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The men's guide to whether your embarrassing health problems are worth worrying about... including the sign your testicle could fall off in six hours
They are the very vital part of the male anatomy which - at least when it comes to health checks - may not always get the attention they deserve.
A 2019 survey of 2,000 men, by snack manufacturer KP Nuts and the men's health charity Movember, found almost one in four men owned up to fiddling with their testicles at least ten times a day.
For some it was even more frequent, averaging around 50 times a day.
Yet the same poll also found 62 per cent had not had their testicles checked by a doctor in more than a decade.
Testicles are prone to a wide range of medical ailments and injuries – some relatively benign, others potentially very serious
Many also confessed that they never carried out do-it-yourself checks on themselves for suspicious lumps or bumps that might indicate a potential problem.
This is despite the fact that around 2,500 men a year in the UK are diagnosed with testicular cancer, many in their 20s and 30s.
While 90 per cent or so survive for at least ten years if it is detected early, it still claims the lives of around one man a week in Britain.
And it’s not just cancer – testicles are prone to a wide range of medical ailments and injuries, some relatively benign, others potentially very serious.
Read our must-have guide to all things testicular so that you – or maybe your partner – are fully equipped to spot potential health problems before they get out of hand.
SUDDEN, SEVERE PAIN ON ONE SIDE
It could be: Testicular torsion
This is a problem that occurs when the spermatic cord, which carries blood to each testicle, becomes twisted (in much the same way as a garden hose does). Blood flow is reduced or cut off completely as a result. It affects around one in 4,000 males under 25 and is a medical emergency, requiring urgent treatment.
It is caused when one or both testicles are not secured properly from birth to the bottom and back of the scrotum (the sack of skin beneath the penis).
This makes it easier for the testicle to twist round – often as a result of a sporting injury or even just rolling over during sleep – resulting in a kink in the spermatic cord.
In most cases, it triggers severe pain in the scrotum and testicles, along with swelling and redness on the affected side. The testicle may also feel much higher than usual due to being twisted out of position. It’s most common between the ages of 12 and 18, but it can occur at any age.
Unfortunately, there is no way of knowing if your testicles aren’t properly secured, and many men only discover this when the cord becomes twisted. There is no way of preventing this happening, either.
‘Any male who gets acute testicle pain should go straight to A&E – don’t bother calling NHS 111 (in case it is testicular torsion),’ says Gordon Muir, a consultant urological surgeon and andrologist at King’s College Hospital and the private Cadogan Clinic in London.
‘If we don’t operate on a twisted testicle within six hours there’s a high chance it will die off.’
For the operation, performed under general anaesthetic, surgeons cut into the scrotum to reposition the twisted testicle. They then fix it in place with stitches so it doesn’t happen again.
‘The trouble is a lot of patients turn up at A&E complaining of general abdominal pain because the pain has radiated and they don’t realise it’s a testicular problem – and so the testicles don’t get examined,’ says Mr Muir. ‘They may be told it’s an infection, for example, and given antibiotics for it – when it’s not.’
There have been cases of young men losing a testicle, he adds, calling this failure to properly examine patients a ‘kind of medical negligence’.
SWOLLEN OR BULGING BLOOD VESSELS
It could be: A varicocele
Bulging blood vessels on the lower legs are common in those affected by varicose veins. But men can also get a similar condition in their testicles, known as a varicocele: here, the veins in the pouch (scrotum) around the testicle become swollen and dilated, forming a bulge that can be seen and felt when a man is standing or bending forwards.
‘Some men say it feels like a bag of worms,’ says Mr Muir.
The veins in the scrotum have a key job to do in transporting oxygen-depleted blood out of the testicles and back towards the lungs, where it picks up more oxygen.
But a varicocele occurs when the blood pools in the veins, rather than circulating efficiently out of the scrotum. They usually form in puberty and in many cases cause no pain or complications.
However, they can reduce sperm production, affecting a man’s fertility when he gets older. Studies show 10 to 20 per cent of men who have a varicocele have difficulty fathering a child.
It’s known that valves inside the veins that are supposed to keep blood moving smoothly in the right direction can malfunction, causing blood to pool. But the reason why this occurs is unclear.
An anatomical model of a male pelvis, which includes the scrotum, testicles and penis
Men are more likely to get a varicocele in their left rather than their right testicle. This is because the vein in the left one follows a slightly different path to the one in the right, which makes smooth blood flow a little more difficult to sustain.
‘Most men don’t even know they have it until they find they have problems with their fertility,’ says Mr Muir.
The most common treatment is embolisation – where tiny metal coils or a type of foam (or sometimes both) – are injected into the damaged vein.
These form a barrier to stop any more blood flowing into the damaged vein, so it collapses and dies off – and the varicocele disappears. Blood can then continue moving smoothly back towards the lungs via other healthy blood vessels.
REDNESS, SWELLING, PAIN
It could be: Epididymitis
Attached to each testicle is a tightly coiled tube called the epididymis. This is where sperm cells are stored to finish maturing once they have moved out of the testicles.
Roughly three in 1,000 men will get a condition called epididymitis – where an infection gets into this tube and causes testicular pain and swelling.
In younger men, this is most commonly due to a sexually transmitted infection (STI) such as chlamydia or gonorrhoea, but in older men (60 and over) it is often caused by a urinary tract infection (UTI) where the bacteria responsible have migrated down to the scrotum.
‘Epididymitis is very common in older men who get a lot of urinary tract infections,’ says Mr Muir.
‘This is usually because they have benign prostatic hyperplasia, a condition where the prostate swells with age and presses on the urethra, the tube that empties the bladder.’
The blockage can allow bugs, which would otherwise get flushed out with the flow of urine, to flourish in the bladder and urethra, triggering an infection which then travels to the epididymis.
But epididymitis can also be due to an injury or a blow to the testicles, or a build-up of pressure inside the tube that can occur after a vasectomy – a procedure to sterilise men by cutting and sealing the tubes that carry sperm out of the body.
Signs of infection include testicle pain, a build-up of fluid around the affected testicle that feels like a bump or swelling, and tenderness and heat (caused by the infection) in the scrotum.
Depending on the cause of the infection, you may be given antibiotic injections or tablets, or a combination of both.
Some forms of epididymitis can go away on their own but this may take up to six weeks – which heightens the risk of permanent damage that might reduce fertility.
BALLOONED SCROTUM
It could be: A hydrocele
About one in ten baby boys and one in 100 men develop a hydrocele – a build-up of watery fluid around one or both testicles that can leave the scrotum looking like a balloon filled with liquid.
It’s mostly harmless and in the vast majority of cases there is no known cause.
In babies, it can happen when fluid drains incorrectly from tissues in the abdomen into the genitals, pooling inside the scrotum.
In men, it’s likely to be due to some kind of injury or trauma to the testicles.
‘It’s not painful but it is an awkward condition,’ says Mr Muir.
‘In some men, the scrotum can get to the size where they cannot even get their trousers on.’
If the swelling begins to affect quality of life, doctors can perform a simple and straightforward procedure – usually done as day-case surgery under a local anaesthetic – to drain the excess fluid.
This involves making a tiny incision in the scrotum, removing the fluid and sewing up the hydrocele sac (the bag of tissue that holds the fluid) so it cannot refill and cause a repeat of the problem. Mr Muir says: ‘This type of surgery is 95 per cent successful.’
(In babies, hydroceles often go away in time so doctors don’t usually consider surgery.)
Heavy lifting and exercise is discouraged for the first couple of weeks after the procedure and men are advised to wear close-fitting underpants for support until any swelling has gone down.
TENDERNESS AND SWELLING
It could be: Orchitis
Mumps is a common viral infection most of us associate with infancy. And thanks to the highly effective MMR jab routinely offered to all toddlers in the UK, infections are still quite rare.
But there has been a steep rise in cases among adolescents and university students in recent years, mostly among those whose parents rejected the MMR jab for them as infants over fears – later discredited – that the vaccine was linked to autism.
Now anecdotal evidence from doctors suggests this may also have triggered a spike in cases of orchitis – a mumps-related infection which causes pain and swelling in one or both testicles. Indeed, a UK mumps outbreak in 2005 saw rates of orchitis more than double. Orchitis can also be caused by bacterial infections, such as UTIs and STIs.
The NHS website says orchitis affects up to one in three males who get mumps after puberty.
And just under half of those experience some shrinkage in the size of their testicles as a result, with one in ten sufferers also seeing a decline in sperm count. This is thought to be because mumps can cause testicular tissue to die off.
But the NHS states this 'very rarely' causes infertility.
Doctors often prescribe antibiotics and men are advised to take over-the-counter painkillers such as ibuprofen to dull the pain, or apply a cold or warm compress to the affected testicle to soothe it.
Wearing close-fitting underwear that supports the scrotum can also ease the discomfort.
P.S. WHAT IF ONE TESTICLE IS BIGGER THAN THE OTHER?
Most men’s testicles are about the same size, but it’s not unusual to have one slightly bigger than the other.
Equally, it’s fairly common to have one that hangs lower than the other.
And in the majority of cases, this is the left one.
‘This is normal,’ says Mr Muir. ‘Unless it has lumps or bumps on it that shouldn’t be there, this doesn’t matter at all.’
One theory as to why the left one usually hangs lower is that it has a slightly more dense network of tiny blood vessels in it than the right testicle, adding to the weight and making it droop slightly. Exactly why the male body has evolved this way is unclear.