS-CoV-2.

The patient’s result was also positive.

At the same time, he did not have an STD or other health problems that could cause such symptoms, the examination revealed only inflammation of the spermatic cord.

Since it was previously reported that the coronavirus is capable of infecting the testicles, the doctors concluded that SARS-CoV-2 was the cause of the pain.

On the second day of treatment, the pain disappeared, but the virus was detected in smears for more than three weeks.

“Complaints of pain in the genitals, such as discomfort in the scrotum, have been reported in other studies in 19% of male patients,” the authors report. “In our case, the patient had no other symptoms besides the edema and pain in the testicles. It also took longer to clear the virus than it did with pneumonia. Our research shows that COVID-19 can affect male genitalia directly, without affecting any other organ systems, and should be monitored closely.While these symptoms are not considered typical for COVID-19, our case suggests that patients with genital pain may be infected with SARS-CoV-2. ”

Doctors urge to test men with complaints of genital pain for SARS-CoV-2, even if they do not have symptoms characteristic of coronavirus infection.

They fear that the virus, entering the testicles, can damage them and impair spermatogenesis and even lead to infertility. But there is still not enough data to confirm or deny this.It is also still unclear if the virus can spread through semen.

“Patients with COVID-19 are recommended to be monitored in the long term to identify any detrimental effects of this infection on the male reproductive system,” the authors write.

Earlier, experts from the University of Miami confirmed that SARS-CoV-2 is able to penetrate testicular tissue. The researchers analyzed testicular tissue from six men who died from COVID-19.

In three samples, a violation of spermatogenesis was observed, and in one of them, using electron microscopy, it was possible to detect the virus itself.

The median time between first positive COVID-19 test result to death was 11 days. One case was diagnosed posthumously.

It is logical that the testes, which are responsible for the production of sperm and testosterone, become a target for the virus, the authors note. SARS-CoV-2 binds to ACE2 receptors, which are present in many organs – including the lungs, heart, intestines, kidneys, and testes.

But the question still remains, in what concentration the virus must be present in the testes so that it can be detected in the semen, as well as how much it must be in the semen for the virus to be sexually transmitted.

Certain other viral diseases, such as mumps, can interfere with sperm production, lead to inflammation of the testicles and cause fertility problems in 10-20% of affected men. Perhaps SARS-CoV-2 acts in a similar way, causing inflammation in the testes, scientists suggest. At least during the examination of the tissues of the testicles, signs of inflammation were observed in them.

Inflammation of the testicles and their appendages (orchioepididymitis)

Testicular volume

Testicular volume is one of the most important criteria for assessing puberty in adolescents. However, even in adulthood, testicular volume remains an important parameter that requires special attention. The volume of the organ is proportional to the amount of sperm and testosterone molecules synthesized there.Studies carried out in Europe have revealed the average values ​​of testicular volume in healthy and infertile men. The volume of testicles in healthy men was about 20 ml, in infertile men – 18 ml [1]. The given values ​​are valid only for white Europeans, since for Asians the normal volumes differ significantly and cannot be guided by them.

Despite the given average volumes of 18-20 ml, the alarm should be beaten only if the testicular volume is less than 15 ml. According to research data, such volumes are associated with an increased incidence of oligoasthenoteratozoospermia.This is the name for a decrease in the number, quality and motility of sperm. Testicular volume less than 12 ml is associated with non-obstructive azoospermia – the absence of sperm in the semen [2].

Many doctors pay attention to the difference in the volume of different testicles in the same man. In most cases, the left testicle is 1-2 ml less than the volume of the right testicle. If the left testicle is significantly smaller than the right one, then it is necessary to look for the reasons for the poor performance of the left testicle. A significant difference can be considered a difference in volumes of more than 2 ml.The most common cause of this size difference is varicocele – varicose veins of the scrotum. Varicocele usually occurs on the left side, so it makes sense that the left testicle is usually smaller than the right. By the way, a significant decrease in the left testicle is a separate indication for surgical treatment of varicocele.

The testicular volume is calculated by multiplying the length, width and anteroposterior size of the testis by a factor of 0.71. The specified coefficient was calculated on the basis of experimental work published more than ten years ago.The study involved twenty patients with prostate cancer. Since prostate cancer is dependent on testosterone, the testes are removed to treat it: bilateral orchiectomy is performed. The authors measured the length, width and height of the testicles, first by ultrasound before removal, and then clarified the true size of the organ after its removal. Measurements of the true volume were carried out by the method of water displacement. It turned out that the coefficient 0.71 is the closest to the truth, and the classical formula with the coefficient 0.52 is the farthest from the truth [3].

I will give an example of measuring the volumetric indicators of the testicles. A real story taken from one of my appointments: a 24-year-old patient, testosterone level 17 nmol / l (normal), spermogram without deviations (normozoospermia).

• RIGHT testicle : length 44 mm, width 22 mm, anteroposterior dimension 28 mm.

Testicular volume was 44 x 22 x 28 x 0.71 = 19 ml

• LEFT testicle : length 42 mm, width 22 mm, anteroposterior dimension 25 mm

The testicle volume was 42 x 22 x 25 x 0.71 = 17 ml

Thus, the volume of the testicles corresponds to the average norm, and the difference in volumes does not exceed 2 ml, which also falls within the normal range. In this situation, I already knew about the normal function of the testicles, but for the first time, measuring the volume of the testicles is an excellent diagnostic test.

References

1. Jensen TK, Jørgensen N, Punab M, et al. Association of in utero exposure to maternal smoking with reduced semen quality and testis size in adulthood: a cross-sectional study of 1,770 young men from the general population in five European countries.Am J Epidemiol 2004; 159: 49-58.
2. Boeri L, Capogrosso P, Ventimiglia E, et al. Testicular volume in infertile versus fertile white-European men: a case-control investigation in the real-life setting. Asian J Androl. 2021 Mar 12.
3. Sakamoto H, Saito K, Oohta M, Inoue K, Ogawa Y, Yoshida H. Testicular volume measurement: comparison of ultrasonography, orchidometry, and water displacement. Urology. 2007 Jan; 69 (1): 152-7.

90,000 Testicular cancer symptoms and signs in men

Testicular cancer treatment

Therapeutic tactics depend not only on the stage of the pathological process, but also on the type of tumor.

The main operation for treating any type of testicular cancer is orchiectomy. It involves the removal of the testicle and spermatic cord.

If the pathology is detected at stage 1, this is enough to cure the pathology. Local relapses of the tumor are practically not found. In 15% of cases, the disease recurs from the regional lymph nodes. In such a situation, doctors administer radiation and chemotherapy.

After orchiectomy, observation is required to detect metastases in time.The observation period is 10 years. If during this time there is no relapse, most likely, the disease will never return. In the first year, medical examinations and laboratory tests are required once every 3 months, then – once every 6 months. CT is performed with the same frequency.

Some patients with stage 1 cancer and all patients with stage 2 require para-aortic lymph node removal. If cancer cells are found in the removed lymph nodes, the patient is shown 2-4 cycles of chemotherapy.In some non-seminoma tumors, the indication for chemotherapy can be determined by the level of tumor markers in the blood.

If the lymph node dissection is not performed, the nodes are irradiated with radiation. Seminomas are more sensitive to it. At stage 1, 10-15 fractions are enough (treatment takes place within 2-3 weeks). At stage 2, higher doses of radiation are required to destroy metastatic foci in the lymph nodes.