Testicular self-examination

The testicles, also known as testes, are the oval-shaped male reproductive organs located in the scrotum under the penis, and produce sperm and the hormone testosterone.[1] Testicular cancer is one of the less common cancers, tends to mostly affect men between ages 15 and 49 and typically presents with a painless testicular swelling or lump, or any change in shape or texture of the testicles.[2]

Monthly self-examination of the testicles, starting at puberty, may be an effective way of detecting testicular cancer at an early, and potentially treatable stage.[3][5] Recommendations vary with some physicians advocating monthly TSE to men ages 15 to 55.[6][7]

Practitioners may recommend testicular self-exam (TSE) when the following risk factors are present:

• Family history of testicular cancer[5]
• Past testicular tumor[4]
• Undescended testicle[5]
• Testicular Atrophy[4]

There is no general medical consensus for recommendations on TSE. The effectiveness of performing TSE in reducing morbidity and mortality from testicular cancer is not known. Not all organisations endorse the procedure as a screening test, arguing that it may lead to unnecessary treatments. The benefit of TSE is uncertain; thus, the US Preventative Services Task Force and the Royal Australian College of General Practitioners do not recommend routine screening while the American Cancer Society recommends TSE for men over the age of 20, and the European Association of Urology recommends TSE for men with risk factors.[4] In 2018, the American Academy of Family Physicians doubted benefits of TSE to screen for testicular cancer due to high false-positive results, the low incidence of disease, high cure rates of treatment and harms from diagnostic procedures.[8][9]

For men who choose to perform TSE, it is recommended to be done at the time every month.[5] TSE is performed in front of a mirror in the standing position, after a warm bath or shower, when the scrotum is relaxed and the testicles are lower and more easily felt.[1][10]

Subsequently, in a systematic order, any outer skin changes and swellings that are visible are noted, after which both hands are used to feel each testicle. By placing each thumb on top of the testicle and each middle and index finger below, the testicles can be comfortably rolled between the fingers and thumb. Alternatively, one hand can be used to stabilize the testicle, while it is felt using the other hand.[1][3][5] The whole procedure should be painless.[1][3][5]

Variations in size between left and right testicles is often normal[11] and by performing TSE, men become familiar with their own anatomy, allowing them to know when a lump or change is suspicious, warranting further assessment.[2]

The next step involves locating the long tube-like structure behind each testicle, which collects and transports sperm, called the epididymis.[3]

Sometimes, if a young adult male has a spouse or partner, the spouse/partner will perform or assist in the exam, which can be done as a form of sex play and/or foreplay. The spouse or partner often is the one that spots testicular changes without formal screening.[4]

TSE may reveal a number of findings including:

• a lump in one testicle[5]
• Pain or tenderness in a testicle, possibly feeling of fullness or pain in the scrotum, penis, or groin/abdomen[5]
• build-up of fluid in the scrotum[5]
• a change in the size of one testicle or the relative sizes of the two (it can be normal for one testicle to be slightly larger, or hang lower than the other)[1]

Some signs and symptoms of testicular cancer found during the TSE are common to other disorders of the male urinary tract and reproductive organs, some of which require prompt medical attention to preserve reproductive and urinary function. These include hydrocele testis, a varicocele, a spermatocele, genitourinary system cancers, urinary tract infections, sexually transmitted infections, or testicular torsion.

In 2018, Chris Hughes from the TV show Love Island, was examined by TV physician Chris Steele on This Morning, a live TV show. Steele explained that "a lot of men who find something wrong are embarrassed to go to a GP to discuss it...it’s a very frustrating area, testicular cancer, but it’s eminently curable, it’s a young man’s cancer, it’s easily detectable”.[12]

Testicular self-examination has generally low rates of practice in part because males are poorly informed, but also because of psychological aversion.[13] Comparatively woman are more diligent in performing breast self-examination than men. A person's likeliness to perform self-examination is related to their fear of developing cancer.[14] In addition to sex there is some reason to believe that socioeconomic factors also relate to frequency of examination.[15]

• Breast self-examination
• Well-woman examination

• Testicular Cancer. Orchid (2015)
• Testicular self-examination. WebMD