This title came from a program called Save The Nuts, www.protectthenuts.com, which is focused on men checking themselves for testicular cancer. A man’s testicles are important for reasons, which include their concept of their manhood, their confidence, fertility, and potency. Despite the vulnerable position of the testicles, testicular trauma is relatively uncommon. Mobility of the scrotum may be one reason severe injury is rare. The testicles are also prone to injury because they are not protected by muscle or bone. Given the importance of preserving fertility, traumatic injuries of the testicle deserve careful attention. This blog will discuss the common conditions associated with trauma to those gems down there!
The anatomy of testicles
Testicles are also known as testes (one is a testis) or ‘balls’. They are two small, oval-shaped male sex glands that produce sex hormones and sperm. Each testicle is housed in a fibrous outer covering called the tunica albuginea. Sperm production needs a temperature that is around 2 °C lower than the body, which is why the testicles are located outside the body in a sack of skin (the scrotum).
The spermatic cord attaches the testicle to the body. Testicular torsion occurs when the spermatic cord twists and cuts off the blood supply to the testicle. This condition can occur at any age, but tends to be more common between the onset of puberty and the mid-20s. It requires urgent medical attention.
Hard physical activity can cause this twisting of the cord. In most cases, however, it is caused by abnormalities in a male’s anatomy (body structure and organs) that make it easier for the testicle to twist or rotate around the cord.
Symptoms of testicular torsion include:
- Severe pain
- Scrotal swelling
- Nausea and vomiting.
These symptoms can often be confused with an infection of the testicles. An infection should not be diagnosed until torsion has been ruled out.
Urgent medical attention is needed to save the testicle when torsion is diagnosed. Surgery must untwist the spermatic cord and restore blood flow to the testicle. A doctor uses physical examination and ultrasound scans to make the diagnosis. Sometimes, a doctor can only make a conclusive diagnosis at the time of surgical exploration.
The survival rate of the affected testicle is poor unless surgery is performed within four to six hours. Unnecessary investigations should not take place if torsion is suspected, as delays to surgery can affect the viability of the testis. If the blood supply has been disrupted for too long, the testis may not be viable or salvageable and may need to be removed.
In many cases, the surgeon will also secure the spermatic cord on the unaffected side, to prevent future torsion of the other testicle. If the torted testicle has to be removed, then a surgeon can put a prosthesis or silicone testis into the scrotum for cosmetic reasons.
Other conditions that can affect the testicles include:
- Epididymitis – the epididymis is a collection of small tubes located at the back of each testicle. They collect and store sperm. Epididymitis is infection and inflammation of these tubes. Causes include urinary tract infections and sexually transmissible infections (STIs). Treatment includes antibiotics
- Epididymo-orchitis – infection of the epididymis and testicle that causes inflammation and pain. Treatment includes antibiotics
- Varicoceleor varicose veins – 10 to 15 per cent of men have a varicocele, where veins draw blood from the testicle. This blood has to rise against gravity when the man stands up. Valves in the veins help this process. If the valves don’t work, blood pools in the veins. This swells the veins and gives the appearance of ‘varicose veins’. Varicoceles usually don’t need treatment, unless the varicocele is severe enough to cause discomfort or impair fertility. The links between varicocele and infertility are complex and research is ongoing. Treatment includes surgery or radiological techniques that can block the testicular veins
- Haematocele – a blood clot caused by trauma or injury to the testicles or scrotum. In some cases, the body is able to reabsorb the blood. If not, the person will need surgery to remove the clot
- Hydrocele – abnormal build-up of fluid that causes the affected testicle to swell. In some cases, the body can reabsorb the fluid. Even though the condition is painless, the hydrocele may become so large that the person will need surgery to remove it
- Spermatocele – an abnormal build-up of sperm-filled fluid next to the epididymis, which feels like a separate lump on the testicle. This is harmless, but can be removed surgically if it becomes large or bothersome. It is more common after a vasectomy
- Undescended testicles – either one or both testicles are missing from the scrotum and are lodged inside the lower abdomen. Premature and low-weight newborn boys are most prone to undescended testicles. This condition is a known risk factor for testicular cancer and strongly related to infertility. Unless the testicle is brought down into the scrotum by 12 months of age, there is a high risk of damage to sperm production in later life
- Testicular cancer – an abnormal growth or tumour that appears as a hard and usually painless lump in either testicle. In most cases, testicular cancer can be cured if the person seeks medical treatment early. Surgical removal of the affected testicle (orchidectomy) is usually the first treatment for all testicular cancer.
Suggestions on how to reduce the risk of testicular problems include:
- Take all reasonable precautions to prevent accidents. For example, drive safely and always wear a seatbelt.
- Protect yourself from sexually transmissible infections (STIs) by wearing a condom.
- Always use protective equipment such as a jockstrap or hard cup while playing sports.
- If you injure your testicles, always seek urgent medical advice.
- Perform testicular self-examination (TSE) once every month. Regular TSE helps you become familiar with the look, feel and shape of your testicles so you will notice any abnormalities. See your doctor for further information on how to perform TSE.
Always see your doctor if you experience any scrotal or testicular pain or unusual symptoms, or if you find a lump or swelling.
Those gems between our legs are worthy of protecting. If you feel any discomfort or lumps or bumps down there, see your doctor your potency and fertility are worth protecting.