Testicular Self-Examination

Peter Kolettis, writing for the Male Reproductive Health Alliance (MRHA), discusses the fact that testis cancer is the most common solid tumor for men in their reproductive years. He describes the procedure for a testicular self exam, and notes the positive effects on a man's fertility - and his life - of early detection and treatment of any potential problems, such as a tumor.

Testicular Self-Examination

Peter N. Kolettis, M.D.


Division of Urology

University of Alabama at Birmingham

Testis cancer is the most common solid tumor for men in their reproductive years. Testis tumors can grow rapidly, so prompt detection and treatment are critical. If detected early, most men with testis cancer can be cured of the disease. Although men with advanced disease are frequently cured, they require more treatment, which can have more complications, including infertility.

Testis tumors are usually firm but painless masses. Occasionally, a man will describe a heavy feeling secondary to the tumor. Typically, the tumor is detected by the man or his partner who feel the mass; this leads to seeking an evaluation. If a man suspects any abnormality of his testes or scrotum, he should see a urologist as soon as possible.

Because testis tumors grow rapidly, early detection is important. It makes sense that regular testicular self-examination is beneficial. A testicular self examination is not painful or difficult and most men are comfortable performing it. It is suggested that a man perform the examination once a month on a day that is easy to remember, for example, on his birthday.

The examination can be performed either while standing or lying down. A man should hold the testis with one or both hands and then allow it to slide underneath the fingertips. He should examine the testes for size, consistency and any firm or irregular areas. Any difference in the texture or consistency between the two testes should also be noted. The man should also become comfortable separating the testis from the spermatic cords, which contain the blood vessels and vas deferens and are above the testes. Any possible abnormality of the testes or scrotum whatsoever should be evaluated by a urologist. Any possible abnormalities of the scrotum are usually also evaluated by ultrasound.

A testis tumor is usually felt inside rather than on the surface of the testis. Also, many masses or other abnormalities of the scrotum such as hydroceles, spermatoceles and varicocelesare actually outside the testis, but can be felt during a testicular self-examination. Hydroceles and spermatoceles are not harmful, but can cause discomfort or be of concern, as they may feel like "something extra" in the scrotum. Varicoceles, often described as a "bag of worms" are outside the testis and can also be felt during self examination while in the standing position. Varicoceles are associated with infertility and can cause pain. Finally, a hernia can also be felt in some cases as a bulge in the groin or scrotum.

It is strongly recommended that any possible abnormality discovered during a testicular self-examination be evaluated by a urologist. Fortunately, most abnormalities are not cancer, especially those that are outside the testis. It is not expected, however, that the man will be able to determine what is a tumor and what is not. A urologist can then educate the man, initiate any additional testing that is required and reassure the patient about the results if he does not have a tumor. If the man does have a possible tumor, the urologist can initiate the next steps in evaluation and treatment. Finally, the urologist can review the testicular self-examination with the man and give him additional tips on performing it.

To sum it up, the testicular exam is painless, easy to perform, free, and has no risks. The potential health benefits are tremendous: the man can possibly detect a significant problem such as a testis tumor in its early stages which can literally be life saving. Other conditions that could be detected can also affect the man's health and fertility. Thus, by performing the testicular self examination, a man can have a significant, positive effect on his own health and well being.

Peter N. Kolettis, M.D.

Peter N. Kolettis, M.D. Professor Division of Urology University of Alabama at Birmingham

Dr. Kolettis is Professor of Surgery at the University of Alabama at Birmingham. He joined the faculty in July of 1998 and has served as the Urology Residency Program Director since July 2003. He graduated magna cum laude from the University of Notre Dame. He then received his MD degree from the University of Chicago Pritzker School of Medicine. Dr. Kolettis completed his Urology Residency and Fellowship in Male Infertility at the Cleveland Clinic Foundation.

Dr. Kolettis is author or co-author of 46 publications and serves as a reviewer for Fertility and Sterility, American Family Physician, Journal of Andrology, the Journal of Urology and Urology. He has been invited to give presentations at national and international meetings. Dr. Kolettis is married and has three children. In addition to spending time with his family he enjoys sports and music.