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Movember: the importance of testicular self-examination

11 November 2021

Testicular self-examination in men is a simple manoeuvre that, correctly oriented, can give us a lot of information regarding testicular well-being or discomfort. Therefore, it should become as frequent and effective for men as breast self-examination is for women.

 

Some statistics on testicular cancer

Testicular cancer constitutes approximately 1% of all male tumours. The incidence of testicular cancer, in its different variants, is quite low in our environment: the appearance of new cases is estimated at 1.9 per 100,000 inhabitants per year; far from the 50.9 cases per 100,000 inhabitants per year of female breast cancer.

It should be noted that testicular cancer affects mainly white Caucasians from central and northern Europe, with a minimal incidence in black or Asian males in general. It mainly affects young people between 15 and 35 years of age, and rarely (only 10% of cases) those over 50 years of age.

The possible findings from a bilateral testicular self-examination can be many, most of them benign in nature. However, given the easy accessibility as well as the simplicity of this manoeuvre makes it easy to add to for example you shower routine once every couple of weeks.

The testicles are located below and on both sides of the penis and are housed in the scrotal sac, made up of skin and several other layers of protection, among which there is muscular tissue, which causes the sac to wrinkle or relax, leaving the testicles more exposed or more tucked in.

The presence of specific pathologies of the scrotal skin is frequent, in the form of small fatty cysts, varicose veins or moles which, although they should be consulted with the specialist for possible treatment, should not be a cause for alarm, since their presence has nothing to do with testicular problems per se.

As far as the testicles are concerned, we should explore them both, one after the other with both hands at the same time, and preferably with the scrotal sac relaxed, which greatly facilitates self-exploration. The testicle has an ovoid shape, with a smooth surface, is quite consistent and slides easily into the scrotal sac. It is necessary to go completely around it in order to explore its entire surface. This part of the manoeuvre should never be painful under normal conditions.

Usually the testicles, in the healthy male, are practically equal in size and consistency. The left testicle is usually lodged in the scrotal pouch a little lower than the right, although it is only very evident in men with a wide scrotal pouch and thin skin, which allows the testicles to hang more freely. However, this finding is absolutely normal.

The back part of the testicle is rather more complex, as it contains a pigtail-like structure called the epididymis. This is the part where the sperm matures and it takes the sperm from the testicles upwards.   This part is sometimes more prominent as well as very sensitive to palpation which is completely normal, sometimes it is a new casual finding in very sporadic self-examinations, but in no case is it a tumour finding.

The epididymis continues upwards, towards the groin, through the vas deferens, which is accompanied by arteries, veins, nerves, etc., all surrounded by a muscular layer, which together represents what we call the spermatic cord. This is responsible for the testicles to rise and fall at certain times of the day in a natural way, with heat or cold, with relaxation or nervousness, pain, etc.

 

Findings in self-examination

In testicular self-examination there are a series of findings that are important to consider, such as the appearance of painless increase of the size of your scrotum, whether permanent or intermittent, the appearance of painless lumps or nodules in the testicles or in the neighbouring structures, which can also be permanent or intermittent and, in general, the appearance of any change in the shape, size or consistency of any of the testicles.

These findings should always be consulted and evaluated by the specialist physician, in this case the urologist who, through a careful examination and simple tests (a scrotal ultrasound and blood tests – looking for tumour markers when necessary), can quickly diagnose what is causing the abnormality, and to distinguish benign pathologies, from malignant pathologies, like testicular cancer that requires a rapid, almost urgent surgical approach.

On many other occasions, the testicular exploratory findings are painful, appearing in addition to the increase in size, inflammation or redness of one of the testicles, a sensation of heaviness in the scrotum or pain in the lower abdomen or in one of the groins. Usually, the latter are not findings typical of tumour pathology, but rather of urinary or genital infectious processes, but nevertheless they should also be evaluated by the specialist, and treated appropriately until they are completely cured.

 

Contact a doctor 24 hours 7 days a week without leaving home and ask them any health-related question. Also, if you or your family have to make an important decision about an intervention and want to contrast the treatment with a world leading expert, contact us and we will assess your diagnosis with the Second Medical Opinion service.

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