Testicular Self-Exam: How to Check for Lumps & Cancer Signs

What Is a Testicular Self-Examination?

A testicular self-examination (TSE) is a simple physical check you perform on your own testicles to detect lumps, swelling, or other changes that could indicate testicular cancer or other conditions. By examining your testicles regularly, you become familiar with their normal size, shape, and consistency, making it easier to notice any abnormalities early.

Testicular self-examination is one of the simplest and most effective screening methods available for detecting testicular cancer in its earliest stages. Unlike many other cancers that require sophisticated imaging or laboratory tests for detection, testicular abnormalities can often be felt through a simple physical examination. This makes regular self-examination an invaluable tool in men's health care, empowering individuals to take an active role in monitoring their own health.

The concept behind testicular self-examination is straightforward: by regularly checking your testicles, you develop a thorough understanding of what feels normal for your body. This baseline knowledge becomes crucial because when something changes – whether it's a new lump, a change in size, or an alteration in how a testicle feels – you're more likely to notice it quickly. Early detection is particularly important with testicular cancer because the disease is highly treatable when caught early, with cure rates exceeding 95% for localized tumors.

Healthcare organizations worldwide, including the American Urological Association (AUA) and the European Association of Urology (EAU), recognize the value of testicular awareness. While recommendations vary regarding formal screening programs, there is broad consensus that men should be familiar with their bodies and aware of any changes that might occur. This awareness often begins with understanding how to properly examine the testicles and knowing what findings warrant medical attention.

Why Testicular Self-Examination Matters

Testicular cancer is the most common cancer in young men between the ages of 15 and 35, yet it remains one of the most curable cancers when detected early. The challenge is that testicular cancer often develops without causing pain in its initial stages. A man might have a growing tumor for weeks or months without experiencing any discomfort, which is why relying on symptoms alone can lead to delayed diagnosis. Self-examination provides a proactive approach to detection that doesn't depend on waiting for symptoms to appear.

Beyond cancer detection, regular testicular self-examination can help identify other conditions that may require medical attention. These include hydroceles (fluid accumulation around the testicle), varicoceles (enlarged veins in the scrotum), epididymal cysts (fluid-filled sacs in the epididymis), and infections such as epididymitis or orchitis. While these conditions are typically not life-threatening, they can cause discomfort and may benefit from treatment. Early identification allows for timely medical evaluation and appropriate management.

How Do I Perform a Testicular Self-Examination?

To perform a testicular self-examination, take a warm shower or bath first to relax the scrotum. Then, using your thumb and first two fingers, gently roll each testicle between your fingers, feeling for any hard lumps, bumps, or changes in size or consistency. The entire examination should take only 2-3 minutes.

Performing a testicular self-examination is a straightforward process that requires no special equipment and can be completed in just a few minutes. The key to an effective examination is creating the right conditions – primarily ensuring that the scrotum is relaxed enough to allow thorough palpation of each testicle. Here is a comprehensive, step-by-step guide to performing an effective self-examination.

Step 1: Prepare with Warmth

The ideal time to perform a testicular self-examination is during or immediately after a warm bath or shower. The warm water serves an important purpose: it causes the scrotal skin to relax and the scrotum to hang lower, which makes the testicles more accessible and easier to examine thoroughly. When the scrotum is contracted from cold temperatures, the testicles are drawn up closer to the body, making a thorough examination difficult.

If you prefer not to examine yourself in the shower, you can alternatively warm the area by placing a warm, damp cloth over your scrotum for a few minutes before beginning the examination. The goal is simply to ensure that the scrotal skin is relaxed enough to allow you to feel the testicles clearly.

Step 2: Apply Soap or Lubricant

Using mild, unscented soap, intimate wash, or body oil during the examination helps your fingers glide smoothly over the scrotal skin. This lubrication serves two purposes: it makes the examination more comfortable, and it allows you to detect subtle abnormalities that might be harder to feel with dry skin. The smooth gliding motion makes it easier to identify any irregularities on the surface of the testicles.

Step 3: Examine Each Testicle Individually

Begin by cupping the scrotum in the palm of one hand to support it and get a sense of its overall weight. This initial step helps you notice if there is any unusual heaviness, which can sometimes be an early sign of a problem. Then, focus on examining one testicle at a time.

Using the thumb and first two fingers of your other hand, gently roll the testicle between your fingers. Apply gentle but firm pressure – enough to feel the structure of the testicle but not so much that it causes pain. Feel the entire surface of the testicle, checking for any hard lumps, bumps, or areas that feel different from the rest of the testicle.

A normal testicle should feel smooth, firm but not hard, and slightly spongy when you apply gentle pressure. The surface should be even, without any hard nodules or protrusions. Take your time with this process – rushing through the examination may cause you to miss subtle findings.

Step 4: Locate and Identify the Epididymis

Behind and slightly above each testicle, you will feel a soft, tube-like structure called the epididymis. This is a normal part of the male reproductive anatomy – it's a coiled tube that stores and transports sperm from the testicle. The epididymis may feel like a small bump or ridge, and it's important to recognize this structure so you don't mistake it for an abnormal lump.

The epididymis may be slightly tender to touch, which is normal. It should feel soft and rope-like, not hard. Familiarizing yourself with the location and feel of the epididymis helps you distinguish normal anatomy from potential abnormalities.

Step 5: Repeat on the Other Side

After thoroughly examining one testicle, repeat the entire process with the other testicle. Compare how the two testicles feel to each other. While it's normal for one testicle to be slightly larger than the other or to hang at a different level, any new or significant difference in size, shape, or consistency should be noted.

Step 6: Examine the Entire Scrotum

Finish the examination by feeling the entire scrotum, including the spermatic cord – the cord-like structure that runs upward from each testicle. This cord contains blood vessels, nerves, and the vas deferens (the tube that carries sperm). It should feel like a smooth, firm tube. Note any swelling, tenderness, or unusual masses along its length.

What Should Normal Testicles Feel Like?

Normal testicles should feel smooth, firm but not hard, and slightly spongy when gently pressed. The surface should be even without hard lumps or bumps. It's completely normal for one testicle to be slightly larger than the other and for one to hang lower. The soft, rope-like epididymis at the back of each testicle is also normal anatomy.

Understanding what normal testicles should feel like is fundamental to effective self-examination. Without a clear sense of normal anatomy, it becomes difficult to recognize when something has changed. The first time you perform a self-examination establishes your personal baseline – what your testicles normally feel like – which you can then compare against in future examinations.

A healthy testicle typically feels like a smooth, egg-shaped organ. When you roll it gently between your fingers, you should feel a uniform consistency throughout – firm but with some give when you apply gentle pressure, similar to a hard-boiled egg without the shell. The surface should be smooth and regular, without any hard nodules, bumps, or irregularities.

The size of testicles varies considerably between individuals, but on average, each testicle is approximately 4-5 centimeters long, 3 centimeters wide, and 2 centimeters thick. They're roughly the size and shape of a small egg or a large grape. What matters most is not achieving some "ideal" size but rather knowing what's normal for you and being alert to any changes.

Normal Anatomical Variations

Several anatomical variations are completely normal and should not cause concern. Understanding these variations helps prevent unnecessary anxiety during self-examination. First, it's very common for one testicle to be slightly larger than the other – this difference is typically small and consistent over time. Second, one testicle often hangs lower than the other, usually the left one. This asymmetry actually helps prevent the testicles from pressing against each other and is entirely normal.

The epididymis, which you'll feel at the back of each testicle, can sometimes be mistaken for a lump by men who are unfamiliar with this structure. The epididymis is a soft, somewhat comma-shaped or cord-like structure that attaches to the back and top of each testicle. It may feel slightly tender when pressed. Recognizing this structure as normal anatomy is an important part of effective self-examination.

What Warning Signs Should I Look For?

Key warning signs during a testicular self-exam include: a hard, painless lump on or in the testicle (most important sign), noticeable swelling or enlargement of a testicle, a feeling of heaviness in the scrotum, dull ache in the lower abdomen or groin, and any change compared to previous exams. Sudden severe pain requires emergency care as it may indicate testicular torsion.

Knowing what warning signs to look for during a testicular self-examination is just as important as knowing the proper technique. While most findings during self-examination will be normal, certain changes warrant prompt medical evaluation. The key is to distinguish between normal variations and potentially concerning abnormalities.

Hard, Painless Lump

The most important warning sign of testicular cancer is a hard, painless lump on or in the testicle. This is often described as feeling like a small pea or marble attached to the testicle. The critical characteristic is that cancer-related lumps are typically hard – distinctly different from the normal spongy texture of the testicle – and they are usually not painful to touch. This lack of pain can actually be dangerous because it may lead men to ignore the lump or delay seeking medical attention.

It's important to note that not all lumps are cancer. In fact, most lumps found on the testicles turn out to be benign conditions such as cysts, hydroceles, or varicoceles. However, any new lump should be evaluated by a healthcare provider to determine its nature. Only a proper medical examination, often including ultrasound imaging, can definitively determine whether a lump is cancerous or benign.

Swelling or Enlargement

A noticeable increase in the size of one testicle compared to the other, or compared to how it felt in previous examinations, can be a sign of various conditions including cancer. While some size difference between testicles is normal, a sudden or significant change in size warrants medical evaluation. Swelling may occur gradually over weeks to months, which is why regular monthly examinations are valuable – they help you notice gradual changes that might otherwise go undetected.

Heaviness in the Scrotum

Some men with testicular cancer report a sensation of heaviness or dragging in the scrotum, even before a lump becomes apparent. This feeling of weight can be subtle and is sometimes described as a sense that the testicle feels "fuller" than usual. While this sensation can have other causes, it should prompt a self-examination and potentially a medical visit if it persists.

Dull Ache in the Lower Abdomen or Groin

A dull, persistent ache in the lower abdomen or groin area can sometimes be associated with testicular conditions. This pain may be subtle and may come and go. While many causes of lower abdominal discomfort are unrelated to the testicles, any persistent ache in this area, especially when combined with other testicular changes, should be mentioned to a healthcare provider.

When Should I See a Doctor?

See a doctor if you find a lump or mass on your testicle, notice swelling or size change, experience persistent pain or heaviness in the scrotum, or discover any abnormality during self-examination. Even if you're unsure whether a finding is significant, it's always better to have it checked. Most abnormalities are not cancer, but only a medical evaluation can provide certainty.

One of the most important aspects of testicular self-examination is knowing when findings require professional medical evaluation. While self-examination empowers you to monitor your own health, it's not a substitute for medical care. When in doubt, always err on the side of caution and consult a healthcare provider.

You should schedule an appointment with a healthcare provider if you discover any of the following during self-examination:

• Any new lump or mass on the testicle, regardless of whether it's painful
• Noticeable change in size of one testicle compared to previous examinations
• Change in consistency – if a testicle feels harder or softer than before
• Persistent swelling of the scrotum
• Ongoing pain or discomfort in the testicle, scrotum, or groin
• Heaviness or dragging sensation in the scrotum
• Fluid accumulation around the testicle

Many men hesitate to see a doctor about testicular concerns due to embarrassment or fear. It's important to remember that healthcare providers examine patients regularly and are trained to handle these concerns professionally and sensitively. Additionally, most findings turn out to be benign conditions that are easily treated. The peace of mind that comes from a professional evaluation far outweighs any temporary discomfort from the visit.

What to Expect at the Doctor's Visit

During a medical evaluation for testicular concerns, the doctor will typically begin by asking questions about your symptoms, when you first noticed the abnormality, and your medical history. They will then perform a physical examination of your testicles, scrotum, and groin area. This examination is similar to the self-examination but performed by a trained professional who can better assess any findings.

If the doctor identifies any concerns during the physical examination, they may order additional tests. The most common diagnostic test is a scrotal ultrasound, which uses sound waves to create images of the testicles and can help distinguish between solid masses and fluid-filled cysts. Blood tests may also be ordered to check for certain markers that can be elevated in testicular cancer.

What Can Cause Changes in the Scrotum?

Changes in the scrotum can be caused by various conditions including hydroceles (fluid around the testicle), varicoceles (enlarged veins), epididymal cysts (fluid-filled sacs), infections like epididymitis or orchitis, and testicular cancer. Most scrotal abnormalities are benign and treatable, but all changes should be evaluated by a healthcare provider to rule out serious conditions.

While the primary goal of testicular self-examination is to detect testicular cancer early, many findings during self-examination are caused by benign conditions. Understanding these conditions can help you have more informed conversations with your healthcare provider and may reduce anxiety about findings that turn out to be non-cancerous.

Hydrocele

A hydrocele is a collection of fluid in the sac surrounding the testicle (the tunica vaginalis). This condition causes the scrotum to swell and may make the affected side feel heavy. Hydroceles are usually painless and can be detected during self-examination as a smooth swelling around the testicle. The testicle itself typically feels normal within the fluid collection. Hydroceles are generally harmless and may not require treatment unless they become large enough to cause discomfort.

Varicocele

A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins in the legs. During self-examination, a varicocele may feel like a "bag of worms" above the testicle. Varicoceles are more common on the left side and are usually painless, though some men experience a dull ache or heaviness, particularly after prolonged standing or physical activity. While varicoceles are generally benign, they can sometimes affect fertility and may warrant treatment if they cause symptoms or fertility concerns.

Epididymal Cyst

An epididymal cyst (also called a spermatocele) is a fluid-filled sac that develops in the epididymis. These cysts typically feel like small, smooth lumps separate from the testicle itself, located in the area of the epididymis at the back of the testicle. Epididymal cysts are benign and usually don't require treatment unless they grow large enough to cause discomfort.

Epididymitis and Orchitis

Epididymitis is inflammation of the epididymis, while orchitis is inflammation of the testicle itself. These conditions are often caused by bacterial infections and typically present with pain, swelling, warmth, and redness of the affected area. Unlike the painless lumps associated with cancer, infections usually cause notable discomfort. These conditions require medical treatment, typically with antibiotics.

Testicular Cancer

Testicular cancer typically presents as a hard, painless lump on the testicle or a change in the size or consistency of the testicle. It's the most common cancer in men aged 15-35 but is highly treatable when detected early. Risk factors include undescended testicle (cryptorchidism), family history of testicular cancer, personal history of testicular cancer in the other testicle, and certain genetic conditions. If testicular cancer is suspected, further evaluation with ultrasound and blood tests is typically performed.

How Often Should I Perform a Testicular Self-Exam?

Perform a testicular self-examination once a month on a set date that's easy to remember. Monthly examinations provide the optimal balance between vigilance and practicality, allowing you to detect changes early while making the habit easy to maintain. The first examination establishes your baseline – what your testicles normally feel like.

The recommended frequency for testicular self-examination is once per month. This monthly schedule provides several advantages. It's frequent enough to detect changes relatively early, yet not so frequent that it becomes burdensome or difficult to maintain as a habit. Monthly timing also makes it easy to remember – many men choose to perform their self-examination on the first day of each month or on another easily remembered date.

The purpose of the first self-examination is to establish a baseline – to learn what your testicles normally feel like so that you have a point of comparison for future examinations. This baseline knowledge is crucial because it allows you to recognize changes over time. Without knowing what's normal for you, it's difficult to identify when something has changed.

Consistency is key to effective self-examination. Irregular or infrequent examinations may fail to detect changes early enough to make a difference in outcomes. By making monthly self-examination a habit, you increase the likelihood of detecting any abnormalities at the earliest possible stage.

Age to Begin Self-Examination

Men should begin performing testicular self-examinations from puberty (around age 15) and continue throughout life. Testicular cancer is most common in young and middle-aged men, with the highest incidence occurring between ages 15 and 35. However, testicular cancer can occur at any age, so regular self-examination remains important throughout adulthood.

For adolescents, parents and healthcare providers can play an important role in educating young men about the importance of testicular health and self-examination. Many young men are unaware that testicular cancer is a significant health concern for their age group, and education about self-examination can empower them to take charge of their own health.

How Can I Take an Active Role in My Health?

Take an active role in your testicular health by performing monthly self-examinations, understanding what's normal for your body, reporting any changes promptly to your healthcare provider, and asking questions during medical appointments. Being informed and proactive about your health leads to better outcomes and greater peace of mind.

Testicular self-examination is just one component of taking an active role in your health. Broader health awareness involves understanding your body, being attentive to changes, and communicating effectively with healthcare providers. This proactive approach to health empowers you to participate meaningfully in your own care.

When you visit a healthcare provider with a concern about your testicles or any other health issue, being an informed patient can lead to better care. This includes clearly describing your symptoms and when they began, mentioning any changes you've noticed during self-examination, asking questions if you don't understand something, and requesting clarification about any recommended tests or treatments.

Understanding medical information empowers you to make informed decisions about your health. Don't hesitate to ask your healthcare provider to explain things in plain language if medical terminology is confusing. Resources like this article and other reputable health information sources can help you understand health topics, but they should complement, not replace, professional medical advice.