Testicular Examination and Testicular Self-Examination

Test Overview

Testicular examination and testicular self-examination 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 examination

This is a complete physical examination 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 examination is an important part of a routine physical examination 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-examination

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

Why It Is Done

Testicular examination

This examination 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-examination

Self-examination 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 examination 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-examination 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 examination

The examination 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 tumour. Also, a testicle with a tumour 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.

Testicular self-examination

To do a self-examination, stand and place your right foot on a chair or other surface about chair height. Then gently feel your scrotum until you locate the right testicle. Roll the testicle gently but firmly between your thumb and fingers of both hands. Check the surface carefully for lumps. The skin over the testicle moves freely, so it is easy to feel the whole surface of the testicle.

Repeat the process on the other side. Lift your left leg and check your left testicle. Feel the whole surface of both testicles.

How It Feels

An examination 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-examination 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 examination or doing a self-examination.

But there is a chance that these examinations 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 examination and testicular self-examination are two ways to find lumps or other problems of the testicles.

Testicular examination and testicular self-examination
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.
Normal:	There is no pain or discomfort during the examination.
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-examination, 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-examination, 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 examination. 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 that is not attached to a testicle is floating in the scrotum. This is not a cause for concern.

What Affects the Test

Your doctor will talk with you about anything that might keep you from having these examinations or that may change the results.

What To Think About

An undescended testicle may increase the risk of testicular cancer. Parents should check their children or have them checked by a doctor to be sure that both testicles have descended before puberty.
The Canadian Cancer Society (CCS) recommends that, by age 15, all men should know how their testicles normally look and feel and that men should talk to their doctor if they notice any changes in their testicles.

To learn more about the diagnosis and treatment of testicular cancer, see the topic Testicular Cancer.

Medical Tests: Questions to Ask the Doctor

References

Citations

U.S. Preventive Services Task Force (2011). Screening for Testicular Cancer: Reaffirmation Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/testicular/testicuprs.htm.

Other Works Consulted

American Cancer Society (2012). Can testicular cancer be found early? Testicular Cancer Detailed Guide: Early Detection, Diagnosis, and Staging. Available online: http://www.cancer.org/Cancer/TesticularCancer/DetailedGuide/testicular-cancer-detection.

Rew L, et al. (2005). Development of the self-efficacy for testicular self-examination scale. Journal of Men's Health and Gender, 2(1): 59–63.

Stephenson AJ, Gilligan TD (2012). Neoplasms of the testis. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 1, pp. 837–870. Philadelphia: Saunders.