The testicles are male gonads, which serve dual functions: production of spermatozoa and the synthesis of the male hormone testosterone. During puberty the testicles increase in size from a volume of about four ccs (peanut size to about the size of a walnut (twenty-five ccs) at the end of development. Spermatozoa and testosterone are produced soon after a boy begins puberty. Clinicians who provide care for adolescent males will often do a complete genital examination at the annual checkups. This includes a painless examination of each testicle.
Shortly before birth, the testicles descend into the scrotum in most boys. About three-four percent of newborn males have cryptorchidism where one or both testicles have not appeared in the scrotum. Most of the testes that have not descended into the scrotum by birth will do so by the time the male is six months old. Surgical treatment may be necessary if descent has not occurred by age one year. A very small percentage of adolescent males, 0.8 percent, have an undescended testicle. A physician should evaluate this and treatment should be arranged since the undescended testicle in an adolescent may not serve its dual functions, and in fact may be prone to cancer. Occasionally the undescended testicle in an adolescent not only fails to function, but it also fails to grow when the other testicle is growing. A surgeon can remove the small testicle and replace it with a prosthetic testicle.
Some adolescent males have an active cremasteric reflex. If the inner thigh near the scrotum is stroked, then the cremasteric reflex may be elicited causing the testicle on the same side to ascend toward the body. Some boys have very active cremasteric reflexes so that the testicle may actually leave the scrotum and stay in the inguinal canal. This does not necessarily require any treatment.
The most common testicular pain in adolescent males is termed “ blue balls.” This is not a medical entity nor is “blue balls” a medical word. Most clinicians who specialize in adolescents know about this entity. Discomfort in the testes or scrotum may occur from sexual arousal. Most than likely, the male with “blue balls” develops testicular pain from slowed venous drainage due to the sexual arousal. “Blue balls” are a benign entity. Ejaculation is said to relieve the discomfort that can range from mild to severe in intensity.
Some types of testicular pain may signal an emergency medical situation where a clinician should be consulted. The testicles are suspended in the scrotum by tissues that include the spermatic cord and blood vessels. Most boys’ testicles are also attached to the back of the scrotal wall. In a small percentage of adolescent boys, this attachment does not occur, so the testicle is able to twist around the axis of the spermatic cord. If this happens, the blood supply to the testicle may be compromised. This will cause swelling, bleeding and pain in the testicle and testicular damage may result from the compromised circulation. This is termed testicular torsion and it is a surgical emergency. Usually a surgical procedure is needed to untwist the compromised tissue, fix the attachment of the affected testicle and also check and repair any attachment issues that may affect the other testicle. If the teen waits too long to seek medical care, then the testicle may become gangrenous and removal may be necessary.
Another cause of testicular pain is torsion of the appendix testicle. In this case, the adolescent male may have a sudden or gradual onset of testicular pain. Since the tissue that is compromised is much smaller than that seen in testicular torsion, the symptoms are less prominent. Ultrasound examination may help to identify which vestigial remnant around the testicle is producing the pain. Surgery is usually not necessary.
Epididymitis is an infection or inflammation of the epididymis, which is a structure at the top and back of each testicle. The most common cause of epididymitis in adolescents is an infection due to gonorrhea or chlamydia. The teen has testicular pain that can develop quickly or over several hours. It may include just the epididymis or may include the entire testicle. The adolescent should seek medical care and evaluation since sexually transmitted infections need to be treated with medications.
Inflammation of the entire testicle is called orchitis. This was not infrequently seen after a mumps virus infection in adolescent males, but it is much less common now that males receive the mumps immunization. Teens with orchitis may develop mild to severe testicular pain and swelling as well as nausea, vomiting, abdominal pain and fever. Orchitis could cause the testicle to shrink in size and lose its two functions. There may be an increased risk for testicular cancer in a testicle that has been afflicted with orchitis.
Most adolescent males endure some type of testicular injury. The most common causes of injury to the testicles in the teen age group include contact sports, motor vehicle accidents; straddle injuries from bicycle riding and injury during sexual play. Beside the pain, which can be excruciating, there may be bleeding into or around the testicle, rupture of the testicle or movement of the testicle into the inguinal canal. Moderate or severe testicular injuries need to be evaluated by medical personnel. An association has been reported with testicular injuries, elevation of some sex hormones and infertility. During contact sports, it is especially important to wear a protective cup.
Tumors of the testicle are the most common solid tumors in young adult males although testicular tumors have been reported in infants as well as elderly males. Testicular tumors are more common in white males compared to nonwhites. Although not all causes of testicular cancer are known, it is felt that injury to the testicle, atrophy due to orchitis and undescended testicles may have a role in the future development of testicular cancer.
Adolescent males who develop testicular cancer may report a sensation of fullness or heaviness in the scrotum. A hard mass on the testicle may be felt; some males have reported feeling the mass for months before presenting to the physician. When a testicular tumor is suspected, the patient is usually sent to a urologist who will perform a series of blood tests, ultrasound and other scans to determine the nature of the tumor.
Solid testicular masses are usually treated with surgery and this includes removing the entire testicle. Since testicular cancer can spread to other parts of the body, clinical staging is performed to see if the tumor has spread. In some situations, chemotherapy is done after the testicle is removed.
Lance Armstrong, a bicyclist who won the Tour de France was diagnosed with testicular cancer in 1996. In addition to the surgery to remove the cancerous testicle, he underwent chemotherapy since the cancer had spread to his lungs, abdomen and brain. Despite his illness, he rallied, trained and went on to win the 2,269 twenty-one-day road race. Subsequently he fathered a child. A monthly testicular self examination by all adolescent males(starting no later than age sixteen years) is invaluable in helping to identify early any testicular masses and may save your life.
Related topics:
Accidents, athletic injuries, chlamydia, gonorrhea, masturbation, sports, testicular self-examination
