Testicles are also known as testes (one is a testis) or ‘balls’. They are two small, oval-shaped male sex glands that produce sex hormones and sperm. Each testicle is housed in a fibrous outer covering called the tunica albuginea. Sperm production needs a temperature that is around 2° C to 4° C lower than the body, which is why the testicles are located outside the body in a sac of skin (the scrotum).
There are various non-cancerous conditions that can affect the testicles and they are also prone to injury because they are not protected by muscle or bone. It is important to seek prompt medical attention for any testicular complaint.
Testicles are easily injured because they are not protected by muscle or bone. The type of injury could be ruptured blood vessels or tearing of the testicle. Possible injuries include:
- penetrating (for example, stab wound)
- impact from a moving object (for example, a kick to the testicles)
- impact from hitting an immovable object (for example, a fall onto a hard surface).
A doctor can assess injuries to the testicles by physical examination and ultrasound. If the testicles seem normal, the doctor may prescribe pain-relieving medication. Even without an ultrasound, a surgeon may choose to explore the testicle, particularly in cases of possible testicular torsion.
Surgery is usually performed under a general anaesthetic. Significant injury to the testicles may require surgical exploration and repair, or potentially removal of the affected testis. A man’s fertility is not affected if he still has one functioning testicle.
The spermatic cord attaches the testicle to the body. Testicular torsion occurs when the spermatic cord twists and cuts off the blood supply to the testicle. This condition can occur at any age, but tends to be more common between the onset of puberty and the mid-20s. It requires urgent medical attention.
Hard physical activity can cause this twisting of the cord. In most cases, however, it is caused by abnormalities in a male’s anatomy (body structure and organs) that make it easier for the testicle to twist or rotate around the cord.
Know your balls (testes)
The anatomy of the testicle includes:
- testicle – small, oval-shaped sex gland that produces sex hormones and sperm. Another term for testicle is testis
- epididymis – a series of small tubes attached to the back of the testicle that collect and store sperm. The epididymis connects to a larger tube called the vas deferens
- scrotum – the skin sack that houses the testicles. Sperm production needs a temperature around 4°C lower than the body, which is why the testicles are located outside the body in the scrotum.
Symptoms of testicular torsion
Symptoms of testicular torsion include:
- severe pain
- scrotal swelling
- nausea and vomiting
- a lump or swelling in or on the testicle itself
- change in testicular size
- change in testicular shape
- change in the consistency or feel of the testicle
These symptoms can often be confused with an infection of the testicles. An infection should not be considered until torsion has been ruled out.
Urgent medical attention is needed to save the testicle when torsion is diagnosed. Surgery must untwist the spermatic cord and restore blood flow to the testicle. A doctor uses physical examination and ultrasound scans to make the diagnosis. Sometimes, a doctor can only make a conclusive diagnosis at the time of surgical exploration.
The survival rate of the affected testicle is poor unless surgery is performed within four to six hours. Unnecessary investigations should not take place if torsion is suspected, as delays to surgery can affect the viability of the testis. If the blood supply has been disrupted for too long, the testis may not be viable or salvageable, and may need to be removed.
In many cases, the surgeon will also secure the spermatic cord on the unaffected side, to prevent future torsion of the other testicle. If the torted testicle has to be removed, then a surgeon can put a prosthesis or silicone testis into the scrotum for cosmetic reasons (usually at a later date).
Testicular self exam. Hot to test testicles (balls)?
You already know testicles are also called the testes, the male reproductive organs that produce sperm and the hormone testosterone. They are located in the scrotum under the penis.
Now let us discuss about simple balls test. You can do this test during or after a shower. This way, the scrotal skin is warm and relaxed. It is best to do the test while standing.
- Gently feel your scrotal sac to locate a testicle.
- Use one hand to stabilize the testicle.
- Use your fingers and thumb of the other hand to firmly but gently feel the testicle. Feel the entire surface.
- Check the other testicle in the same way.
Another way to examine your testicle in given in the image below.
Testicular self-examination, correct results
Become familiar with the look, feel and shape of normal testicles; this will help you notice any abnormalities.
The characteristics of healthy testicles include:
- Each testicle feels like a smooth, firm egg.
- One testicle tends to hang lower than the other.
- One testicle may be slightly larger than the other.
- There is no pain or discomfort when the testicles and scrotum are handled gently.
Abnormalities in testicles
If you find a small, hard lump (like a pea), have an enlarged testicle, or notice any other differences that do not seem normal, see the doctor right away.
Consult your specialist if:
- You cannot find one or both testicles. The testicles may not have descended properly in the scrotum.
There is a soft collection of thin tubes above the testicle. This may be a collection of widened veins (varicocele).
- You have pain or swelling in the scrotum. This may be an infection or a fluid-filled sac (hydrocele) causing a blockage of blood flow to the area.
- Sudden, severe (acute) pain in the scrotum or testicle that lasts for more than a few minutes is an emergency. If you have this type of pain, seek medical attention right away.
A lump in the testicle is often the first sign of testicular cancer. If you find a lump, see a doctor right away. Most testicular cancers are very treatable. Keep in mind that some cases of testicular cancer do not show symptoms until they reach an advanced stage.
Other conditions that can affect the testicles include:
- Epididymitis – the epididymis is a collection of small tubes located at the back of each testicle. They collect and store sperm. Epididymitis is infection and inflammation of these tubes. Causes include urinary tract infections and sexually transmissible infections (STIs). Treatment is usually antibiotics.
- Epididymo-orchitis – this is infection of the epididymis and testicle that causes inflammation and pain. Treatment is usually antibiotics.
- Varicocele or varicose veins – 10 to 15 per cent of men have a varicocele, occurring where veins draw blood from the testicle. When a man stands up, blood in the veins has to move against gravity to return to the heart. Valves in the veins help this process. If the valves don’t work, blood pools in the veins. This swells the veins and gives the appearance of ‘varicose veins’. Varicoceles usually don’t need treatment, unless the varicocele is severe enough to cause discomfort or impair fertility. The links between varicocele and infertility are not fully understood and research is ongoing. Treatment may include surgery or radiological techniques that can block the testicular veins.
- Haematocele – this is a blood clot caused by trauma or injury to the testicles or scrotum. In some cases, the body is able to reabsorb the blood. If not, the person will need surgery to remove the clot.
- Hydrocele – this is an abnormal build-up of fluid that causes the affected testicle to swell. In some cases, the body can reabsorb the fluid. Even though the condition is painless, the hydrocele may become so large that the person will need surgery to remove it.
- Spermatocele – this is an abnormal build-up of sperm-filled fluid next to the epididymis, which feels like a separate lump on the testicle. This is harmless, but can be removed surgically if it becomes large or bothersome. It is more common after a vasectomy.
- Undescended testicles – either one or both testicles are missing from the scrotum and are lodged inside the lower abdomen. Premature and low-weight newborn boys are most prone to undescended testicles. This condition is a known risk factor for testicular cancer and strongly related to infertility. Unless the testicle is brought down into the scrotum by 12 months of age, there is a high risk of damage to sperm production in later life.
- Testicular cancer – this is an abnormal growth or tumour that appears as a hard and usually painless lump in either testicle. In most cases, testicular cancer can be cured if the person seeks medical treatment early. Surgical removal of the affected testicle (orchidectomy) is usually the first treatment for all testicular cancer.
Prevention or treatment of testicle problems
- pain medication
- anti-inflammatory medication
- bed rest
- elevating the scrotum
- applying cold packs to the scrotum
- wearing an athletic cup for support
- avoiding lifting heavy objects
- abstaining from sexual intercourse
- The person should wear supportive underwear.
- The person should avoid strenuous activity.
- avoid getting balls sucked in mouth or played around extensively during oral sex
Other treatments include:
- Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum. On rare occasions, a physician may be able to manually untwist the testicle, but this is not common. The importance of having testicular pain evaluated immediately cannot be overemphasized.
- Undescended testicles are diagnosed by physical examination. In some cases, the missing testicle can be felt in the lower abdomen. Treatment can include hormone injections to prompt the testicles to descend, although surgical correction is the preferred treatment.
- Most of the time, surgery is needed to correct the testicle problem. Surgery should be done as soon as possible after symptoms begin. If it is performed within 6 hours, most testicles can be saved. During surgery, the testicle on the other side is often secured into place as well. This is because the unaffected testicle is at risk of testicular torsion in the future.
Reduce risk of testicular problems
Suggestions on how to reduce the risk of testicular problems include:
- Take all reasonable precautions to prevent accidents. For example, drive safely and always wear a seatbelt.
- Protect yourself from sexually transmissible infections (STIs) by wearing a condom.
- Always use protective equipment such as a jockstrap or hard cup while playing sports.
- If you injure your testicles, always seek urgent medical advice.
- Perform testicular self-examination (TSE) regularly to become familiar with the look, feel and shape of your testicles so you will notice any abnormalities. See your doctor for further information on how to perform TSE.
- Always see your doctor if you experience any scrotal or testicular pain or unusual symptoms, or if you find a lump or swelling.
It’s important to seek treatment right away to prevent testicle complications. Once treatment is received, it’s important that you take your entire course of antibiotics to treat the infection. You should also see your doctor after you’ve finished the medication to make sure that the infection has cleared. This will help ensure that you make a complete recovery.