Testicular Self-Examination: How to Do It Step by Step

Testicular cancer occurs most often between ages 15 and 40, and in a history of undescended testicle the risk is elevated compared with the general population; orchiopexy (fixing the testicle in the scrotum) performed before puberty reduces the risk but does not eliminate it. Testicular cancer caught at an early stage responds very well to treatment.

The best time for the exam is after a warm shower or bath; the scrotal skin is relaxed and the testicles are easy to feel. The whole process takes two to three minutes.

• Stand up and first look at the scrotum in the mirror: is there swelling, asymmetry, or a change in the skin?
• Examine each testicle separately with both hands: hold the testicle gently with your index and middle fingers on top and your thumb underneath.
• Roll the testicle slowly between your fingers, feeling its entire surface. It should be smooth, even, and oval; light pressure should not cause discomfort.
• You will feel a soft, cord-like structure at the back-upper part of the testicle: this is the epididymis (the duct that stores sperm) and is normal; do not mistake it for a mass.
• Also gently feel the spermatic cord extending upward from the testicle; note any thick bundle of veins (varicocele) or tenderness.
• Compare the two testicles: it is normal for one to be slightly larger or sit a little lower than the other; what matters is that the difference does not change over time.
• Pick the same day each time (for example, the first weekend of every month) and keep in mind the normal you've found.

What you're looking for is a change in the testicle itself, something palpable that wasn't there before. Cancer usually begins as a painless, hard lump, the size of a pea or larger, inside or on the surface of the testicle.

• A new, painless firmness or nodule in the testicle
• Noticeable growth or shrinkage of the testicle from one month to the next
• Hardening or irregularity in consistency
• A sensation of heaviness in the scrotum or dull, persistent pain in the groin
• Fluid buildup in the scrotum or sudden swelling
• The operated testicle shifting upward out of the scrotum, toward the groin

• In an operated testicle, there may be a small area of adhesion or slight irregularity at the point where it was fixed in the scrotum; this stays the same from the earliest exams onward. A finding that doesn't change is not a problem; a new or growing finding should be evaluated.

If you notice a new firmness or growth, don't wait for next month; seek an exam within a few days. Evaluation is done with a brief exam and, if needed, an ultrasound; most findings turn out to be benign (cyst, epididymal swelling, varicocele, hydrocele).

• Within a few days: new firmness, growth, change in consistency, sensation of heaviness.
• Emergency: sudden severe pain, redness, nausea — suspected torsion.
• Report at your checkup: the testicle shifting position, persistent dull pain, a change in the skin.

At the start of adolescence, usually around ages 12–14, the physician informs the teenager during the exam about how to do it and walks through the first exam together. The family emphasizes that this conversation is not shameful, but as ordinary a health habit as brushing your teeth.

• On this team, pediatric urology and adult urology work side by side; follow-up through adolescence and adulthood for a young man operated on in childhood continues under one roof, and self-examination training is part of that follow-up.