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What are testicles?

The testicles are part of the male reproductive system. They are two oval-shaped organs located inside the scrotum. The testicles produce testosterone and make sperm. Testicular disorders can lead to issues such as:

Hormonal imbalances.
Sexual dysfunction.
Infertility.

What are some of the more common testicular problems?

Testicular trauma

The testicles hang outside of the body, and so they are susceptible to injury. Testicular injuries are common during contact sports. Men can protect their testicles by wearing an athletic cup while competing in any contact sport.

There are a range of possible symptoms with testicular trauma. This includes:

Severe pain in the scrotum.
Bruising and/or swelling in the scrotum.
Pain and discomfort in the lower abdomen.
Nausea and/or vomiting.

Most of the time, the testicles can absorb the shock that comes from an injury without serious damage. In more severe injuries, treatment may be needed and you should seek medical attention.

In mild cases, your healthcare professional will likely recommend medication, rest and ice to the affected area. In more severe cases of trauma, an ultrasound scan imaging test will be ordered. If the trauma is severe, the testicle can rupture and blood can leak out. In these cases surgery is needed to stop the bleeding, repair the rupture and save the testicle.

Testicular torsion

Within the scrotum, the testicle is secured to the body at the top end by a structure called the spermatic cord. The spermatic cord contains blood vessels that supply the testicles. When this cord gets twisted, the blood supply to the testicles is cut off. The loss of the blood supply to the testicles can cause the following symptoms:

Severe, sudden pain.
Enlargement of the affected testicle.
Tenderness.
Nausea and vomiting.

If you have these symptoms, seek immediate medical attention to rule out testicular torsion.

Testicular torsion happens most commonly in men in the early teens to the mid-20s but it can also happen at other ages. Sometimes the torsion is brought on by exercise or injury, but in the majority cases, it is due to the way your testicles sit in your scrotum; this is something that you are born with.

Testicular torsion requires emergency surgery to restore the blood flow. Ideally the surgery should be done within four hours of the initial symptoms. The longer the delay, the less likely the testicle can be saved. If the testicle’s blood flow has been cut off for too long, it cannot be saved and needs to be removed.

Testicular cancer

There are sperm cells in the testicles, and the vast majority of testicular cancers begin in cells of this type. In the United States, testicular cancer is the most common type of cancer in men between ages 20 and 40 years old. It most commonly develops in one testicle, but in two percent of cases, it can happen in both testicles.

By far the most common presenting symptom is a painless lump in the testicle. There are other possible presenting symptoms including:

Testicle pain.
A dull dragging sensation in the scrotum.

Less common symptoms include:

A dull ache in the lower abdomen.
Back pain.
Lower leg swelling.
Bone pain.
Cough.
Breast swelling.

There are some known factors that increase your risk of having testicular cancer:

Age: Testicular cancers occur most commonly between the ages of 15 and 55 years, and is the most common type of cancer for men between the ages of 20 and 40.
Race: Caucasian men are 3.6 times more likely to get testicular cancer than are African-American men and are 2.5 times more likely to get testicular cancer as Asian-American men.
Having an undescended testicle (cryptorchidism): This is a condition in which one or both testicles do not descend from the abdomen into the scrotum.
Family history: If you have a family history of testicular cancer your risk of having testicular cancer is higher.

Testicular cancer is an uncommon but highly treatable form of cancer. There are several treatment options:

Surgery: The surgeon removes the cancerous testicle through a cut in the groin. In more advanced cases, they may also remove some of the lymph nodes in the abdomen as well.
Radiation therapy: This treatment option uses radiation to damage and destroy the cancerous cells.
Chemotherapy: This involves using medications to either kill the cancerous cells or stop their growth.

Early detection and treatment is important to the success of any cancer treatment, and the same applies for testicular cancer. If testicular cancer is detected before it spreads beyond the testicle, the cure rate is as high as 99%. Even if it spreads to the lymph nodes and to other parts of the body, with treatment the long-term cure rate is in the range of 80% to 90%.

Early detection is very important. Monthly testicular self-examinations are one way to do this. A testicular self-examination is performed after a warm bath or shower when the skin on the scrotum is relaxed. After looking for any changes in appearance, carefully examine each testicle by rolling it between your fingers and thumbs to check for any lumps or changes in the size of the testicles.

Epididymitis

The epididymis is a long tube that is responsible for collecting, storing and transporting sperm cells that are produced in the testicles. The epididymis connects the testicles to the vas deferens (the tubes that carry sperm).

Epididymitis occurs when these tubes become inflamed or infected. This can be due to a urinary tract infection or due to a sexually transmitted infection. Sometimes epididymitis can happen without an infection. Regardless of the cause, there are a few common symptoms of epididymitis, including:

Scrotal pain.
Scrotal swelling.
Fever (in severe cases).
A collection of pus, or abscess (in severe cases).

Seek medical attention. Antibiotics are the main form of treatment. Your healthcare professional may also suggest rest, ice (to reduce the swelling), a scrotal supporter and anti-inflammatory medications (such as ibuprofen). Using condoms during sex can help prevent sexually transmitted infections, which can lead to epididymitis. If left untreated, epididymitis can produce scar tissue, which can block sperm from leaving the testicles. This can create fertility problems, especially if both testicles are involved.

Hypogonadism

The testicles are responsible for making testosterone. Testosterone is needed to develop and maintain male physical characteristics including:

Muscle mass and strength.
Fat distribution.
Bone mass.
Sperm production.
Sex drive.
Facial and body hair.

Hypogonadism means the testicles (gonads) do not produce enough testosterone. There are two types of hypogonadism:

Primary hypogonadism: This occurs due to a problem with the testicles themselves.
Secondary hypogonadism: The brain normally sends chemical messages to the testicles, telling them to make testosterone. If this is disrupted, this leads to secondary hypogonadism.

Hypogonadism can occur at any time. When it occurs between birth and the onset of puberty, puberty does not occur. This means the voice will not deepen, there will be no beard or pubic hair and the testicles and penis will not increase in size.

If hypogonadism happens as an adult, it may cause the following symptoms:

Reduced sex drive.
Reduced energy levels.
Issues getting an erection.
Problems with having children.
Depressed mood.
Decreased growth of beard and body hair.
A reduction in the size or firmness of the testicles.
Decreased muscle mass and an increase in body fat.
Enlarged male breast tissue.
Mental and emotional symptoms similar to women with menopause, such as hot flashes, mood swings, irritability, depression and fatigue.

Both types of hypogonadism can be caused by a variety of different factors. Primary hypogonadism may be caused by:

Klinefelter's syndrome: Men have one X chromosome and one Y chromosome. The Y chromosome contains the genetic material that determines male gender and related masculine characteristics. Men with Klinefelter's syndrome have an extra X chromosome. This results in abnormal testicle development and lower testosterone production.
Undescended testicles: This condition is called cryptorchidism. It happens when the testicles do not descend from the abdomen into the scrotum before birth. An undescended testicle does not develop normally and so there are issues with either testosterone and sperm production.
Mumps orchitis: Some boys and men who get mumps get a painful swelling of the testicles called mumps orchitis. This condition damages the testicles and reduces both sperm and testosterone production.
Testicular injuries: Trauma can damage the testicle’s ability to make both testosterone and sperm.
Cancer treatment: Chemotherapy or radiation therapy can affect both testosterone and sperm production. Sometimes this is temporary, but it can also be permanent. Many men choose to preserve their sperm before beginning chemotherapy or radiation therapy.
Chronic liver disease or chronic kidney disease: Chronic, severe illnesses can reduce the testicle’s ability to make testosterone.

Some causes of secondary hypogonadism include:

Pituitary disorders: Head injuries or pituitary tumors affect testosterone production.
Kallman syndrome: This is a genetic condition where the hypothalamus does not send messages to the testicles to make testosterone.
Medications: Certain medications such as chronic steroids used for various health conditions can cause low testosterone.
Drugs: Anabolic steroids and opiates can lower testosterone production.
Life-threatening illnesses: Any major illness such as a heart attack, head injury or major trauma can lead to lower testosterone levels.
Inflammatory diseases: Certain inflammatory diseases such as sarcoidosis, histiocytosis and tuberculosis can affect the hypothalamus and pituitary gland and thus affect testosterone production.
Meningitis: Meningitis can negatively impact the pituitary gland and reduce testosterone levels.
Obesity: Men with overweight or obesity have lower levels of testosterone than men without those conditions.

The most important single test for the diagnosis of hypogonadism is the testosterone level. This is a blood test that is done early in the morning. Usually a confirmatory blood test is required before treatment.

Testosterone replacement therapy is the most common treatment for hypogonadism. There are various forms of testosterone replacement therapy including:

Transdermal patch.
Topical gel.
Implantable pellets.
Injections.
Nasal spray.
Buccal tablets.

There are risks and benefits to testosterone replacement. Your healthcare professional will discuss these with you before starting treatment.