Testicular self-examination

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Testicular self-examination
Testicular Self-Examination.jpg
A man examines his testicles
Other namesTSE
MedlinePlus 003909

Testicular self-examination (TSE) is a procedure where a man examines his own testicles and scrotum for possible lumps or swelling. [1] It is usually undertaken at home while standing in front of a mirror and after having a warm bath or shower. [1] Monthly self-examination of the testicles starting at puberty may be an effective way of detecting testicular cancer at an early, potentially treatable stage, [2] which can lead to a 5-year survival rate of 98%. [3] In men aged 15 to 40, testicular cancer is the most common cancer, [4] [5] and the annual rate of increase over the last 10 years in cases of testicular cancer has been shown to be approximately 1% each year. [6] Testicular cancer typically presents with a painless testicular swelling or lump or any change in shape or texture of the testicles. [7]

Contents

TSE is also indicated if there are certain risk factors present, such as a family history of testicular cancer. [8] [9] Additionally, outside of the possible early detection of testicular cancer, other "off label" uses of TSEs include detection of indirect inguinal hernias, varicocele, and infections that may affect the testicles, such as mumps. [3] The efficacy of TSEs in detection of these pathologies relies on proper technique, but if done correctly, TSEs can be very beneficial to the health of the individual and have many public health benefits as well.[ citation needed ]

Uses

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. [2] [8] Recommendations vary with some physicians recommending the use of monthly TSE for men ages 15 to 55. [10] [11]

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

Professional Guidelines

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 organizations endorse the procedure as a screening test, arguing that it may lead to unnecessary treatments, and unnecessary anxiety. [9] The benefit of TSE is uncertain due to there being no randomized control trial studying the use of TSE. [12] Many organizations have established their own guidelines in regard to the utilization of testicular self examination as well as the use of testicular examination by a medical provider as a diagnostic tool. These guidelines can be found in the table below.

Current Recommendations for Testicular Examination
OrganizationRecommendation
US Preventive Services Task Force Grade D rating, Not recommended to be conducted by clinician nor patient. [9]
American Urological Association List TSE as a screening test in their “Men’s Health Checklist” for urologists and other clinicians [12]
American Academy of Family Physicians Recommend against screening due to high cure rates of advanced disease, false-positives, and harms caused by diagnostic procedures. [13]
American Cancer Society No defined recommendation but state it should be conducted when completing a thorough routine cancer screening. [9]
Royal Australasian College of General PractitionersRecommend against screening since there is no evidence that those who routinely screen will be able to detect early stage tumors. [9]
European Association of Urology Recommend screening in those with clinical risk factors. [9]

Technique

For men who choose to perform TSE, it is recommended to perform TSE once monthly, at approximately the same time every month. [8] Performing TSE during or after a warm bath or shower may help to relax the skin of the scrotum and make the structures within the scrotum easier to feel. [1] [2] [14]

Existing guidelines indicate that TSE is best performed in the standing position. Individuals performing TSE may choose to stand in front of a mirror in order to visualize the scrotum and testicles from various angles. First, the scrotum and testicles may be visually examined for any skin changes or visible swelling. [2] Then, with the thumb placed on the upper surface and the index and middle finger placed on the lower surface, each testicle can be rolled between the thumb and fingers to feel for potential findings. [8] It is also recommended to locate and feel the epididymis, a soft, rope- or tube-like structure that runs behind each testicle, in order to avoid confusing this structure for a potentially abnormal finding. [2] [14]

Findings

Normal findings during TSE include testicles that feel round, smooth, and homogenous in texture, and that are mobile within the scrotum. [8] It is normal and common for one testicle to be larger and hang lower in the scrotum than the other. [2] [8]

Findings that may be abnormal and should be discussed with healthcare providers include:

Limitations

The effectiveness of performing routine TSE in men without symptoms in reducing morbidity and mortality from testicular cancer is not clear, and as such, not all organizations endorse the procedure as a screening test, arguing that it may lead to unnecessary treatments. [9] Additionally, some signs and symptoms of testicular cancer found during TSE are common to other disorders of the male urinary tract and reproductive organs, including hydrocele testis, spermatocele, genitourinary system cancers, urinary tract infections, sexually transmitted infections, or testicular torsion, which may prompt medical attention to preserve reproductive and urinary function. These potential false positives may cause unnecessary concern or anxiety [15] to patients.

Society and culture

Testicular self-examination has generally low rates of practice in part because young men have very low rates of health-seeking behaviors, leading to higher rates of mortality and morbidity. [16] [17] [18] This is likely influenced by the fact that men face potential perceived societal pressures and judgement, which create obstacles to these patients seeking care. [19] [20]

See also

Related Research Articles

<span class="mw-page-title-main">Testicle</span> Internal organ in the male reproductive system

A testicle or testis is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testosterone. Testosterone release is controlled by the anterior pituitary luteinizing hormone, whereas sperm production is controlled both by the anterior pituitary follicle-stimulating hormone and gonadal testosterone.

<span class="mw-page-title-main">Testicular torsion</span> Medical condition

Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testicle. The most common symptom in children is sudden, severe testicular pain. The testicle may be higher than usual in the scrotum and vomiting may occur. In newborns, pain is often absent and instead the scrotum may become discolored or the testicle may disappear from its usual place.

<span class="mw-page-title-main">Testicular cancer</span> Medical condition

Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle or swelling or pain in the scrotum. Treatment may result in infertility.

<span class="mw-page-title-main">Cryptorchidism</span> Medical condition

Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. The word is from Greek κρυπτός 'hidden' and ὄρχις 'testicle'. It is the most common birth defect of the male genital tract. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life, making the true incidence of cryptorchidism around 1% overall. Cryptorchidism may develop after infancy, sometimes as late as young adulthood, but that is exceptional.

<span class="mw-page-title-main">Epididymitis</span> Medical condition

Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Onset of pain is typically over a day or two. The pain may improve with raising the testicle. Other symptoms may include swelling of the testicle, burning with urination, or frequent urination. Inflammation of the testicle is commonly also present.

Blue balls is slang for an uncomfortable testicular sensation that can occur during a state of male sexual arousal. The term is thought to have originated in the United States, first appearing in 1916. Another slang term used for the condition is lover's nuts. Some urologists call this condition epididymal hypertension or sexual arousal orchialgia. Most often it describes a temporary fluid congestion (vasocongestion) in the testicles, caused by prolonged sexual arousal in the human male without ejaculation.

<span class="mw-page-title-main">Orchiopexy</span> Surgery to fix a testicle into the scrotum

Orchiopexy is a surgery to move and/or permanently fix a testicle into the scrotum. While orchiopexy typically describes the operation to surgically correct an undescended testicle, it is also used to resolve testicular torsion.

<span class="mw-page-title-main">Spermatocele</span> Medical condition

Spermatocele is a fluid-filled cyst that develops in the epididymis. The fluid is usually a clear or milky white color and may contain sperm. Spermatoceles are typically filled with spermatozoa and they can vary in size from several millimeters to many centimeters. Small spermatoceles are relatively common, occurring in an estimated 30 percent of males. They are generally not painful. However, some people may experience discomfort such as a dull pain in the scrotum from larger spermatoceles. They are not cancerous, nor do they cause an increased risk of testicular cancer. Additionally, unlike varicoceles, they do not reduce fertility.

<span class="mw-page-title-main">Testicular atrophy</span> Reduction in the size and function of the testicles

Testicular atrophy is a medical condition in which one or both testicles diminish in size and may be accompanied by reduced testicular function. Testicular atrophy is not related to the temporary shrinkage of the surrounding scrotum, which might occur in response to cold temperature.

<span class="mw-page-title-main">Hydrocele</span> Accumulation of fluid in a body cavity

A hydrocele is an accumulation of serous fluid in a body cavity. A hydrocele testis, the most common form of hydrocele, is the accumulation of fluids around a testicle. It is often caused by fluid collecting within a layer wrapped around the testicle, called the tunica vaginalis, which is derived from peritoneum. Provided there is no hernia present, it goes away without treatment in the first year. Although hydroceles usually develop in males, rare instances have been described in females in the canal of Nuck.

<span class="mw-page-title-main">Varicocele</span> Medical condition

A varicocele is an abnormal enlargement of the pampiniform venous plexus in the male scrotum; the female equivalent of painful swelling to the embryologically identical pampiniform venous plexus is called pelvic compression syndrome. This plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Varicoceles occur in around 15% to 20% of all men. The incidence of varicocele increase with age.

<span class="mw-page-title-main">Hematocele</span> Medical condition

A hematocele is a collections of blood in a body cavity or potential space. The term most commonly refers to the collection of blood in the tunica vaginalis around the testes, known as a scrotal hematocele. Hematoceles can also occur in the abdominal cavity and other body cavities. Hematoceles are rare, making them harder to diagnose and treat. They are very common especially as slowly growing masses in the scrotum usually in men older than 50 years.

<span class="mw-page-title-main">Scrotoplasty</span> Type of surgery to create or repair the scrotum

Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. However, scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants began in 1940 made from materials outside of what is used today. Today, testicular implants are created from saline or gel filled silicone rubber. There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.

<span class="mw-page-title-main">Testicular pain</span> Medical condition

Testicular pain, also known as scrotal pain, occurs when part or all of either one or both testicles hurt. Pain in the scrotum is also often included. Testicular pain may be of sudden onset or of long duration.

<span class="mw-page-title-main">Testicular sperm extraction</span>

Testicular sperm extraction (TESE) is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI) as part of in vitro fertilisation (IVF). TESE is often recommended to patients who cannot produce sperm by ejaculation due to azoospermia.

Testicular rupture is a rip or tear in the tunica albuginea resulting in extrusion of the testicular contents, including the seminiferous tubules. It is a rare complication of testicular trauma, and can result from blunt or penetrating trauma, although blunt trauma is more likely to cause rupture.

<span class="mw-page-title-main">Scrotum</span> Sac of skin that protects the testicles

The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum contains the external spermatic fascia, testicles, epididymis, and ductus deferens. It is a distention of the perineum and carries some abdominal tissues into its cavity including the testicular artery, testicular vein, and pampiniform plexus. The perineal raphe is a small, vertical, slightly raised ridge of scrotal skin under which is found the scrotal septum. It appears as a thin longitudinal line that runs front to back over the entire scrotum. In humans and some other mammals, the scrotum becomes covered with pubic hair at puberty. The scrotum will usually tighten during penile erection and when exposed to cold temperatures. One testis is typically lower than the other to avoid compression in the event of an impact.

<span class="mw-page-title-main">Orchiectomy</span> Surgical removal of one or both testicles

Orchiectomy is a surgical procedure in which one or both testicles are removed. The surgery can be performed for various reasons:

<span class="mw-page-title-main">Scrotal ultrasound</span> Medical ultrasound examination of the scrotum.

Scrotalultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.

Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development and is normally included in an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam is conducted to detect various ailments, measure sexual development, or verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities, urethral opening abnormalities, problems related to uncircumcision, lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues and many others. In some instances where a physical examination of the male genitals is not sufficient to diagnose an individual than an internal genital examination using imaging or ultrasounds will be needed for further evaluation.

References

  1. 1 2 3 4 5 6 "Testicular self-exam". MedlinePlus Medical Encyclopedia. National Institutes of Health . Retrieved 23 August 2019.
  2. 1 2 3 4 5 6 7 "Testicular Self-examination; Frequently-asked questions" (PDF). Leaflet No.16/135. British Association of Urological Surgeons.
  3. 1 2 Rovito, Michael J.; Leone, James E.; Cavayero, Chase T. (2018-05-01). ""Off-Label" Usage of Testicular Self-Examination (TSE): Benefits Beyond Cancer Detection". American Journal of Men's Health. 12 (3): 505–513. doi:10.1177/1557988315584942. ISSN   1557-9883. PMC   5987946 . PMID   25990509.
  4. ↑ Kennett, Alexandra; Shaw, Jonathan W; Woolley, Paul D (2014-10-01). "Testicular self-examination amongst genitourinary medicine clinic attendees". International Journal of STD & AIDS. 25 (12): 844–850. doi:10.1177/0956462414522774. ISSN   0956-4624. PMID   24516080. S2CID   206582831.
  5. ↑ van As, N. J.; Gilbert, D. C.; Money-Kyrle, J.; Bloomfield, D.; Beesley, S.; Dearnaley, D. P.; Horwich, A.; Huddart, R. A. (June 2008). "Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse". British Journal of Cancer. 98 (12): 1894–1902. doi:10.1038/sj.bjc.6604280. ISSN   1532-1827. PMC   2441965 . PMID   18542063.
  6. ↑ Kawakami, Takahiro; Okamoto, Keisei; Ogawa, Osamu; Okada, Yusaku (2004-01-03). "XISTunmethylated DNA fragments in male-derived plasma as a tumour marker for testicular cancer". The Lancet. 363 (9402): 40–42. doi:10.1016/S0140-6736(03)15170-7. ISSN   0140-6736. PMID   14723995. S2CID   240676.
  7. ↑ "Testicular cancer". National Health Service United Kingdom. 24 November 2017. Retrieved 22 August 2019.
  8. 1 2 3 4 5 6 7 8 9 10 11 Shaw J (February 2008). "Diagnosis and treatment of testicular cancer" (PDF). American Family Physician. 77 (4): 469–74. PMID   18326165.
  9. 1 2 3 4 5 6 7 8 9 Ilic D, Misso ML (February 2011). "Screening for testicular cancer". The Cochrane Database of Systematic Reviews (2): CD007853. doi:10.1002/14651858.CD007853.pub2. PMID   21328302.
  10. ↑ "Testicular Cancer - Screening". Cancer Network. American Society of Clinical Oncology (ASCO). 28 October 2015. Retrieved 23 August 2019.
  11. ↑ "Testicular Cancer" (PDF). The Urology Foundation. Retrieved 23 August 2019.
  12. 1 2 Rovito MJ, Manjelievskaia J, Leone JE, Lutz M, Cavayero CT, Perlman D (May 2018). "Recommendations for Treating Males: An Ethical Rationale for the Inclusion of Testicular Self-Examination (TSE) in a Standard of Care". American Journal of Men's Health. 12 (3): 539–545. doi:10.1177/1557988315620468. PMC   5987962 . PMID   26634857.
  13. ↑ "American Academy of Family Physicians". Choosing Wisely. American Board of Internal Medicine. 2018. Retrieved 22 August 2019.
  14. 1 2 3 "Patient Information: Self-Examination of the Testes". Cancer Network. 17 April 2008. Retrieved 2021-09-13.
  15. ↑ Friman, Patrick C.; Finney, Jack W. (1990-12-01). "Health Education for Testicular Cancer". Health Education Quarterly. 17 (4): 443–453. doi:10.1177/109019819001700408. ISSN   0195-8402. PMID   2262324. S2CID   6086822.
  16. ↑ Rovito, Michael J.; Manjelievskaia, Janna; Leone, James E.; Lutz, Michael; Cavayero, Chase T.; Perlman, David (May 2018). "Recommendations for Treating Males: An Ethical Rationale for the Inclusion of Testicular Self-Examination (TSE) in a Standard of Care". American Journal of Men's Health. 12 (3): 539–545. doi:10.1177/1557988315620468. ISSN   1557-9891. PMC   5987962 . PMID   26634857.
  17. ↑ Marcell, Arik V.; Ford, Carol A.; Pleck, Joseph H.; Sonenstein, Freya L. (April 2007). "Masculine beliefs, parental communication, and male adolescents' health care use". Pediatrics. 119 (4): e966–975. doi:10.1542/peds.2006-1683. ISSN   1098-4275. PMC   2488152 . PMID   17403834.
  18. ↑ Marcell, Arik V.; Howard, Terry Lee; Plowden, Keith; Watson, Catherine (December 2010). "Exploring women's perceptions about their role in supporting partners' and sons' reproductive health care". American Journal of Men's Health. 4 (4): 297–304. doi:10.1177/1557988309335822. ISSN   1557-9891. PMID   19477751. S2CID   206765901.
  19. ↑ Addis, Michael E.; Mahalik, James R. (January 2003). "Men, masculinity, and the contexts of help seeking". The American Psychologist. 58 (1): 5–14. doi:10.1037/0003-066x.58.1.5. ISSN   0003-066X. PMID   12674814. S2CID   19006114.
  20. ↑ Leone, James E.; Rovito, Michael J. (May 2013). ""Normative content" and health inequity enculturation: a logic model of men's health advocacy". American Journal of Men's Health. 7 (3): 243–254. doi:10.1177/1557988312469659. ISSN   1557-9891. PMID   23283809. S2CID   31494230.
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