Testicular Examination and Testicular Self-Examination

Test Overview

Testicular exam and testicular self-exam are two ways to find lumps or other problems in the testicles.

The two testicles, or testes, are the male sex organs. They are located in the scrotum, a pouch below the penis. The testicles make sperm and the male hormone testosterone. Each testicle is about the size and shape of a small egg. At the back of each testicle is a coiled tube called the epididymis. It stores sperm.

The testicles develop in the belly of an unborn male baby. In most cases they move down into the scrotum before or soon after birth. But sometimes they do not descend as expected. Having an undescended testicle can increase the risk for testicular cancer.

Testicular exam

This is a complete physical exam of the groin and the genitals, which are the penis, scrotum, and testicles. Your doctor will feel the organs and check them for lumps, swelling, shrinking, and other signs of a problem.

A genital exam is an important part of a routine physical exam for every teenage boy and man. Baby boys should also have their genitals checked for problems they were born with, such as an undescended testicle. An undescended testicle is more common in premature babies than in full-term babies.

Testicular cancer is rare, but it is the most common cancer in men younger than age 35. It often appears as a painless lump or swollen testicle. In the early stages of the cancer, the lump may be about the size of a pea. In many cases, this cancer is found by the man himself or by his sex partner. The chance of cure is very high when this cancer is found early and treated right away.

Testicular self-exam

A self-exam can help find testicular cancer at an early stage. Many times this cancer is found during self-exam as a painless lump or a swollen testicle.

Why It Is Done

Testicular exam

This exam can help find the causes of symptoms like pain, inflammation, swelling, or lumps in the testicles. It can also look for problems such as an absent or undescended testicle.

Testicular self-exam

Self-exam helps a man learn the normal size, shape, and weight of his testicles and the area around the scrotum. This helps him notice any changes from normal.

How To Prepare

You do not need to do anything special to prepare for an exam done by your doctor. But for comfort, you may want to empty your bladder ahead of time. You will be asked to undress and put on a hospital gown.

A self-exam is painless and takes only a minute. It is best to do it after a bath or shower, when the muscles of the scrotum are warm and relaxed.

How It Is Done

Testicular exam

The exam may be done first while you are lying down. Then it may be done again while you are standing. Your doctor will check your belly, your groin, and your penis, scrotum, and testicles. The doctor will feel the scrotum and both testicles to check their size, weight, and texture. The doctor will also look for signs of swelling or lumps. The doctor will note if a testicle is missing or if the testicles are shrinking.

If a lump is found in a testicle, the doctor will place a strong light behind the testicle. This is to see whether light can pass through it.

• Light will not pass through a tumor. Also, a testicle with a tumor generally looks heavier than a normal testicle.
• Light will pass through a mass or swelling caused by a hydrocele. A hydrocele is a buildup of fluid. It feels like water in a thin plastic bag.

The other testicle will be felt and checked too, to make sure it does not have any lumps, masses, or other problems.

Your doctor will also check the lymph nodes in your groin and your inner thigh for swelling.

Self-exam

• The self-exam is best done during or after a bath or shower—when the scrotum, the skin sac that holds the testicles, is relaxed.
• Stand and place your right leg on a raised surface about chair height. Then gently feel your scrotum until you find the right testicle.
• Roll the testicle gently but firmly between your thumb and fingers of both hands. Carefully feel the surface for lumps. Feel for any change in the size, shape, or texture of the testicle. The testicle should feel round and smooth. It is normal for one testicle to be slightly larger than the other one.
• Repeat this for the left side. Feel the entire surface of both testicles.
• You may feel the epididymis, the soft tube behind each testicle. Get familiar with how it feels so that you won't mistake it for a lump.

How It Feels

An exam done by your doctor may cause mild discomfort if your testicles are tender or swollen. And anytime the genital area is touched, there is a chance your body will react. So you may have an erection. This is normal, and your doctor knows this. You do not need to feel embarrassed.

A self-exam does not cause pain or discomfort unless a testicle is swollen or tender. A lump that is cancer usually feels firm. But it probably will not be tender or painful when pressed.

Risks

There is no chance of a problem from having a testicular exam or doing a self-exam.

But there is a chance that these exams might appear to find a problem when there isn't one. This is called a false-positive result. False-positive results may lead to tests or treatments that you don't need.

Results

Testicular exam and testicular self-exam

Normal:	Each testicle feels firm but not hard. The surface is very smooth, without any lumps or bumps. The spongy, tube-shaped structure (epididymis) may be felt on the top and down the back side of each testicle. One testicle (usually the left) may hang a little lower than the other. One testicle may be a little larger than the other. This difference is usually normal.
	There is no pain or discomfort during the exam.
Abnormal:	A small, hard lump (often about the size of a pea) is felt on the surface of the testicle, or the testicle is swollen. If you notice a lump or swelling during a self-exam, contact your doctor right away. This may be an early sign of testicular cancer. Prompt treatment gives the best chance for a cure.
	One or both testicles are absent. If you cannot feel two testicles while performing a self-exam, contact your doctor. You may have an undescended testicle. If you cannot feel both testicles in your baby's scrotum, talk to his doctor.
	A soft bunch of thin tubes (often called a "bag of worms" or "spaghetti") is felt above or behind the testicle. This may mean there is an enlarged, twisted vein in the scrotum, called a varicocele.
	Sudden pain or swelling in the scrotum is noticed during the exam. This may mean an infection, such as epididymitis. Or it may mean blood flow to the testicle is blocked (testicular torsion). Either of these needs to be checked by a doctor right away.
	A lump is felt above the testicle on one side of your scrotum. You may have a spermatocele, which is a painless, fluid-filled cyst found in the epididymis. These cysts are usually not a problem and rarely need treatment.
	A lump that is not attached to a testicle is floating in the scrotum. These lumps don't often require treatment but should be checked out by a doctor.