Men’s health centre

Testicular disease

They may be rare, but testicular diseases can be painful and in some cases even life threatening if you don’t recognise them and do something about them early. Here’s how.

Why should I care about testicular disease?

Happily, significant testicular disease is uncommon and usually not serious. Occasionally, however, it can be life threatening. It’s important to seek medical advice for any testicular pain or any change in your testicles, such as a lump or firmness. Even if you’re embarrassed, delaying an evaluation is not worth the risk.

As you might guess, testicular cancer is the most serious form of testicular disease. It mostly affects men aged 20 to 55. Testicular cancer accounts for 1% of all cancers in men. If caught early, it is usually curable. Some 95% of men diagnosed with testicular cancer survive.

Risk factors for testicular cancer include:

• Previous history of testicular cancer
• Undescended testicle as a child
• A close relative with testicular cancer

More common than testicular cancer is epididymitis, which is inflammation of the epididymis, a tubular structure next to the testicle where sperm mature.  Unprotected sex or having multiple sex partners increases the risk of infectious epididymitis.

As many as one out of every five men has a varicocele, which refers to swollen and dilated veins above the testicles, a condition that is usually small and insignificant. Hydroceles, which come from increased fluid around the testicle, also pose little risk.

What is testicular disease?

Testicular disease can take a variety of forms:

Testicular cancer. Like any cancer, testicular cancer happens when cells in the testicle develop mutations that cause them to “misbehave”. The cells may multiply recklessly and invade areas where they don't belong. In testicular cancer, this process usually creates a slow-growing painless lump or firmness in one testicle. In most cases, the man himself discovers it at an early stage. If a man gets medical attention early on, testicular cancer is almost always curable.

Testicular torsion. “Torsion” means twisting - and for a testicle, that's not a good thing. When testicular torsion occurs, the twisting “kinks off” and blocks the blood vessels to one testicle. Certain men have a developmental problem that makes them susceptible to testicular torsion. Although testicular torsion is rare, it is an emergency. Sudden testicular pain demands an immediate trip to accident and emergency. If treatment is delayed, the testicle can die.

Epididymitis. The epididymis is a long, coiled tube that sits alongside the testicle. Its job is to store sperm while they mature. Epididymitis occurs when the epididymis become inflamed or infected. Sometimes, this is a sexually transmitted infection. More often, epididymitis comes from injury, a buildup of pressure such as after a vasectomy, or from urine backwashing into the tubules during heavy lifting or straining. Epididymitis can cause symptoms ranging from mild irritation to severe testicle pain and swelling and fever.

Varicocele. Varicocele is a dilation of the veins above the testicle and is usually harmless. Occasionally, however, varicoceles can impair fertility or cause mild to moderate pain. If you have a bulge above your testicle, especially when you're standing or “bearing down”, a doctor should examine you.

Hydrocele. Hydrocele refers to a fluid collection surrounding the testicle and is usually benign. But if it is large enough, it can cause pain or pressure. Though men can develop a hydrocele after injury, the majority of men with hydroceles have no obvious trauma or known cause.