- Males, no matter their age, should report swelling of the testicles
- The problem could be a hernia, testicular torsion or testicular cancer
- There are mixed views on recommending testicular self-examination
A few weeks ago, I saw a 16-year-old for a routine physical.
When I did his testicular exam, I found a left inguinal (groin) hernia the size of a lemon. For the uninitiated, this means the left side of his scrotum was twice as big as the right.
When I asked "Jeremy" how long the bulge had been present, he got quiet and said, "I'm not sure -- four months, maybe."
When I asked him why he did not tell me about the swelling, he responded, "I don't know."
Jeremy was not being evasive or difficult. He did not report the swelling because he had hoped it would go away. This is an example of denial, something all people are prone to.
The exact age breakdown for inguinal hernias is unknown, but more than 750,000 are diagnosed and surgically corrected every year in the United States.
I referred Jeremy to a surgeon, who repaired the hernia without complications. But the take-home message is clear: If something else had been causing the swelling, such as testicular cancer, not telling anyone about it for months might have had a different outcome.
Testicular torsion is another serious condition that can happen at any age, but is more common in teenagers. As I have posted on my blog, males of all ages, but especially teenagers, are reluctant to report problems in this particular location.
I educate all of my adolescent patients about testicular torsion so they will act quickly if they develop the sudden onset of testicular pain.
I also encourage all my male patients to check their testicles on a monthly basis to look for other problems.
Although testicular cancer is rare (5.4 cases per 100,000 males), it is the most common cancer in males aged 15 to 39. Because the incidence of testicular cancer is low, there is disagreement among medical professionals regarding the value of monthly screening.
The U.S. Preventive Services Task Force and the American Cancer Society do not recommend testicular self-examination because studies have not proved that screening reduces the death rate from this disorder.
There is also no evidence that patients remember how to do the exam correctly or perform it as recommended. That being said, the survival rate for Stage 1 testicular cancer is better than the advanced disease.
The American Academy of Pediatrics recommends testicular self-exams on its parenting website, HealthyChildren.org.
Dr. Gil Rushton, chief of pediatric urology at Children's National Medical Center in Washington, agrees that testicular self-exams are worthwhile even though they may not be an "evidence-based" procedure.
The best time to do an exam is after a shower when the scrotum is relaxed.
-- Examine one testicle at a time.
-- Using gentle pressure, roll each testicle between your thumb and fingers. Testicles are egg-shaped and should feel smooth and firm. One may be slightly bigger than the other, but they should be about the same weight and consistency.
-- Feel for small lumps, swelling, hardness or other changes in the shape of the testicle.
-- The epididymis is a spongy, tube-like structure that is attached to the top and back of each testicle. It is a normal finding.
-- If you notice a change in either testicle, see your doctor promptly.