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140: Mastering the Testicular Self-Exam

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140: Mastering the Testicular Self-Exam

May 02, 2023

You check your car's oil and your smoke detectors, but are you checking your own body? Urologist Dr. John Smith joins the Who Cares guys to emphasize the importance of regular testicular self-exams, a vital health habit that many men overlook. Learn why you should be doing it monthly, and learn the correct technique to safeguard your well-being and catch potential issues early on.

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Troy, I've got a question for you.

Troy: Yes.

Scot: How often are you checking out your testicles?

Troy: This is being recorded. I don't know . . .

Scot: Yeah, we're getting right to the topic. Your testicles, I mean, your boys, your nuts, your stones, your huevos, your nards.

Troy: Oh, good. I wasn't sure what you were talking about. Now I know.

Scot: Your family jewels.

Troy: The first word I didn't understand, so yes.

Scot: How often are you checking those out?

Troy: Like a testicular self-exam?

Scot: Sure.

Troy: It's recommended once a month. And Scot, you know me. If the medical profession recommends it, I do it. I'm a very good patient.

Scot: Mitch?

Mitch: Probably not as often as I should.

Scot: It's like the dentist, right? How often are you flossing? Probably not as often as you should. That's always the answer I give.

So now the next question. Troy, you ever find something during a self-exam?

Troy: No, I have not, fortunately.

Scot: Mitch?

Mitch: Yeah. I've had some epididymitis in the past that I found.

Scot: All right. So I periodically . . . I don't know if I do it every month, like the medical, but I have and I have found a lump. I've had that thing ultrasounded, and I found out everything was okay. And I was told that if it ever starts hurting, that's when we're going to worry about it.

Mitch: Wow.

Scot: Otherwise, just it is what it is. Even if it gets bigger, it's fine. Just if it starts hurting.

Mitch: Okay.

Scot: Yeah. So back in Episode 52, we had Dr. John Smith on, and he answered some listener questions, but one in particular stuck out for Mitch. And that's the inspiration for today's show. What question piqued your interest, Mitch?

Mitch: So one of our listeners asked about how often should you be feeling your own testicles to prevent cancer and whatever else. Yeah, that one really hopped out at me because I hadn't . . . We talked about its importance and whatever, but I don't know what I'm doing down there. And now I'm all embarrassed that that's what we're talking about today, because that's apparently what the episode is about.

But do you just jostle on down there? Is there a procedure? What am I supposed to be doing down there to check and make sure I'm doing okay?

Scot: Right. Or are there some sort of pre-described things that you should do, right? 

Mitch: Like a process, or is it just dah-dah-dah-dah-dah? I don't know.

Scot: Well, that's what we're going to find out today. How exactly should a guy do a testicular exam? This is "Who Cares About Men's Health," where we provide information, inspiration, and maybe a different interpretation of your health. My name is Scot. I bring the BS. The MD to my BS, Dr. Troy Madsen.

Troy: Yes, Scot. I'm here. I'm present.

Scot: Okay. Mitch, caring about his health more and more every day and always bringing his unique perspective, welcome to the show.

Mitch: Howdy.

Scot: And urologist Dr. John Smith is back to answer the important questions about testicular exams.

Dr. Smith: Thank you for having me.

Scot: Yeah. And why do they call them family jewels? Why is that a nickname? You're a urologist. You should know.

Dr. Smith: I have no idea. That's one I've never looked up.

Scot: Have you looked up other ones?

Dr. Smith: I mean, some you don't really have to look up, but they're just things you've heard since you were on the playground in fifth grade.

Scot: So I looked up family jewels, and who knows if this is accurate or not, but in ancient times, families would possess actual jewels, which was where a lot of their wealth was. And if they lost their family jewels, that would be a bad thing. The family would have a hard time continuing. And the same is true for if a man's family jewels were damaged. Then the lineage would also stop, the family lineage. So I don't know if that's true or not, but I liked it.

Dr. Smith: Seems reasonable. 

Scot: Dr. Smith, what are the benefits of regular self-exams? Let's get into the topic.

Dr. Smith: So the benefit of self-examination is just to make sure that there's nothing there that is concerning and nothing that is going to cause you problems long term or nothing to be concerned about.

Like you said, you found something, you went, and they checked it out. They said, "Eh, it's no big deal." But there are times where those things do become a big deal.

Scot: Okay. And are self-exams just for detecting cancer, or can they reveal other health concerns or issues?

Dr. Smith: Cancer is the big one that we're looking for. Also, you should know your body and if there are some inconsistencies there between examinations. Like Mitch said, he found epididymitis, which is simply some inflammation and tenderness of the epididymis. I call that the mullet of the testicle because it sits on top of the testicle. If you go and look at the schematic, that's what it looks like. But it sits on top, and when it gets inflamed, it can be painful and uncomfortable, and it's something that you may want to go seek care for, because it is uncomfortable.

Scot: I mean, do you have anything specifically? Are there things that can go wrong with the testicles other than cancer that I want to really be concerned about? Are there real concerns? It sounds like Mitch just had a little discomfort. I mean, is that a big deal?

Mitch: At the time, I swore something terrible was happening down there. It was like, "Do I go to the emergency room?" and everything.

Scot: Wow.

Mitch: Yeah, it's like, "Oh, no, this is not right."

Dr. Smith: I mean, there are things that can happen. Epididymitis is one. Some people will get fluid that gathers around the testicle called a hydrocele, which can be bothersome and a little bit disconcerting because you have a swollen up side of the scrotum. They can get rather large.

You can have an epididymal cyst, which is a small bag of fluid in the epididymis, which sometimes they can get large and become painful.

You can have a varicocele, which is a varicose vein. There's a group of veins around each testicle called the pampiniform plexus. That's your $400 word for the day. And when it starts to have varicosities in it, it can cause a sense of heaviness and swelling in the scrotum, as well as cause fertility issues possibly in the future. So that's one you may want to look out for.

And then, obviously, testicular cancer is something that people are concerned about, but there are plenty of other things. And there are several other little small things, but none of them are necessarily problematic until they either become painful or large enough that they interfere with your daily activities.

Scot: Okay. So kind of the bottom line, though, is that if something is different or unusual, that's what you're looking for. Would that be a fair statement? And then that's when you should talk to a health care provider? Or should you take a wait and see on some of those things?

Dr. Smith: So if you are concerned, you should talk to a healthcare provider. But most of the time, you are looking for something that changes.

Now, Troy brought up doing a monthly examination. I mean, that's what's recommended. It's kind of like flossing. How many people actually do it that frequently?

Troy: Once in a while. Hopefully more than one person does it more than once in a while.

Scot: I thought it was going to be more frequent, was going to be the answer.

Dr. Smith: Well, I don't mean flossing once a month, but the frequency at which you're supposed to do these things a lot of times doesn't happen in the timing that you would think that it should happen. And that's okay.

But if you notice that there is something different or strange, it's nice to know exactly what it felt like before, so that when you do have a conversation with the healthcare provider, you can say, "Hey, this is different, and this is what I'm feeling that is different." That kind of clues us into some of the things that we should be looking for.

Scot: So on testicular cancer, before we get to the actual question that Mitch had of "What should I be doing?" I understand testicular cancer isn't super common. Is that correct? Give us a little rundown of how common it is, who it kind of impacts, and that deal.

Dr. Smith: Yeah. So testicular cancer is not super common. It happens more in younger men. There's actually what's called a bimodal distribution of it. A majority of them happen in younger aged individuals in their late teens, 20s, and early 30s. And then there's a second little spike around the early 60s that people need to watch out for. But a majority of those cases happen in the younger demographic.

I believe the number is . . . and I'm going to double check on them. About 1 in 200 men will have testicular cancer.

Scot: One in 270. I actually have that number right here.

Dr. Smith: Okay. I was pulling that one from my memory banks. I was like, "I'm pretty sure it's like 1 in 200 or 300." Yeah, 1 in 270. So, again, it's not super common, but I mean, a little less than 0.5% of folks will end up dealing with it at some point in their life.

Scot: And I think it's kind of tricky because it impacts young people, right? You don't tend to think cancer is impacting younger people. 

Dr. Smith: Right.

Scot: So the good news, though, with testicular cancer, too, is early detection really leads to good success rates for treatment. Talk about that just briefly. Just like we talked about colonoscopy and male breast cancer, if you catch this stuff early, the news is good. 

Dr. Smith: Right. So a majority of people do very well after this. Ninety-five percent of people are treated and treated well, don't have a lot of problems down the road. And so it is one of those where when you catch it, you catch it early.

I think it also is nice that it happens in younger age group folks where they're healthy, their bodies heal very well. And oftentimes it does mean the loss of the testicle that has the cancer. A majority of time, or always, they will take that testicle out. And the good news is it doesn't affect fertility terribly because you've got another testicle and your body has some redundancy there of making sure that you're still able to have fertility, which is nice.

Scot: So are you feeling for a lump? Is that what you're feeling for, for testicular cancer?

Dr. Smith: Yeah. So I'll kind of go through how to do an exam. Go ahead.

Scot: Yeah, I think that's the next thing here. What do you do? But before we get there, I want to know, Troy, when you do your self-exam, what do you do?

Troy: This is really getting too personal, Scot.

Scot: I mean, did you look up how to properly do it, or do you just kind of play your own game?

Troy: Boy. I probably did look up how to properly do it at one point, and I'm sure in medical school I learned how to properly do it as part of our physical exam training, because there's that.

But yeah, I'm really feeling for lumps and bumps. There are definitely lumps and bumps on the testicle regardless. It's not just a perfectly smooth marble.

Scot: Boy, that's another one. Marble.

Troy: Yeah, contrary to popular belief or terminology. But I'm feeling for changes, and usually you kind of have a good sense of what you're dealing with there. Then if there are very hard, firm lumps, like the size of a pea, something that's very tender, those are things that would make me more concerned.

Scot: Mitch, how about you? What's your process?

Mitch: Oh, my. That's why I'm having this question. Do I just . . .

Scot: I know. Just kind of roll things around or . . .

Mitch: Yeah, it's just like . . .

Scot: . . . you squeeze things?

Mitch: Some gentle squeezing, I guess, is what I do. Maybe both hands.

Scot: Oh, both hands?

Mitch: Yeah, don't you . . . I don't know. I want to make it as quick and efficient. I have no idea what I'm doing.

Dr. Smith: I'm with Mitch.

Scot: Okay. You want to make it as quick and efficient as possible. Is that how you're with Mitch?

Dr. Smith: No, I think Mitch using two hands is the appropriate way to go about it.

Scot: Yeah. So, Dr. Smith, now let's find out who got it right or close. Talk us through this.

Dr. Smith: I don't think there's a wrong way to do it as long as you're doing it and you know your body and you can tell that there's a difference there. But usually, the way I tell people to do it is . . . Sometimes I'll say, "Hey, just do it after you get out of the shower where things are warm and they're a little bit easier to palpate." Because the scrotum tends to relax when it's warm. So that's a great time to do it, is right after you get out of the shower or after you've taken a bath or something like that, where things are a little bit more relaxed.

You can stand in front of a mirror and make sure that things look the same. If there are any bulges or things that you see in a mirror is a great way to just start before you even touch yourself.

And then I usually say to pick a side and start there and do it the same way every time. And then you don't miss anything.

Take two hands so you can isolate one testicle. Left, right, doesn't matter. And then usually you take the testicle between your finger and your thumb or two fingers and thumb and kind of roll it in your fingers. Give it a little bit of a compression to make sure that it feels a little bit spongy. I mean, it shouldn't feel like you're able to squish it, but a little bit of sponginess.

If it feels rock hard, testicular cancer feels more like rock hard. And so that would be something where if you compared both sides and you're like, "Hey, this one's kind of squishy and this one's not," that would be something to look for.

And then you can feel upwards on top. There's the mullet of the testicles, or the epididymis that's there that you feel on the top, and you're able to kind of feel that. And you might feel some abnormalities there. Or if there's a cyst there or something that feels abnormal, you'd give it a nice feel down.

Look for tender spots, like Troy said. So, again, everyone's doing the right thing here.

And then you can move up the cord and feel for anything as you come up, where a varicocele, that varicose vein, feels like a bag of worms that kind of is towards the top of the spermatic cord as you go up towards the base of your penis.

And then you can repeat that same process on the other side and just kind of get a feel.

That's a great way to just do a quick exam. It takes a minute or two, and then you're kind of done.

So all of you guys hit on some really good things that you should do. Again, there's not really a wrong way. It's just making sure that you know if there's a change month to month, or quarter to quarter, or however frequently you're doing them, that you are able to identify that and then have that conversation with your healthcare provider.

Mitch: Wow. Thanks for the benefit of the doubt, but no, my hands were one on each trying to figure out what's going on down there. This idea of . . .

Scot: At the same time?

Mitch: Yeah, efficient. Efficiency. 

Troy: "Let's get this done." Nice. I admire your efficiency.

Dr. Smith: He hits a stopwatch and has 15 seconds to get it done.

Mitch: Thirty seconds.

Scot: Am-ball-dextrous right there is what you are.

Mitch: But it makes sense, I guess. And I was mostly focusing on the testicle itself. Even being someone who has had issues with my epididymis before, I didn't even think of feeling up there or the tubes or anything. But yeah, that's the three major things that could have issues, any sort of issue, the testicle, the epididymis, and the . . . what is it? What's that tube?

Dr. Smith: The spermatic cord.

Mitch: The spermatic cord. Those are the three things.

Scot: Yeah, which is what I think I had. I think I had a cyst on the spermatic cord. I mean, that's not technically on the testicle. If you feel something like that . . . It's almost separate, right? It's a separate small sort of a thing. Are those generally cancerous if it's on the spermatic cord? Or is testicular cancer just really isolated to the testicle?

Dr. Smith: So you can have a tumor in either location. They're less common in the spermatic cord, but they still can occur. And so they did the right thing. You get an ultrasound and you go, "This is a big nothing burger," and you leave it alone.

Scot: It was a big nothing burger, and I appreciated that. Hey, Mitch, guess what I found when I Googled how to give yourself a self-exam? It came up with a graphic. We didn't have to have this conversation at all. You could have just Googled this. You embarrass all us guys.

Mitch: No, I think it's important to talk through.

Scot: No, it is.

Mitch: Did you send me . . . is this the picture? Oh, wow. Yeah. Okay. I see what's up.

Scot: So it's from the Testicular Cancer Awareness Foundation. You can find, actually, the steps that Dr. Smith talked about if you want to see more what's going on.

Dr. Smith: How did I do? Did I do okay according to their standards?

Mitch: Yeah. Spot on.

Scot: I think so. Looks good.

Dr. Smith: Okay. That's just what we teach people in my clinic, so I hope I'm doing it right then.

Scot: I mean, is this a conversation you have with your patients, Dr. Smith? Like, "Hey, are you doing self-exams or you're not doing them?" I'm leading to another question, but I'm curious. Is this a conversation you ever have with your patients?

Dr. Smith: Yeah, I have it quite frequently with my patients. A lot of my patients are already doing it, and that's why they're there. "Hey, Doc, I was feeling this, and I felt this." And so it's like, "Oh, yeah. How often are you doing that exam?" "Oh, I do it every month," or, "I just noticed it," or, "I don't usually feel, but something was different." It's kind of organic in a lot of ways.

But there are some patients, younger patients or patients who've had issues where they found it, and then they're like, "What can I do?" "Well, you can do a self-exam and make sure that you're feeling to make sure the stuff isn't happening again," and that kind of thing.

Scot: It's crazy because this isn't discussed as much as, say, breast cancer exams for women. That's pretty common that it's suggested that women do self-exams in between their mammograms. Why is that? Where did you guys learn that this was even something you were supposed to do?

I guess what I'm getting at is, like, for women, it's talked about a lot. So you just kind of pick up on, "Oh, this is something I should do." But I didn't have this conversation with my dad. My dad didn't sit me down and . . .

Troy: I'm going to tell you something here that's going to surprise you guys. I did have this conversation with my dad.

Mitch: Oh, really?

Scot: Did you really? Well, your dad is a doctor.

Troy: With my dad and 30 other fifth-grade boys. My dad's a pediatrician, so he would give the "maturation talk" in fifth grade at the school. Talk about humiliating. Absolutely humiliating to be in this classroom with 30 other boys, or maybe it was more, and having my dad talk about these sorts of things in front of everyone.

And the funniest was the next year, I think the principal decided he was going to do it. But the dads come in and they're there with their boys, and the principal is trying to give this talk, and just his armpits, the sweat lines under his armpits, you could have just wrung his shirt out and filled a bucket up with it. And so finally he's like, "Dr. Madsen, would you like to take over?" I was just like, "No, not again."

Yeah, my dad's a pediatrician, so yes, I did have this talk with my dad and a whole lot of others there too.

Scot: I don't remember that at all.

Troy: You didn't have that in school, the maturation talk? They didn't talk about this kind of stuff?

Mitch: I did a maturation, but it was mostly like, "Hey, your body's going to be changing. Here's some deodorant." There wasn't how to check your testicles for anything wrong.

Troy: I remember it was part of it because there was a video we watched, and I think it talked about a testicular self-exam and that kind of stuff in it. So I think that was my first exposure and my first anxiety-provoking experience in terms of everything that could go wrong with my testicles.

Mitch: It's so interesting, though, just how much anxiety not just you were experiencing, but was your dad anxious? He was fine? He's a doctor.

Troy: Oh, no. He's so cool. He's like, "Whatever. I'll talk about this stuff all day."

Mitch: But your principal. It's just like, "Why is this so hard to talk about?"

Troy: It was hilarious. Oh, I know. Yeah, that's another discussion entirely. But he was just sweating. He was so anxious and sweating like crazy trying to talk about this stuff and saying words like penis and testicle. So that'll get your heart rate up. It'll make you sweat a little, I guess.

Scot: Hey, Dr. Smith, is there anything in the literature that talks about why guys don't do the exam? If a guy's not getting diagnosed, is it because he didn't do the exam? Is that why? Or didn't go in? He did find something and didn't go in?

Dr. Smith: I don't know of any literature that kind of breaks that down and says, "Hey, guys don't do this because of this, this, and this." But a lot of times, obviously there is something different. And a lot of times, the testicular cancers that I've diagnosed, guys come in and they're like, "Hey, this is getting bigger, and it's going quickly." And then we get an ultrasound, and they're in that age group, and we say, "Hey, man, you've got cancer." At that point, it's not the time to be like, "Hey, were you doing your self-exams?"

So I don't know that I've ever had that conversation, but it'd be interesting. I could probably do a retrospective study with a lot of those guys and kind of reach out with a survey and say, "Hey, is this something that you did on a regular basis or not?"

I mean, I would imagine most men do not do regular self-examinations. I guess most men probably feel down in their genitals at some point on a monthly basis, whether it's in the shower or something else, but probably not a proper going through the motions and making sure that everything feels very similar.

And I think a lot of these guys end up doing that kind of thing where they're like, "Oh, I was adjusting myself," or, "My son inadvertently kicked me in the groin," or, "I got hit with a softball at a softball game and it swelled up, and I wanted to make sure it was okay." And then you get an ultrasound and you're like, "Whoa, there's something more here."

Scot: Yeah. So it's more of just a lack of knowledge that guys . . . this is something we should be doing probably more than anything else? 

Dr. Smith: Yeah.

Scot: All right. Well, you should be doing it. There's the takeaway. That's my takeaway. Troy, what's your takeaway?

Troy: My takeaway is . . . I don't know. What is my takeaway?

Scot: You should do it. 

Troy: Just keep doing testicular self-exams. Yeah, I think that's the takeaway. And I will tell you my takeaway from seeing a lot of very anxious people in the ER who come in is most times it's nothing. Most times, you feel something different, and maybe you are feeling the epididymis or maybe just something is a little off. So if you do feel something, get it checked out. But I think also a takeaway is don't let it get you super anxious. It's probably nothing, but yeah, get it checked out.

Scot: And Dr. Smith, you are our expert, but did you have a takeaway?

Dr. Smith: I think you guys hit it on the head, but do the examinations. If you have questions or concerns, you can always come in and have it checked out. That's what we do on a regular basis, and we're happy to give you that peace of mind when it's needed.

Scot: All right. Well, gentlemen, thank you very much for being on the show. The takeaway: Do that testicular self-exam. Chances that it's going to be cancerous? Pretty small, but it could be. The key is to catch it early, and a testicular self-exam is a great way to do it as opposed to kind of getting lucky and just finding out during some other sort of an exam or some other sort of incident, like Dr. Smith talked about.

If you have any comments or thoughts on today's show, please feel free to reach out to us. You can email us, Thanks for listening, and thanks for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

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