Testicular Problems     

The testicles are located inside the scrotum, a loose bag of skin underneath the penis. They produce male sex hormones and sperm cells for reproduction. Lumps, swelling, pain, or other changes in the testicles can indicate a variety of problems, ranging from minor to serious. Because these symptoms have a number of possible causes, you should see your doctor to ensure correct diagnosis and treatment.

Testicular Cancer

Cancer of the testes is fairly rare, but it is the most common form of cancer in men between the ages of 20 and 35. It accounts for 12 percent of all cancer deaths in young men. Testicular cancer usually responds well to treatment, especially when detected early.

Causes

The cause of testicular cancer is not known, but there are certain risk factors that can make you more likely to get it:

• Normally the testicles descend into the scrotum before birth. Men whose testes have not descended into the scrotum or did not descend until after age 6 are at a much higher risk for testicular cancer, even if the condition was surgically corrected.

• Testicular cancer affects younger men, especially those between the ages of 15 and 35. This type of cancer is uncommon in children and in men over age 40.

• Testicular cancer is four times more common among Caucasian men than African American men.

Symptoms

Begin a self-examination by standing in front of a mirror. Look for signs of swelling in the scrotum. Next, examine each testicle with both hands. With your index and middle fingers underneath and your thumbs on top, gently roll each testicle, feeling for lumps

Cancer usually affects only one testicle. Symptoms may include:

• A lump or enlargement in either testicle

• Pain, swelling, or a feeling of heaviness in your scrotum or testicles

• A dull ache in your lower abdomen or groin

You may have some symptoms of testicular cancer without any pain. Only a small percentage of testicular cancers are painful early on.

Examine your testicles regularly for lumps, swelling, or anything unusual. This is best done after a warm shower or bath, when the scrotal skin is relaxed.

Types of Testicular Cancer

• Seminomas are the most common type of testicular cancer. Nearly all men recover from this type of cancer if it's found and treated early.

• Nonseminomas are a group of cancers that include choriocarcinoma, embryonal carcinoma, teratoma, and yolk sac tumors. These cancers tend to develop earlier in life than seminomas, usually occurring in men in their 20s.

Testicular cancers may be a combination of different types.

Treatment

Seminomas and nonseminomas grow and spread differently, and each type may need different treatment.

• Surgery to remove the testicle through an incision in the groin may be performed. Lymph nodes in the abdomen may also be removed.

• Radiation therapy uses high-energy rays to kill cancer cells and shrink tumors. Seminomas are highly sensitive to radiation therapy; nonseminomas are not.

• Chemotherapy is the use of anti-cancer medications to kill cancer cells throughout the body. Chemotherapy may be used as the initial treatment, or it may be used after surgery to kill any remaining cancer cells.

Treatments for testicular cancer have some side effects. Some treatments may affect your ability to have an erection or interfere with fertility (the ability to produce children). Talk to your doctor about possible side effects before undergoing treatment.

Testicular Pain

Testicular pain may be a sign of a serious medical condition that requires immediate attention, or it may be a less serious problem that can be treated fairly easily.

Causes

Testicular torsion

Epididymitis is the inflammation of the long, coiled tube (epididymis) that carries sperm from the testicle to the vas deferens. It is often caused by a bacterial or chlamydial infection traveling from the urinary duct to the sperm duct. Epididymitis is the most common cause of testicular pain and usually affects only one side. In addition to pain, there may also be swelling and a burning sensation when you urinate.

When the epididymitis spreads to involve the nearby testicle, the condition is called epididymo-orchitis. Orchitis, an infection of the testicle alone, may also occur but is much less common than epididymitis. Orchitis is usually caused by a viral infection and can be associated with the mumps. Although this condition is rare, it can cause infertility and irreversible damage to the testes.

Testicular torsion occurs when a testicle gets twisted in the spermatic cord from which it is suspended within the scrotum (see illustration). This unusual condition can occur spontaneously -- even while you sleep -- or after strenuous activity. Torsion can occur   at any age, though it is most common before age 20. It can strangle the blood supply to the testicle and without immediate treatment can cause permanent damage. Sudden pain, severe enough to cause nausea and vomiting, its the main symptom of testicular torsion.

Pain in the scrotum can also be caused by an inguinal hernia.

Treatment

Epididymitis is usually treated with antibiotics. Your doctor may also recommend several days of bed rest, elevation of the scrotum, use of ice packs, and pain medication, such as acetaminophen (Tylenol). Treatment for orchitis and nonbacterial epididymitis is similar, except antibiotics won't be effective against the virus that caused the condition.

Testicular torsion is a medical emergency that needs to be treated within 6 hours to prevent permanent damage. Your doctor may be able to carefully shift the testicle back into its normal position, but surgery is usually performed to securely anchor it into place.

Self-Care

• Apply an ice pack to the scrotum for 15 to 20 minutes at a time.

• Elevate the scrotal area with a rolled-up towel.

• Wear briefs or a soft athletic supporter to provide support to the area.

• Take acetaminophen (Tylenol) as directed.

• If your doctor has prescribed antibiotics, take your medication exactly the way it is prescribed.