How to Perform a Testicular Self Exam

Testicular cancer is a rare form of cancer, impacting one in every 5,000 people with testicles. It can occur at any age; however 50% of cases occur between the ages of 20 and 35. Fortunately, testicular cancer also has a very high ratio of diagnosis to recovery, with a 95–99% cure rate.^{[1]XResearch source} As with most cancers, early detection is critical to successful treatment and recovery. Understanding risk factors, symptoms, and conducting routine testicular exams is an important part of early detection. You can give yourself a testicular exam once a month in the shower to detect any irregularities early.^{[2]XExpert SourceRobert Dhir, MD
Board Certified Urologist & Urological SurgeonExpert Interview. 23 September 2020.}

Part 1

Part 1 of 3:

Performing a Testicular Self-Examination

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1
Know the symptoms. In order to perform your self-exam accurately, know what to look for in the event cancer may be present. This self-exam is designed to check for the following symptoms:^{[3]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source}
- A lump within the testicle.^{[4]XExpert SourceRobert Dhir, MD
  Board Certified Urologist & Urological SurgeonExpert Interview. 23 September 2020.} The lump does not have to be large or painful to warrant a doctor visit as tumors can begin as small as a pea or a grain of rice.^{[5]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source}
- Testicular Enlargement. This can be of one or both testicles. Note that it is normal for one testicle to hang slightly lower than the other and to be slightly larger than the other. However, if one testicle is larger than the other or has an abnormal shape or hardness, consult a doctor.^{[6]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source}
- Changes in density or texture. Has one testicle become abnormally firm or lumpy? Healthy testicles are completely smooth all over. Note that the testicles are connected to the vas deferens via a small, soft tube at the top called the epididymis. If you feel this while inspecting your testicles, don't be alarmed; this is normal.^{[7]XResearch source}
Find a room where you won't be disturbed and make sure to have a reasonable-sized, (hands-free, if available) mirror. A bathroom mirror or full length mirror can work well. Being able to visually observe an abnormality of the scrotum is an important aspect of the exam and will require removing any clothing currently covering your lower body, including undergarments.^{[8]XResearch source}
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Stand in front of the mirror and examine the skin of the scrotum. Are any lumps visible? Is swelling present? Is there discoloration or anything else that seems out of the ordinary? Be sure to examine all sides of the scrotum, including the back.^{[9]XResearch source}
4
Feel for abnormalities.^{[10]XExpert SourceRobert Dhir, MD
Board Certified Urologist & Urological SurgeonExpert Interview. 23 September 2020.} Continue to stand and hold the scrotum in both hands with your fingertips touching, making a kind of basket with your fingers. Hold a teste between your thumb and index finger on the same hand. Press gently to check the density and texture of the teste, then gently roll the teste between your thumb and first finger. Do the same to the other teste using the alternate hand.^{[11]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source}
- Take your time. Make sure to thoroughly check the entire surface of each testicle.
In addition to performing a monthly self exam, schedule a physical exam with their doctor at least once a year. Your doctor will perform a testicular exam in addition to other exams and tests used to determine your overall health. If you are experiencing symptoms, however, do not wait for your scheduled exam date; contact a doctor right away for an appointment.^{[12]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source}

Part 2

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Understanding Your Risk Factors

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Know what your risks are. Early prevention is crucial to the successful treatment of cancer. Being aware of your risk profile can make you responsive to symptoms if and when they occur. Below is list of known risk factors to be aware of:^{[13]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source}
- Family history of testicular cancer.
- An undescended testicle (also called cryptorchidism). Three out of four cases of testicular cancer occur in an individual with an undescended testicle.
- Intratubular Germ Cell Neoplasia (IGCN). Often called "carcinoma in situ" (CIS), IGCN occurs when cancer cells manifest in germ cells within the seminiferous tubules where these cells are formed. IGCN and CIS is uniform precursors to cancerous tumors of the testes and, in 90% of cases, is found in tissues surrounding a tumor.^{[14]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source}
- Ethnicity. Studies in the US have shown that Caucasian people are more likely to get testicular cancer than other ethnic groups. ^{[15]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source}
- Previous Diagnosis. If you have had and recovered from a prior testicular cancer diagnosis, you are at increased risk that the other testicle will be affected.^{[16]XTrustworthy SourceUniversity of Rochester Medical CenterLeading academic medical center in the U.S. focused on clinical care and researchGo to source}
Studies have shown that managing environmental risks like diet and exercise, as well as refraining from the consumption of cigarettes and alcohol, can help prevent carcinogenesis, the process by which healthy cells turn into cancerous ones. ^{[17]XTrustworthy SourceNational Cancer InstituteAn agency in the National Institutes of Health focused on cancer research and patient supportGo to source}^{[18]XTrustworthy SourceNational Cancer InstituteAn agency in the National Institutes of Health focused on cancer research and patient supportGo to source}
If you are at risk for testicular cancer, clinical trials are currently underway to broaden the variety of preventative therapies; however, available proactive drug regimens like chemoprevention have been shown to prevent the growth and/or re-occurrence of cancer. Your doctor will know if this is option is right for you.^{[19]XTrustworthy SourceNational Cancer InstituteAn agency in the National Institutes of Health focused on cancer research and patient supportGo to source}

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Taking Action If Symptoms Are Present

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Contact a doctor.^{[20]XExpert SourceRobert Dhir, MD
Board Certified Urologist & Urological SurgeonExpert Interview. 23 September 2020.} During a testicular exam, if you encounter a lump, swelling, soreness, unusual hardness, or any other warning sign, get in touch with your doctor right away. Though these symptoms may not confirm the presence of testicular cancer, it is very important to have a thorough examination to know for sure.^{[21]XResearch source}
- Mention your symptoms when making a doctor's appointment. This increases the likelihood that your doctor will see you promptly.
2
Recording all additional symptoms. If you notice any other symptoms affecting either your testicles or any other part of your body, write up a list. Record even those symptoms that do not seem consistent with testicular cancer symptoms. The extra information may help your doctor as he/she makes a diagnosis and and designs a suitable treatment plan. Some of these symptoms may include:^{[22]XTrustworthy SourceUniversity of Rochester Medical CenterLeading academic medical center in the U.S. focused on clinical care and researchGo to source}
- Heaviness, or an aching sensation in the lower abdomen or scrotum.
- Pain in the lower back, unassociated with stiffness or injury.
- Swelling of the breasts (rare).
- Infertility. In rare cases, an individual may experience no other symptoms except infertility.
3
Stay calm and optimistic. Once you've made your doctor's appointment, relax. Remind yourself that 95% of cases are completely curable, and early detection increases that rate to 99%.^{[23]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source} Additionally, know that your symptoms may signal other, less serious causes, including:
- A cyst in the epididymis (the tube at the top of the testicle) called a spermatocele.
- An enlarged testicular blood vessel called a varicocele.
- A fluid buildup in the testicular membrane called a hydrocele.
- A tear or opening in the abdominal muscle called a hernia.
When you meet with a doctor, he or she will perform the same kind of testicular exam as you did to check for the problems you felt. You will be asked for any additional symptoms. The doctor may examine other parts of your body, like your stomach or groin, to check for the spread of cancer. If the doctor feels anything out of the ordinary, additional tests will confirm a diagnosis.^{[24]XTrustworthy SourceAmerican Cancer SocietyNonprofit devoted to promoting cancer research, education, and supportGo to source} to determine whether there is a tumor.

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When should a testicular self-exam be performed?
Robert Dhir, MD
Board Certified Urologist & Urological Surgeon
Dr. Robert Dhir is a board certified Urologist, Urological Surgeon, and the Founder of HTX Urology in Houston, Texas. With over 10 years of experience, Dr. Dhir’s expertise includes minimally-invasive treatments for enlarged prostate (UroLift), kidney stone disease, surgical management of urological cancers, and men’s health (erectile dysfunction, low testosterone, and infertility). His practice has been named a Center of Excellence for the UroLift procedure, and is a pioneer in non-surgical procedures for ED using his patented Wave Therapy. He earned his undergraduate and medical degrees from Georgetown University and was awarded honors in pre-medical studies, urology, orthopedics, and ophthalmology. Dr. Dhir served as chief resident during his urological surgical residency at University of Texas at Houston / MD Anderson Cancer Center in addition to completing his internship in general surgery. Dr. Dhir was voted Top Doctor in Urology for 2018 to 2019, one of the top three Best Rated Urologists in 2019 & 2020 for Houston Texas, and Texas Monthly has named him to the 2019 & 2020 Texas Super Doctors Rising Stars list.
Robert Dhir, MD
Board Certified Urologist & Urological Surgeon
Expert Answer
In general, once a month, or any time you notice abnormalities in your testicles.
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Is frequent ejaculation linked to a higher risk of testicular cancer?
Chris M. Matsko, MD
Family Medicine Physician
Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017.
Chris M. Matsko, MD
Family Medicine Physician
Expert Answer
No, premature or frequent ejaculation is not linked to any type of cancers.
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How do I preform a testicular exam when I'm constantly having sex and masturbating?
Chris M. Matsko, MD
Family Medicine Physician
Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017.
Chris M. Matsko, MD
Family Medicine Physician
Expert Answer
Take a break. You should do a testicular examination separately from when you are having sex or masturbating.
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It's usually easiest to perform a testicular exam after a warm shower, when the scrotum is relaxed.
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Don't panic if you notice any of the symptoms described above. What you notice could very well be nothing at all, but do take the opportunity to see a doctor for further examination.
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This article should not be used as a substitute for professional medical advice and care. Be sure to visit your doctor regularly for checkups, and seek the advice of a qualified medical professional for more information on this or any medical test or problem.
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