Testicle problems
It is a good idea to examine your testicles regularly, so that you become familiar with your own anatomy. Then you will be able to tell if anything unusual develops.
- The testicles make sperm. They are oval in shape, and are usually about
- 4–5 cm long, 3 cm wide and 2 cm thick. One is often slightly larger than the other.
- The epididymis is a sausage-shaped lump stuck onto the back and top of each testicle. It is actually a coil of tiny tubes, which carry and store the sperm. If uncoiled, they would be about 6 metres long.
- The spermatic cords lead upwards from behind the epididymis. They carry the sperm towards the penis, and also contain blood vessels.
- The scrotum is the skin sac that contains the testicles and the epididymis.
How to examine your testicles
- The best time is after a warm bath or shower, when the skin of the scrotum is relaxed.
- Support the scrotum and testicles in the palm of your hand, to feel their weight. One testicle may be slightly larger than the other, but they should be about the same weight.
- Hold a testicle between the thumb and fingers, with your thumb on top and first and second fingers underneath. Roll the testicle gently, feeling for any hard lumps. A normal testicle is oval in shape; it feels firm but not hard and is smooth with no lumps.
- Feel the epididymis, a sausage-shaped lump at the top and back of each testicle. It will feel soft and perhaps slightly tender.
- Feel the spermatic cords which lead upwards from the epididymis and behind the testicles. They are firm, smooth tubes.
- Do the same with the other testicle.
Lumps and swellings
If you are worried about lumpiness of the skin of the scrotum, look at the section on lumps on the scrotum. If you feel a lump within the scrotum, on or alongside your testicle, you must see your doctor straight away. Also see your doctor if one testicle feels enlarged and heavy, or if when you squeeze it gently it feels much firmer than the other side. In all these cases, it could be a cancer of the testicle. This is the most common type of cancer to affect young men in their 20s and 30s (but it can occur at any age). About one in 500 men will develop cancer of the testicle before the age of 50, but the good news is that it can be completely cured in more than 95% of cases. The earlier it is picked up, the better.
In fact, most swellings in the scrotum turn out to be non-cancerous. For example, it is common to have small lumps and cysts in the epididymis and in the spermatic cord. Surgeons do not usually remove these non-cancerous cysts unless they are large and troublesome. It is important that all lumps in the scrotum are examined by a doctor, so even if you think the swelling is non-cancerous have it checked anyway. If your doctor is not sure, he/she will arrange for you to have an ultrasound scan (which is painless).
Swollen, painful testicle
A swollen, painful testicle that has come on gradually (perhaps over a few hours or days) is likely to be caused by an infection. This is called ‘epididymo-orchitis’. It usually occurs on one side only, but sometimes both sides are affected together. The skin over the testicle may be red and shiny. There may be a discharge from the penis. The cause may be a virus (such as mumps) or various bacteria. It can follow a urine infection (see section on cystitis in men), especially in older men. It can also be caused by sexually transmitted bacteria such as chlamydia or gonorrhoea. Obviously, you need to see your doctor as soon as possible for some simple tests and antibiotic treatment, and will need to use a scrotal support (‘jock strap’).
If the pain is very severe and has come on suddenly, it is possible that the testicle and its tubing have become twisted within the scrotum (known as ‘testicular torsion’). This is most common in adolescents, but can occur at any age. You need to contact your doctor straight away, or go to the nearest hospital emergency department.
Cancer if the testicle is usually painless, but in a few cases it is painful (Annals of the Royal College of Surgeons 2004;86:284–8).
Bag of worms’ or varicocele
If you feel something in your scrotum like a bag of worms (most obvious when you are standing), you probably have a varicocele.
What a varicocele is. The ‘spermatic cord’ that leads upwards from the scrotum carries a tube for sperms to reach the penis, and also veins and arteries. The veins of the spermatic cord can become swollen, elongated and looped, similar to varicose veins in the leg – this is a varicocele. If the veins are only slightly swollen they will be unnoticeable, but moderately swollen veins can often be felt. Varicocele does not usually cause any symptoms, although some men report discomfort or may feel embarrassed if the swollen veins are visible under the skin. About 15% of normal healthy young men have a varicocele, usually on the left side.
Varicocele and fertility. Doctors have been arguing for years about whether a varicocele affects fertility, by damaging the development of sperms in the testicle (British Medical Journal 2004;328:967–8). For example, the blood in the swollen veins could act like a hot water bottle, keeping the testicle too warm. Developing sperms like to be cool, which is why the scrotum hangs outside the body. In fact, varicocele is only slightly more common in men with sperm problems and, if it does affect fertility, it is only a small effect.
It is also unclear whether treating a varicocele will improve fertility. In 2001, the Cochrane Collaboration, an international network of experts who look at every scrap of scientific evidence about medical problems, investigated varicocele treatment for fertility. They concluded that routinely treating varicoceles in men who are having fertility problems is ‘ill-advised’, because there is not enough evidence that it does any good. Another survey came to the same conclusion (Lancet 2003;361:1849–52). However, the pendulum now seems to be swinging in the other direction, and many researchers think that treating a varicocele might indeed help fertility (Current Opinion in Urology 2008;18:608–12).
Missing testicle
Some people have a testicle on only one side. On the other side, the testicle is completely missing or it may be felt as a lump in the groin. In either case, it is called ‘undescended testicle’.
How undescended testicle occurs. Your testicles started to develop when you were a tiny fetus (a few weeks after you were conceived). They began high inside your abdomen, near the kidneys at the back. About 6 months before you were born, they started to journey forwards and downwards towards the groin. Meanwhile, your scrotum was developing ready to receive them. About a month or two before birth, the testicles normally complete the journey by descending into the scrotum.
In about 5% of boys, one testicle doesn’t make the journey from the back of the abdomen to the scrotum before birth. Instead, it becomes stuck inside the abdomen or at the groin. This why it is called ‘undescended testicle’. No one knows why it happens. For unknown reasons, it is commonest in babies born in March/April. It is also common in premature babies (Surgery 2004;22:252–5).
Most babies with undescended testicle do not need any treatment – in 2 out of 3 cases the testicle will come down naturally before the baby is 3 months old. If not, the baby will usually need an operation to bring the testicle down. If an operation is needed, it is important that it is done well before puberty starts (New England Journal of Medicine 2007;356:1835–41).
What to do if you have only one testicle. If you are a teenager or an adult with an undescended testicle you should definitely see your doctor. Your doctor should refer you to a hospital specialist (urologist). There is no need to feel at all embarrassed, because all doctors know this is a problem that needs attention. There are at least several issues that you will need to discuss with the urologist.
- Firstly, an undescended testicle is slightly more likely to develop cancer than a normal testicle. The risk is roughly 1 in 2,000. (The risk of testicular cancer in all men is about 1 in 100,000.) In fact, cancer of the testicle is almost always curable, partly because men easily notice a lump on their testicle and therefore it is caught at an early stage. But if the cancer develops in a testicle that is hidden up in the abdomen, it will be difficult to detect. A testicle that has become stuck in the abdomen is unlikely to be producing sperm, so the urologist may suggest that you have an operation to remove it, to prevent it becoming cancerous in the future. This is a complicated decision, which you will have to discuss in detail with the urologist. It may depend partly on your age; cancer of the testicle is most common in young men, so after the age of about 32 years the risk of the operation may outweigh the likelihood of getting cancer and it might be better to do nothing, but your urologist will advise you.
- Secondly, if you have only one testicle you may be worrying about fertility. Although the undescended testicle probably isn’t doing much, you need not be too worried because your other normal testicle is likely to be producing many millions of sperms.
- Thirdly, an undescended testicle is not firmly anchored, and can become twisted on the tissues that surround it. This is called ‘torsion’. Episodes of torsion are very painful. So if you have abdominal pain as well as an undescended testicle stuck in the abdomen, your doctor will need to consider the possibility of torsion.
- Fourthly, if having an empty scrotum on one side bothers you, you can ask the urologist about having an artificial implant to give the appearance and feel of a normal testicle. These are either silicone, or a silicone bag filled with saline (similar to a breast implant).
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated:
Friday, February 26th 2010
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Comments on this article
Posted by raj on 14/03/2010 at 08:57:32 am
i had damage my one testies while playing cricket,i have done operation 3 years back but now my testies get unbalenced
Posted by Andy on 13/03/2010 at 03:16:22 am
Hi, I have a lipoma on my testicle, but since last few months a white patch is appearing and it started spreading all around my testicle, pls advice the remedy. thks
Posted by Optional on 12/03/2010 at 09:03:00 am
I am worried that my left testis is nearly 2 cm lower than my right one...i need help,please write comment soon as possible.....
Posted by Optional on 11/03/2010 at 08:42:57 am
when i have sex one of my testicals gos inside me not all the time but most can you shged some light on this for me plz
Posted by Optional on 11/03/2010 at 03:48:35 am
CAN ONE STILL BORE,PRODUCE CHILDREN WITH A PAINING TESTICLE,
Posted by Optional on 07/03/2010 at 07:59:12 pm
SENSATION around my TESTICLES/URINARY SYSTEM I always have this periodic BURNING SENSATION around my TESTICLES, and at times the urinary track. It causes me weak erection. Even when I am having sex, the penis weakens right inside of the vagina. This is terrible. Initially, we thought it was Staph or some kind of STD. The doctor prescribed some antibiotics, which I took. I discovered that each time I took these antibiotic (Ciproflaxacin; Erythromycin…etc), the whole things for a while, the penis get much harder and sex becomes very pleasurable and lasting. But about a week or two, it relapses into the former weak situation. I have taken several antibiotics in series as these things occur, even though the doctor often says that the urine culture does not yield any growth. At a time, my doctor said it is psychological. But I do NOT agree. Why is it that only when I take such drugs that everything disappears and I fell strong? My whole system is also affected. My tummy/bowel gets affected, with movements in my system. Even my stool is disjointed when this thing starts, but when it clears, the stool is strong and joined. Just recently, my doctor recommended BLADDER and PROSTRATE SCAN, suspecting there could be stones in the bladder. But the result also came out negative, without anything seen. I am 37 years now. I am NEITHER diabetic NOR hypertensive. What could wrong with me? Which other tests do I need to do? Please, advise.
Posted by aman on 07/03/2010 at 02:13:19 am
i have a big problem my testis my one side testis destroy and i feel lack of sex
Posted by help on 25/02/2010 at 03:32:10 am
both of my testicals feel rock hard but my right tstical hurts also i get a sharp pain running up the right side of my abdomement can somone give me more information
Posted by Anonymous on 22/02/2010 at 10:03:39 am
this is very helpful info thanks
Posted by charlie on 12/02/2010 at 03:45:00 pm
Hi i have one testicle that is lower than the other which is the right side i have had this scince weel when i can remeber i was about 13 and now 17 going on 18 and it worrys me alot i have been on the nhs web site n it says it is normally occoured in men that the left side is slightly lower than the other and for me its the right side i havent been to the doctors or told any 1 because ITS EMBARRASING really want an awnser cause i dnt wont to be infertile if any one nose wht it could b plz right a comment thanks
Posted by doubt on 10/02/2010 at 08:19:00 am
Respected sir, My testicle one is up and another one is down and why happened this please tell me answer ..
Posted by M.i.khalil on 31/01/2010 at 05:28:00 pm
Before one year i went to doctor on account of infertility. Doctor became sure by USG that one testis in the ring of inguinal canal & the other not visible. Then a laperoscopic operation was lunched & unvisible testis was drawn near the root of penis. But i donot feel it. On the other hand at present the other testis seems to be more down. And my doctor diclared me azoospermia. Will i be able to be father ? Please give me suggestion.
Posted by gman on 28/01/2010 at 09:10:00 am
between my legs under my testicles it is very warm and if i wear pants, it is very hot by my testicles, what is this, if i hold my testicles in my hand they are very warm ,n i hav to put cold water on them to feel better what is this i hav had this condition since 1995
Posted by Desire on 28/01/2010 at 08:01:00 am
I m usually having pain in my left testicle (felt on the upper side). sometime in both testicles. The doctor prescribed the medicine and it healed a little but in routine it come that i m having the same problem. (mean to say. it pains for 3-4 days and then after taking medicine it again starts after 15-16 days). anyone can properly suggest that what the actual problem is as it is very embarassing situation. Thanx
Posted by Anonymous on 17/01/2010 at 06:55:00 pm
when i was spending time with my girlfriend, a liquid comes out from my penis, then a pain will come on the testis mostly on the right side. can you tell me the reason for this.
Posted by rick on 16/01/2010 at 11:36:00 am
hi, above my left testicle i seen to have some sort of knot or ball of shedded testie skin above my testie. i masturbate much to frequently and sometimes depending on my postiton my left testie may slide left towards my leg and semi out of the scrotum. please help im reall worried.
Posted by Clay on 16/01/2010 at 02:56:00 am
I have had testicle pain for eight months now, the doctors said after two ultra sounds that is was an inflammed epydidymis. I have been through three antibiotics and also daypro for inflammation, nothing seems to take it away. I dont know if being bi-polar has anything to do with it, please someone help me. 1/16/10
Posted by Jatin on 15/01/2010 at 09:26:00 pm
I got hurt on ma left testes 2 years ago.It had gone swolen and i even met a doctor.He prescribed me few medicines after examining my testicles and then within a week or so it healed.But now at times after i have sex with my girlfriend i observe that i can push either of my testicles back to my abdomen.My sperm count is still normal.Is this something normal or am i in trouble?
Posted by prince on 10/01/2010 at 10:10:00 pm
hello one of my testis is atrophied due to epidydimo orchitis, will it effect my future relation with ma wife or will it cause hurdle to be me a father?
Posted by unknown on 08/01/2010 at 07:49:00 pm
Hi i have a problem with one of my testical. One of the testical has swollen up amd the other one is hardly felt or is very soft. The pain is slowely developing and one touched is painful. what can i do regarding the problem. is it a serious issue??? Need advise
Posted by michael on 08/01/2010 at 07:16:00 pm
hi im michael and im 18... i noticed that i have an "undescended testicle" im worried that it may cause me cancer... im the only one who knows this and i dont tell my mother because its embarassing on my part... and im kinda lack on money and i cant afford a surgery anybody who cant advice something would be deeply appriciated
Posted by jamie on 07/01/2010 at 06:18:00 pm
i have a long like lump on the back of my left testicle any help
Posted by iqbal on 05/01/2010 at 11:34:00 am
i have only one testical and i am normal but i worried that will i be a father
Posted by A worried mother on 04/01/2010 at 04:53:00 pm
I am worried that my son's testicles are undescended/retractile. He is almost 4 and nothing has been done to give me some answers and the NHS just don't seem to be following the guidelines with regards to the treatment that seems standard with this problem. Is his health at risk? Should something be done sooner?
Posted by Anonymous on 01/01/2010 at 07:49:00 am
my testicales are so small.why please tell me
Posted by Anonymous on 30/12/2009 at 08:48:00 am
i have very small testicles, almost as if they havent developed since childhood. it has plagued my whole life and is most embarassing. is anyone else suffering as i am? is there anything i can do for my years ahead?
Posted by Anonymous on 15/12/2009 at 10:57:00 pm
on my left testicle i have a kinda lupy objecy above it, i get shooting pains now and again and it kinda worries me alot, i have being to hospital and i have had 2 scans and they said that nothing is wrong so what can it be if it isnt cancer?
Posted by anonymous on 03/12/2009 at 12:31:00 pm
i'm frustrated because my testicles are alwys itching and i have a rush, pimples, its embarrasing because i always scrub them infront of my girlfriend they become worse after having sex because of moisture, i want to have kid with my girlfriend but invain, i dont know if this is caused by my problem..please help i need to find a specialist
Posted by ghost on 03/12/2009 at 03:40:00 am
My penis curves slightly and i have noticed after masturbation that it can have a numb-like feeling at the base. i have also noticed that my testicles have become very sensitive to touch and it feels like there is a knot on the top of them
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