Testicular Lumps: What to Check For, and What They Usually Are

This is a one minute habit that almost nobody was taught. It is not a screening program, because no country screens for testicular cancer with a test. It is simpler than that: you learn what your own normal feels like, so that a change registers as a change rather than as something you half-noticed and then stopped thinking about.

What normal feels like#

A testicle should feel smooth and firm all over, roughly like a hard-boiled egg with the shell off. Behind and slightly above each one runs the epididymis, a soft, slightly ropey coiled tube. That is supposed to be there, and it is the thing most often mistaken for a lump by a man checking for the first time. Above it you can usually feel the spermatic cord running upward, firm and cord-like.

One side sitting lower than the other, usually the left, is normal. One being a little larger is normal. Symmetry is not the standard. Your own baseline is.

How to check#

In the shower, when the water has been warm long enough for the skin to relax. Cold makes everything draw up tight and impossible to feel.

Take one testicle between the thumb in front and the fingers behind. Roll it gently, covering the whole surface. Then feel the epididymis along the back and top, so you know where it is and stop finding it by surprise. Then the other side.

You are feeling for a firm lump or a hard area on the body of the testicle itself, and for a change in size, weight or consistency compared with last time. Once a month is enough. More often than that and you will notice nothing except your own anxiety.

What most lumps turn out to be#

Three of those six are common and benign. That is roughly the real distribution: most men who find something and get it checked are reassured.

The one that gets missed#

Testicular cancer usually presents as a firm, painless lump or a hardness on one testicle, or as one side becoming heavier or larger. Sometimes there is a dull ache in the scrotum or the lower belly rather than a lump. Occasionally the first thing a man notices is tenderness or swelling of breast tissue, because some of these tumors produce hormones.

The word to underline is painless. People wait because it does not hurt, and not hurting feels like evidence that it is nothing. It is the opposite. Infections hurt. Torsion hurts violently. A painless firm lump on the testicle is the presentation that most needs an appointment this week.

The counterweight to all of this is that caught early it is one of the most curable cancers in medicine, with five year survival well above 95 percent in early disease. The treatment is markedly easier when it has not spread, which is the entire argument for a one minute habit.

The emergency#

Sudden, severe pain in one testicle, often with nausea or vomiting, and often starting during the night or during exercise, can be testicular torsion. The cord twists and cuts off the blood supply. The window to save the testicle is measured in hours, roughly six of them, and it narrows fast after that.

This is not a wait-until-morning situation and it is not something to check on the internet first. It is most common in teenagers and young men. If this happens, go to an emergency department.

Who is at higher risk#

A few things raise the baseline: an undescended testicle in childhood, even if it was corrected; a father or brother who had testicular cancer; and having had it in one testicle already. Being in the 15 to 40 age band is itself the largest factor. None of these change what you do, they just make the one minute habit more clearly worth it.

What I see most#

Two patterns, over and over. The first is a young man who found something months ago, decided it was probably nothing because it did not hurt, and came in only when a partner insisted. The delay almost never changes the diagnosis. It sometimes changes the treatment.

The second is a man who has found his own epididymis for the first time at 34 and is convinced he has found a tumor. He has not. But the visit is still worth it, because he leaves knowing what his own anatomy feels like, and the next time he finds something he will know whether it is new.

Neither of these men should feel foolish, and both of them are doing better than the man who never checks.

What happens if it is cancer#

Most men who read this will never need this section, but not knowing is part of what keeps people from getting checked, so it is worth stating plainly.

The first step is almost always removing the affected testicle, which both treats and diagnoses at once, because taking a biopsy risks spreading the disease. It is done under general anesthetic and is usually a same-day or one-night stay. The remaining testicle takes over hormone production in the great majority of men, so sex drive, erections and testosterone typically continue as before. A prosthesis can be placed at the same time or later if a man wants one.

What follows depends on the type and whether it has spread. Some men need nothing further beyond regular surveillance scans and blood tests. Others have a short course of chemotherapy or radiotherapy. Cure rates are high across the board and remain high even when it has spread, which is unusual among cancers and worth knowing before you imagine the worst.

Why men do not check#

Surveys keep finding the same three reasons, and none of them are stupid.

The first is that nobody ever taught them. Girls are told about breast awareness in school and in almost every women's health leaflet. The equivalent for boys is patchy at best, so many men reach forty having never been told what a normal testicle should feel like.

The second is the fear of finding something. This is exactly backwards, but it is human. The men who avoid checking are not calmer, they are carrying a low-grade worry with no way to resolve it, and they lose the one advantage that matters here, which is time.

The third is embarrassment about the appointment. The examination takes two minutes, it is done by someone who does it every week, and it is not remotely the strangest thing that doctor will do that day.

The bottom line#

Once a month, in a warm shower, roll each testicle between your fingers and learn what your own normal is. Most lumps are cysts, fluid or veins, and they are harmless. A firm, painless lump or hardness on the testicle itself needs an appointment promptly, and painless is not reassurance. Sudden severe one-sided pain is an emergency with a window of hours. Found early, this is among the most curable cancers there is, and the only variable you control is how long you wait.