checking your testicles - Dr Anand Patel

We know that many men are unsure about checking their testicles. We all know we should do it but what exactly are you looking for and when should you seek medical help?

We asked male health expert Dr Anand Patel to take us through some of the essential information all men should know. Here’s what he had to say.

The scrotum is a rather unattractive, and somewhat overlooked, part of male anatomy. However, it has a notable role in regulating testicular temperature and, occasionally, for the lumps and bumps that appear.

Understanding the Scrotum

The scrotum is a skin-covered sac, protecting the testicles which have two jobs, producing sperm and testosterone. Its ability to regulate temperature is essential for optimal sperm production at approximately 34 degrees, slightly cooler than the body.

Identifying Scrotal Lumps

Beyond ingrowing hairs, various lumps can appear on the scrotum, each with its own characteristics:

• Cysts: Small, fluid-filled sacs that feel like peas under the skin, commonly are epidermoid cysts. These are made up of elements of the outer layer of the scrotum so move with the skin.

Varicoceles: Enlarged veins in the scrotum, akin to varicose veins, often described as feeling like a bag of worms.

• Hydroceles: Fluid accumulation causing swelling around a testicle, resembling a water-filled balloon. You often can’t feel the testicle well as it’s inside the fluid mass. Your doctor might shine a torch through it (they’re not pranking you)- it should glow red!

• Spermatoceles: Cysts in the epididymis, filled with fluid and sperm, presenting as smooth, firm lumps.


Apart from the lumps directly in the scrotum, hernias can also present as groin lumps. A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. In males, this often happens in the groin area, potentially extending into the scrotum, leading to a noticeable bulge. It’s essential to distinguish these from other scrotal lumps, as hernias may require different treatment, usually surgical.

When to Seek Medical Advice

While most lumps are benign, it’s important to keep a regular eye on your balls. Testicular cancer can manifest as a lump on a testicle and is often painless. Regular self-examinations are vital, and any new or changing lumps should be checked with a medical consultation. Sometimes a testicle can become hard, swollen or very painful. Whilst this can be caused by an infection which needs review, if it happens suddenly, seek emergency advice immediately. A twisting of the testicle in the scrotum can cut off the blood supply, potentially leading to its death.

Treatment Approaches

Treatment depends on the diagnosis. Most cysts don’t require intervention unless causing you problems. Varicoceles might need surgery for pain or fertility issues (because they act like a radiator and heat the testicles). Hydroceles often resolve spontaneously but like most hernias may require surgical treatment if persistent or big.

Overcoming Embarrassment

It’s important to discuss your health issues openly but we understand it can be difficult. Healthcare professionals are used to talking about any of your body parts and will prioritise your health over any embarrassment!

Let's talk about testicular cancer...  

How common is it? 

Although it's rare before puberty, among men aged 15-49 in the UK, testicular cancer is the most common type of cancer. Each year, about 2,400 men receive this diagnosis, which means roughly 1 in 200 men will experience testicular cancer in their lifetime. Thankfully, in the UK, most men recover well from this cancer, especially when detected early. In England, approximately 98% of men survive testicular cancer for over a decade. 

Why does someone get it? 

The exact causes of testicular cancer aren’t fully understood, but certain factors might increase the risk: 

1. Undescended testicles (when they don’t fully move out of your abdomen and into the scrotum (sac) during development in the womb) 

2. Family history of the disease 

3. Previous diagnosis of testicular cancer 

How can I tell if there’s something wrong? 

The most common sign of testicular cancer is a painless or painful lump or swelling in either testicle. Other symptoms might include: 

- A feeling of heaviness, swelling, or fluid buildup in the scrotum 

- A dull ache or sharp pain in the lower abdomen, groin, or scrotum 

- Enlargement or tenderness of the breast tissue, due to hormones produced by the cancer 

- Back pain, cough, shortness of breath, or weight loss, which could suggest the cancer has spread 

Remember, these symptoms can also be caused by various other conditions besides testicular cancer. Still, it's crucial to see a doctor if you notice any changes in your testicles or scrotum. Early diagnosis and treatment greatly increase the chances of recovery. 

How do I examine myself? 

Regular self-examination of the testicles is an easy way to monitor for any changes that might indicate testicular cancer or other issues. Starting from puberty onwards, men should check their testicles monthly. Understanding what feels normal for your body makes it easier to notice any changes. 

Here’s how to do it: 

1.     Take a warm shower or bath to relax the scrotum

2.     You can examine yourself either lying down or standing up comfortably. 

3.     Nudge your penis aside. 

4.     Hold your scrotum with your fingers behind and thumb in front. 

5.     Examine one testicle at a time using both hands, gently rolling it between your fingers as you would a boiled egg – it should feel similarly firm but not hard. Look for any lumps, swelling, or changes in size, shape, or texture. 

6.     Repeat the same for the other testicle. 

7.     If you notice any abnormalities like a painless lump, ache, or sudden fluid buildup, see a doctor promptly. 

Remember, there are soft tubes attached to the back of the testicle that collect and mature sperm. Occasionally, there might be smooth lumps on them, known as epididymal cysts, which are usually harmless. But if they’re new, it’s a good idea to get them checked. 

Important note: It’s normal for one testicle to be slightly larger or hang lower than the other. However, if there’s a change from what’s usual for you, see a doctor right away. 

If you’re not comfortable examining yourself, you can ask your partner for help. For trans women or non-binary individuals with testicles, checking your genitals might be upsetting. Try to do regular checks, and if you notice any changes but don't feel at ease talking to your regular doctor, gender clinics or STI clinics are often understanding and can provide support. 

Happy examining, and remember, it’s okay to get help!