There comes a time for gay men to consider scrotums and testicles from a
medical, rather than esthetic, perspective. Of the health conditions that affect
this part of male anatomy, testicular cancer is the most serious. Although
somewhat rare, cancer of the testicle is still the most frequent type of cancer
among young men between 20 and 40 years of age. Rates of this cancer have
increased in recent decades--for reasons that are not clear--with approximately
7,000 new cases in the United States each year. Fortunately, testicular cancer
can usually be cured--about 95 percent of the time, if it is found early. Which
leads us to suggest that men may benefit from regular self-examination of their
testicles, just as women benefit from regular self-examination of their breasts.
Some experts suggest self examinations about once a month. Here is how:
A good time and place is after a warm shower or bath. Warmth relaxes the
scrotum, allowing the testicles to hang lower with better exposure.
Stand in front of a mirror and look for any swelling or enlargement of a
testicle. It is normal for one testicle (usually the left one) to hang a
little lower than the other. Slight differences in size are also normal.
Put your index and middle fingers under the testicle with your thumb on
top. You should roll each testicle between your thumb and fingers (gently,
of course). Check for any small, firm lumps inside the testicle. Cancerous
tumors are more likely to be felt in the sides or front of the testicle. If
present, they are almost always limited to one testicle and in the earlier
stages they are usually painless.
Dont mistake the normal structures you feel for a tumor. One normal
structure is the "epididymis"--a soft, somewhat irregular
collection of small tubes that carry sperm and are attached to the upper
part of each testicle. Above the epididymis is a loose stringy bundle
containing the spermatic cord and some blood vessels.
If you feel a suspicious lump or swelling, see a medical doctor as soon
as possible. Remember that many causes of swelling are benign, some of these
we will discuss below. But they still need to be checked by a physician.
Doctors will evaluate suspicious masses in the testicle or scrotum with a
physical examination and, if necessary, additional tests such as ultrasound
(brief and painless), and perhaps x-rays and a CT scan. Blood tests may also be
needed. If cancer is diagnosed, then the treatment involves surgery to remove
the affected testicle. Radiation and chemotherapy treatments may be needed,
depending on the nature of the tumor and whether it has spread. Even if there
are signs of spread, the majority of men with testicular cancer can still be
cured with modern treatments.
Speaking of this treatment, of course men hate to think of losing a testicle.
However, the surgery for this type of cancer leaves the healthy testicle intact,
which is sufficient to maintain the production of male hormones and--although
this may be less important to some of us--even preserve fertility. And for
appearances sake--which is important to many of us--an artificial testicle can
be placed in the scrotum so that it still looks like it holds a matching pair.
Aside from tumors, other conditions of the testicle are quite a bit more
A "hydrocele" is a collection of fluid under the membrane that
surrounds the testicle. It gives the appearance of swelling around the
testicle, and may feel soft or fluid-filled to touch. A hydrocele is usually
not associated with cancer, but still should be evaluated by a doctor.
"Epididymitis" is an infection of the tubes that collect sperm,
located on the upper part of the testicle. It causes the rapid development
of swelling and pain that can be quite severe. Sometimes epididymitis
develops as a result of urethritis or a sexually transmitted infection such
as gonorrhea. (Another good reason to use condoms.) Treatment requires
A "varicocele" refers to enlarged veins that are located above
the testicle. They are felt as an irregular, soft cord-like mass above the
testicle, more often on the left side. They are not serious, but sometimes
cause discomfort and may reduce fertility. If mild, they can be left alone.
If bothersome, they can be treated with minor surgery.
"Testicular torsion" refers to a twisting of a testicle that
cuts of its blood supply. Fortunately, it rarely occurs in men, but does
occur occasionally with small boys. It causes acute, severe pain and
requires prompt emergency treatment to restore the blood supply.
So gay men (and men in general) should be aware of the medical conditions
discussed above. The most serious of these, fortunately, are not common. And
with early and proper medical treatment, nearly all these can be treated
successfully with good result. See your doctor, if you have questions.