Andrew Siegel, M.D. Blog # 85
Question: For genital health issues, women have gynecologists, but who do men have for their genital health issues?
The next five blogs will be dedicated to men’s health issues. Today’s blog will cover examination of the testicles and the next three will cover penile issues—fracture of the penis, priapism, and Peyronie’s disease—and the final will be on testicular torsion.
Examining one’s testicles is a simple task that can be lifesaving. For most men, touching/manipulating/rearranging their nether parts is a natural and almost reflex activity that—supplemented with a little instruction, knowledge and direction—can be put to some very good clinical use. What follows will also be appropriate for the partner of the man in question. Several times in my career as a urologist, it has been the man’s partner that was astute enough to recognize a problem that prompted the patient visit in which a diagnosis of testicular cancer was made.
Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20’s, striking men at the peak of life. Lance Armstrong, Scott Hamilton, Eric Shanteau, Tom Green, John Kruk, Brian Piccolo, Richard Belzer, and Bernard Goetz are all members of the testicular cancer club.
The great news is that it is a very treatable cancer, especially so when picked up in its earliest stages, when it is commonly curable. One of the great advantages of having one’s gonads positioned in such an accessible locale (as opposed to the ovaries) is that examination and early cancer diagnosis is a cinch (once again, as opposed to the ovarian cancer, which most often presents at an advanced stage).
The goal of self or partner-exam is to pick up an abnormality in a very early—and treatable—stage, at a time when testes cancer is a localized issue that has not spread to the lymph nodes or lung, which are common sites of metastasis in advanced testicular cancer.
In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle. It most often does not cause pain, so the absence of pain is not a feature that should dissuade you from getting an abnormality looked into. If you feel something that was not present previously, please see a urologist—I promise that you will never be chided for being a “hypochondriac” for getting something checked out. It is truly better to be safe and cautious.
The testicles can be examined anywhere, but a warm shower or bath is an ideal setting as the warm water tends to relax and thin the scrotal sac and allow the testes to descend to a position that is most accessible. Soapy skin will eliminate friction and allow the examining fingers to easily roll over the testicles.
The exam is best performed with the thumb in front and the remaining fingers behind the testicles. The four fingers immobilize and support the testicle and the thumb does the important work in examining the front, sides, top and bottom of the testicle; then the thumb immobilizes the front while the four fingers examine the back of the testes. When examining the back surface of the testicle, the index and middle fingers will do most of the work. The motion is a gentle rolling one, feeling the size, shape, and contour and checking for the presence of lumps and bumps.
Compare the two testes in terms of size, shape and consistency. Generally, the testicle feels firm, similar to the consistency of a hard-boiled egg, although it can vary between individuals and even in an individual. Lumps can vary in size from a kernel of rice to a large mass many times the size of the normal testes. It is important to know that not every testes abnormality is a cancer; in fact, most are benign. The epididymis is a comet-shaped structure located above and behind the testes that is responsible for sperm storage and maturation. It has a head, a body and tail, and it is worthwhile running your fingers over this structure as well.
This exam should be done regularly—perhaps every couple of weeks or so—such that you get to know your (or your partner’s) anatomy to the extent that you will be attuned to a subtle change. Once you get in the habit of doing this on a regular basis, it will become second nature and virtually a subconscious activity that only takes a few moments.
And to every wife, girlfriend, partner…if your man is a stoic kind of guy who is not likely to examine himself here is what to do—at a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.
Bottom line: Have the “cajones” to check your or your partner’s cajones. Because sperm production requires that the testicles are kept cooler than core temperature, nature has conveniently designed man with his testicles gift wrapped in a satchel dangling from his mid-section. There is no organ in the body—save the breasts—that are more external and easily accessible. Take advantage of that accessibility to do regular exams—it just might be lifesaving.
For more info:
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
Available on Amazon in paperback or Kindle edition
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