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36 year old with undescended testes

Q . I am 36 years old and it would appear my testicles have never dropped. This was obviously never picked up when I was young and by the time I realised I was different I was to embarrassed to do anything about it. Certainly my scrotum is empty but I ejaculate and have a normal sex life. I am almost certain that I am infertile but would like this to be confirmed and that nothing can be done about it. I am also worried about testicular cancer since I understand the risk is higher for someone in my position. Should I have my testicles removed or can they be descended even at this late stage of my life. I'm not interested in the cosmetics and have long got used to the stares etc. Have you ever heard of this situation before and can you advise?

A. Yes I have seen this problem and it is now becoming unfortunately more common for unknown reasons. You are correct to be cautious as there is a proven increase in risk from testicular cancer. You should most definitely have them checked. At least one of them must be functioning and producing testosterone if you have the usual male characteristics which can be maintained with testosterone replacement therapy. Most of the ejaculation comes from the prostate not the testes so you would have a normal ejaculation anyway but more importantly your sex drive must be present so once again you must have a good dollop of testosterone in there. See your GP.

Testicle appears to have divided into two

Q . My left testis has developed a sac above it. It appears like the original one divided into two. I say this because the main body of the testis has become smaller than the right and another one seems to have grown on top. They are attached, seemingly within the same sac. It is a bit drawn upwards and does not dangle in the same way as the right testis. There is no pain except when applied pressure. This is normal, but there is more pain on the left testis than the right when the same pressure is applied.I suspect varicocele. About 6/7 years ago, I had an accident causing severe pain. After several months I noticed the growth (or rather, the division of my left testicle).

A. You should be a doctor as your diagnosis is probably correct, or at least it is a hydrocele. Treatment is simple involving drainage of the cyst. It might require surgical closure to make sure it doesn't reappear but most will disappear for good. See your GP for a second opinion to your own, Dr Who.

Testicle not behaving normally - variocele?

Q . About a year ago, I noticed that my right testicle didn't seem to be 'hanging' as it normally does. Lately, profiled in a mirror, I have noticed that it is quite tight and high. This has caused my scrotum to develop a 'flap' under the testes. There is no pain or other symptoms. Upon ejaculation, the right testicle seems to want to disappear into my groin area. It later comes back down again. I am 37 years old and in good health. Could this be a varicole or something?Thanks.

A. So many men want an answer to your question so thanks for writing in. The testes are highly mobile which is part of the problem for torsion where they twist on their own blood supply and cause unbelievable pain. As we get older they tend to hang higher and the scrotum becomes flatter. Even so if there is any change in the way your testicles feel you need to have it checked by your doctor.

Concern about testicle

Q . I have a small ridge (I would describe it as 3 grains of rice end to end) on the underside of my left testicle. It also feels very uncomfortable (no pain, but always aching) and tender to touch. Although I have been to my GP 3 times he cannot feel anything abnormal, although when examined my testicles have contracted tightly so I can understand him not being able to find the lump. He says that there is no blood in my semen or urine so it's unlikely to be anything serious, but it is a continual worry for me.I feel rather stupid worrying about it as I have had this for years.

A. I can understand your concern. There is a ridge, easily felt, along the testicle which is the bumpy duct carrying the sperm from the testicle to the penis called the epididymis. It is normal but you should feel the same sort of bump on the other testicle. If not, and if it is getting larger or there is any pain, you must return to your GP and ask for an ultrasound scan. It sounds to me that you are so concerned it would be a good idea to get it done anyway as you will never relax otherwise until your mind is put at rest.

Concern about development of testicles

Q . I am 22 years old and with age have become increasingly worried about the undevelopment of my testicles, they do not seem to have gone through the dropping process. When I have finished in the bath they will hang down for a while but then just go back into a bunched up and tight position.Is there a hormone medicine I could take to increase development?

A. If I had a new penny for every question on this one I would have at least enough cash for a Euro. So long as your testicles do hang down they are in the right position and - what is most important - they are doing the job they were designed for. The release of testosterone and the production of sperm are their main jobs. Just having them makes the equation easier. Testes are designed to get out of the way by withdrawing onto the abdomen (try finding them after a swim in cold water). If you are really concerned over their function ask your GP to perform a testosterone test. When the time comes for making babies you might want to check out your sperm count but meanwhile I would just enjoy having them in the first place. Some guys are at least one down in the charts.

Painful testicles

Q . I fell off a ladder 3 years ago (Ouch). Since then my right testicle has enlarged and is painful. I had an operation in 1999 December which found my tube was blocked & inflamed. I have regular pain blocks which help with the pain. But last week my right testicle has got even larger and is painful (OUCH). I am due to see the Consultant next month. Should I go to hospital now or just take the pain killers.

A. Being a testicle owner myself I have more than a little empathy and I suspect all of us have uttered ouch at some point. The problem is in the way testicles develop. They form quite late and are separate from the blood supply. Like the brain, this means the white blood cells never come into contact with testicular tissue. Hence the body never recognises testes as 'self'. If they are damaged and this blood/testis barrier is broken down the body reacts as if it is foreign and attacks it just as it would a graft. The tubes and cells which produce sperm can be badly damaged by this process and the effects can last for a long time. I would ask for your referral to be urgently brought forward, an understanding GP can facilitate this. At the very worse turn up at A&E for pain relief.

Mobile and twising testicles

Q . I am 20 years old and I have mobile testicles - the left is more mobile than the right. 3 months ago I noticed that my left testicle had twisted up to around 180 degrees on its vertical axis but I felt no pain. (So I didn't need surgery or anything). Within a couple of days I noticed it had reset back to how it should be when I woke up in the morning. This has happened 4-5 times since and I'm wondering how common this is and whether I should carry on as normal and hope it twists back every time. It's causing no problems but I panic sometimes as it is noticeable. I want to steer clear of any surgery if I have to. Also, at times when it is twisted, I notice a soft lumpy area on the exposed side. When I find this area on the other testicle (the back facing side) it is lumpy too but smaller. Could these areas just be the colletion of tubes or tube attaching to the testicles? Could this area on the left testicle be slightly larger because it is more mobile?The only real problem is that I worry about this - no pain apart from slight residual pain after feeling the left testicle to see what position it's in.

A. I'm so glad you wrote because there will be stacks of men out there who want to know the answer but are too afraid to ask themselves. First of all relax, there is nothing wrong, in fact quite the opposite. The testicles hang very loosely inside the scrotum and can turn relatively freely. This can actually cause a problem if they twist on their own blood supply (torsion). Don't worry, you will know if it happens. The pain is significantly worse than a severe kick in the soft spot and the testicle swells and becomes very hot. The lumpy bits are the epididymis (pipe which carries the sperm from the testicles to the penis). Being a bit rough when checking them will more than explain the pain you feel. If you feel any other differences, see your GP.

Concern about testicle position

Q . About 6 months ago I noticed that my left testicle started hanging about a half inch lower than my right. With no pain I didn't think about it too much. After some observation it looked like my left testicle was almost perpendicular to my right testicle and almost perpendicular to the ground so that's why it seemed so much lower. It doesn't feel any like it's swollen or any other abnormalities are there. Any ideas? Is this something I should be concerned about? I'm 25 years old, active and healthy. Thanks in advance.

A. It sounds as though you need to see a tailor rather than a doctor. Ask any tailor and he will tell you that testicles hang in many ways but usually with one lower than the other for the simple reason that we need to be able to put our legs together without sounding like Donald Duck. The testicles are held very loosely inside the scrotum and are attached only by cords carrying blood vessels and ducts for the sperm. You will probably notice that this angle of dangle changes in cold water as the scrotum tightens around them. As you have already checked for any growths it is unlikely to be anything nasty but even so I would have them checked by your GP.

Scared about testicular cancer

Q . For the past two months I have been bothered by some occasional discomfort in my right testicle (the left one was undescended but fixed during adolesence). I'm most likely to have a re-occurence of the discomfort after sex. Prior to two months ago, I've had some minor erectile problems and first noticed a little tenderness about a year ago. I've performed a self-check and don't detect tumors nor is there any swelling involved. It is much harder for me to sustain an erection when the discomfort flairs up. It'll last a few days and, if I don't have sex for 3-4 days, it goes away. It's not painful but it's "there". I recently (six months ago) went through a battery of cancer tests, even through a leukemia specialist. He concluded, after blood work and other tests, that, like my mother, my average white cell count is 13,000-14,000 and that, otherwise, nothing appears to be wrong.I'm scared to death that I have testicular cancer but I can't find any other info that may explain the discomfort and tenderness that I've been feeling. I would appreciate any insight you can give me. Thank you so very much.

A. Obviously I would need more information, not least your age and why you went through a 'battery of cancer tests'. Testicular cancer is most common in the 16-30 age group although it can occur at any age. Having an undescended testicle does increase your risk but the good news is that as cancers go it is one of the very best for successful treatment.

Blood tests are not very good for picking up testicular cancer. You really need ultrasound examination via referral to a urologist. Most tumours can be felt through the skin of the scrotum, especially while standing in a warm shower. Compare like with like, the rough edge along the top pole of the testicle is normal as the duct carrying sperm is closely attached to the testicle at this point. I doubt that I can give you any reassurance that would be worth a damn so you should express your fears to your GP and ask for a referral to put your mind at rest. Let me know how you get on.

Severe pain in testicles after ejaculation

Q . I am a 19 year old male, and since puberty after every ejaculation, for a few hours if my penis becomes erect again I develop a rather severe pain in my testicles. Most of the time the pain seems to lessen if I urinate but it still does not totally disappear. I went to my GP when I was about 15 for examination and I was told the pain would probably disappear in a few years after I was through with puberty. I'm about at that point now and the pain hasn't recessed yet, should I be worried?

A. No, you should not be worried because if it was anything dreadfully serious you would know by now. The pain is probably not in the testicles but rather in the ducts carrying sperm to the penis which have a muscular coat. This can go into spasm causing pain. As this only happens during ejaculation it is the time when pain will occur. I suspect, like your own GP, that this will eventually decline but I would ask for a referral if the pain is getting worse or not declining.

Pain in testicle after sex

Q . This has started since the last few times that during and after having sex that my husband experiences a pain in his right testicle. This lasts for a few minutes and then recedes. His erection does not last as long as it used to.Do tell me what to do as I am worried about it.

A. Pain during intercourse generally falls into a number of areas. Most of these are to do with the physical interaction which can be a result of vaginal dryness, previous inflammation of the penis or infection. Pain in the scrotum is often unconnected to the sex itself unless there is some other problem. Transitory pain which he describes is common and generally does not have any sinister worries. Even so, like all men, he should be aware of testicular cancer and check himself for changes in the feeling of his testicles.

You can help as generally a man's partner has a better insight into any changes than the man himself. Lumps, tender or otherwise, changes in shape and especially any blood in the semen need the attention of his GP. Erections and how long they last are very difficult to link with any abnormal process. Generally, erectile dysfunction increases with age and this reflects to some extent the increasing risk from diabetes and cardiovascular problems. It would be a good idea for him to check for any of these nasties at the same time.

Swollen tender testicles

Q . My partner has consulted Drs and had hospital appts which have given no conclusive answers. He occasionally suffers with extremely swollen, tender testicles (one or both-mostly left) which cause him much discomfort. He has had prescriptions for Flomax (which was taken quite longterm) which appeared to relieve the problem for a while but the condition keeps coming back from time to time. He experiences no discomfort when laying down and has no discomfort during sexual activity.It appears to occur without warning and there is no obvious pattern to the occurences. Sometimes the 'attack' lasts for about half an hour and other times it can last for hours.Do you have any ideas, please?

A. From what you describe he may be suffering from intermittent torsion where the testicle rotates on itself cutting off its own blood supply. The testicle swells, becomes hot, tender to touch and extremely painful. The problem is catching it when it happens as by the time you arrive at A&E the whole thing has often settled. He needs a urology referral from his GP but - most important - he needs to go straight to A&E as soon as it happens next time so that they can see it for themselves.

Epididymal cyst linked to penis problems?

Q . I think after a visit to the GP I may have an epididymyl cyst. My symptoms are uncomfort on my right testicle (inc small lump at back of testicle) but I also have a burning feeling on the head of my penis after urinating and which also makes oral sex painful (I have stopped it now just in case) and also an itchy testicle sack. Is this all related or is there another problem and have you got any idea what it may be?

A. You might well have a cyst but what you describe could equally be an infection or inflammation of the duct which carries sperm from the testes to the penis. Called epidydimitis and it can occur in a cyst. Generally speaking it would be tender over the bumpy bit of the testis and sometimes feel quite warm. It is worth going back to your doctor to make sure.

Ache in testicle

Q . Over the last five to six years I occasionally get a dull ache in my left testicle. I did visit my local G.P. when the symptons first occured whom after a course of many months tried different antibiotics to no effect. So I changed to a new doctor, who did inspect my testicles and refered me to an outpatient clinic where I saw another Dr & recieved an ultra sound scan (which showed there was nothing untoward). He said that I had soft tissue damage and gave me some antibiotics (which I cannot remember their name). This did stop the ache. I had a repeat prescription a few years later but unfortunatly the symptoms have returned. Could it be caused due to exercise (I play rugby) or excessive masturbation? Are these symptons common? & is the ache likely to go with time? Thank You

A. I can only give you good news, not least because it is based on commonsense. If there was anything terrible going on over five years you would either be dead or very ill by now. Obviously it is very difficult to make a good diagnosis without an examination or your medical notes but you do give me some good clues.

I do not feel you have an infection. Nor do I believe you have anything like torsion or cancer of the testes. I do think that you may have what was once called 'groin strain'. Playing rugby is the clue and it may well be that you have a torn ligament on the pelvis. These share nerves with the scrotum and 'refer' their pain to it as a dull ache. This comes and goes and is worse after exercise but not immediately. An outside diagnosis is a hernia which again can cause pain in the scrotum,

Why not try for a sports injury clinic and see what they say?

Pain in testicles and leaking

Q . Lately I have had pains coming once a while in both my testes is there something wrong because it never happened when I was young and also a few months ago I use to have what seems like sperm leaks.I am 20 why is this happening. I am worried. is it possible late development because it never happened when I was young.

A. Pains in both testicles are, strangely enough, often a good sign that nothing terrible is happening. Cancer of the testes, hydroceles and infection generally only affect one testicle and it is pretty obvious what is going on. Pain in both testicles is often simply groin strain from lifting or a sports injury. It can sometimes be a torn ligament on the pelvis or even a hernia. The 'sperm leakage' is difficult to comment on without more information, but if you mean a 'wet dream' this is absolutely normal as well as enjoyable. Even so, you should always be alert to the possibility of cancer of the testes and check yourself each month.

Swelling testicle

Q . After my bf gets a hard-on one of his balls swells up and it hurts him. We have never had sex and he is still a virgin. We're both kind of worried about this and wonder what could be causing it and why? Thank you for your help!

A. Many men report this phenomenon although the reason for it is not very clear. Most importantly, we do know that it is not dangerous and the chances of him actually exploding with hairy bits flying all round the room are extremely small. It may be a subjective feeling of swelling rather than the testes actually getting bigger. There is no mechanism inside the testes to do this and they produce sperm at a more or less constant rate. The semen which is ejaculated contains a tiny amount of sperm from the testes, all the rest is made by the prostate and other glands to keep the sperm alive and neutralise acids in the vagina.

Other than sympathy and doing what he feels will relieve his discomfort, there is nothing else needed. Beware of falling into the trap of doing anything you do not want to do out of fear from testicular fallout if you follow my drift.

Painful testicle and itchy scrotum

Q . I am 37, when I was 21 I had a benign growth removed off my left testicle and they also removed about half of the testicle. Over the years the remaing half is extremely painful to the touch and has shrunk and become very mushy. About a month ago another problem began, when the scrotum itches and I scratch it I get a severe burning sensation where scratched. It is not isolated to any particular area, the burning last for 3 to 5 minutes then goes away. There is no redness or rash. Any ideas?

A. First some good news: One testicle is more than able to produce enough testosterone for the normal function of the male body and this includes protection from osteoporosis in later life. It can also produce enough sperm to keep you fertile.

I cannot explain the feeling of your testicle which was operated on. One of the problems with the testicles is their peculiar status in the body which ensures they never come into direct contact with the blood. This is important as they are considered 'foreign' by the white blood cells and would be attacked as such. They are not the only part of the body with this strange relationship requiring all nutrients to pass through blood vessels but not the white blood cells. The brain is the same.

Damage to a testes either from trauma - riding a bike with a crossbar while wearing slippy shoes will do very nicely - or surgery increases the risk of white blood cells coming into direct contact with the cells of the testes. If this should happen it can change the nature of the testes into fibrous tissue rather than millions of tubules producing sperm and testosterone.

Similarly, it is impossible to comment accurately on the sensation you experience on the skin of the scrotum. Like any skin on the body it can be sensitised by any number of things and it may not be related to the condition of your testes inside. Washing powder is a classic culprit for sensitising the skin. It might be worth changing your undies from manmade fibre to cotton. It may, however, be linked to the changes you notice in your testicle which could be causing an irritation on the surrounding skin.

Either way, you should get your GP to check you over.

Surgery for hydrocele and cysts in testicles

Q . Following an ultra sound scan, it would appear that I have a hydrocele in my left testicle and several cysts in both testicles. The specialist has suggested surgery - is this the best option (what about draining the hydrocele) and what would the surgery entail in terms of stay in hospital etc? I would like further info on this before I feel happy to have the surgery. What questions should I be asking?

A. Hydroceles are very common and they cause a disproportionate amount of concern for their unhappy owners. They are blind cysts which form in loose spaces within the cords passing from the testicles to the penis. The fluid which builds up is usually harmless sterile salt water but can sometimes contain blood. We don't know why some men develop them but they are not a sign of anything more nasty nor are they caused by trauma, masturbation or doing any of the things your mother warned you about.

You are quite correct to ask about draining this hydrocele and it is often done under a local anaesthetic in general practice. Unfortunately it is not always the definitive answer as the cyst often returns requiring further drainage. Having a needle stuck into your hairy bits is not every man's idea of a good day out so it can be useful to completely remove the cyst surgically. It also gives the opportunity to check the testicles for any other growths or cysts.

Five year old without testicles

Q . My friend has just received some devastating news about her five year old son. From birth she and her local hospital have been aware that her son had an undescended testicle -they thought just one. She has been waiting and waiting for appointments and has only just had an appointment through for a laparoscopy(!) They have discovered that he has no testes at the age of five. They have got to wait another three months to see an endocronologist to answer their questions. What are the implications for future physical development and where can I find more information and support?

A. Good friends are hard to find these days and it is refreshing to have someone to be concerned about someone else's son write to the site. Even so, it is obviously not a good idea to discuss in detail the implications of the investigations with anyone other than the mother and father. I can really only give you basic information and it is not all bad news.

The lack of testicles means that there is also a severe lack of testosterone, the male sex hormone along with the ability to produce sperm. The lack of testosterone can be alleviated through hormone replacement which will need to be lifelong. This will ensure normal male development and lessen the possibility of osteoporosis (thin bones) in later life. Sperm cannot be replaced but there are a wide range of options for fatherhood later on, not least the possibility of using his own cells in the future. Although seemingly a disaster when it first hits the family, there are many things that can be done, not least cosmetic implants which are indistinguishable from the real thing. I am not trying to trivialise the dreadful situation but rather show that abject pessimism is not only out of place, it is counter productive. Good friends show support and maintain confidence. I'm sure you are up to it.

Scrotal pain - could it be a variocele?

Q . My partner woke up on Wednesday night with severe scrotal/testicular pain and pain in the lower abdomen and groin. He was also being violently sick. I took him to casualty and he was kept in on the ward overnight - all blood tests came back fine, urine tests and ultrasound and X-ray all came back normal (apparently) so there was no torsion and no lumps on the testicles. The doctor sent him home tonight but did not say what they thought it could be, just gave him a load of painkillers. I noticed that on the notes they mentioned the word 'varicocele' but not on the final notes they have sent home with him for the GP. So he is now at home taking painkillers with no idea what caused this, although they want to do a follow up in four weeks' time with another ultrasound scan.

A. I can only give you good news. From what you tell me there is nothing horrible happening to your partner. The very worst nasties were eliminated - cancer and torsion. The causes of such pain do vary, but if there is still pain sufficient for him to be taking painkillers, he needs further investigation. Yes, a variocele which is just a bag of fluid collecting in the sheath of the cords passing into the scrotum, can cause problems but they can usually be resolved quickly by draining the fluid from the sac. Prostatitis, an inflammation of the prostate or infection of the testes will cause a prolonged nagging pain and need medial attention. I would ask for a follow up investigation if the pain has not resolved.

Concern about difference between testicles and possible infertility

Q . A year ago I noticed that one of my testicles suspended further than the other and could roam or wander as it pleased. I would have to find it sometimes but yet the other is normal and stays in same steady position. Well recently my wife noticed that the one testicle that use to roam is now soft and mushy, almost depleted while the normal one is still hard and subtle. I have a child of four years. I'm wondering if this is a sign of testicular cancer and if not, could I be sterile? I'm not having any pain in my testicles, however I have been diagnosed with herpes and have lately been getting side and sometimes bad back pain. I'm afraid of going to the doctor because of the results. My wife wants kids and she's afraid that I might be sterile.

A. It is impossible to tell if a testicle is functioning normally from simply feeling it. Yes, you can get a good indication of a possible cancer from the difference between its neighbour, but when it comes to producing sperm it would take a sperm count to give an indication of sub fertility. The mobility of a testicle is usually a good, rather than a bad sign.

Similarly one always hangs lower than the other to allow us to put our legs together without gaining a high voice. Size always varies between them too. I would suggest that as you are worried you should see your family planning clinic who will organise a sperm count and talk to you and your partner about infertility. Already having a child is a very good indication that all is well in the sperm department. Either way you should go for peace of mind through expert medical advice.

Mild pain at top of testicle

Q . I have a mild continuous pain at the top of my right testicle. It sometimes spreads into the right groin. There is no swelling or lumps. It is only slightly tender when touched. There is no sexual dysfunction although it is worrying. What is the possible diagnosis and what shall I do?

A. Without an examination and more information about your age etc I cannot give you a definitive advice but there are certain possibilities. Problems with the testicle itself include a cyst in the duct which carries the sperm to the penis. These are common and can be easily treated. If there is any suggestion of a lump you must consider testicular cancer which is also eminently treatable. Even without a lump it is still a possibility so check it out with your GP. Hernias have a nasty habit of giving this kind of pain with no history of lifting something heavy. Either way you need this one checked by a professional.

Are these calcium deposits and how to remove them?

Q . I have many lumps all over my scrotum. They vary in size. They have been there for about 8 years (since I was 15). They are hard and white and can be itchy. A brief visit to my GP regarding another problem pointed out that they could be calcium deposits? How and what do I do to remove them?

A. The fact they have been there for so long is a good sign that they are nothing horrible. Remember that your scrotum is like any other skin and has sweat glands. It also has bumps like those on your penis which are designed to enhance sexual pleasure for your partner. Take a look at dildos in any sex shop. The last thing they are is smooth.

I suspect you are looking at a mixture of sweat gland secretions and natural 'bumps'. I strongly recommend not trying to remove them. If they are calcium deposits they must come from sweat gland secretions and I very much doubt that these glands produce that amount of calcium. Leave well alone and try out the 'sexual advantage' theory first.

Could this be a hydrocele?

Q . I appear to have a build-up of fluid in the right half of my scrotum, which is about three times its normal size. It is entirely painless, and there are no hard lumps. Am I right in suspecting that this is probably a hydrocele? Could this be related to cycling?

A. It's difficult to be exact without the benefit of examining you, but what you describe would fit the description of a hydrocele. I would suggest a trip to your GP for a quick check up, and hopefully he/she can set your mind entirely at rest. Hydroceles can be related to "trauma" and the repeated pressure of cycling could, I suppose, be the cause of a hydrocele.

Bulging testicle

Q . I noticed today that when I sit down and bring my legs close together so that the knees touch, my left testicle moves very high up, almost completely out of the sac and I can see it bulge under the skin in the groin area. There is no pain and when I stand up it drops back down. This happened once before last year, then it went away. Should I be concerned??

A. The testicles in the majority of cases drop down into the scrotum at or around the time of birth, and after that they should remain in the scrotum. Sometimes testes are slow to drop down into the scrotum (we call these undescended testicles) and an operation is usually required.

What you are describing is more reminiscent of a "retractile" testicle. This is not particularly serious but you should see your GP for a check up. Sometimes there may be an inguinal hernia associated with this condition. At the end of the day you may not require an operation providing:

• Your testicle predominantly resides in the scrotum, not the groin
• You do not get significant pain or other symptoms

Tension between testicles and anus

Q . From time to time depending on my stress levels I notice tension between my scrotum and anus. The tension seems to be slight near my left testicle but it is noticeable (but not uncomfortable!) as you get closer the anus.It feels like a muscular tension. Should I need to be concerned about this? Thanks in advance.

A. Stress and tension can cause a number of bodily symptoms, and I have seen patients with symptoms like yours which were due to stress.

I suppose the obvious thing would be to try and moderate your lifestyle to reduce the levels of stress you experience (if possible). Having said that - unless the symptoms are really bothering you then you probably don't need any specific treatment at present.

Pea shaped objects inside scrotum

Q . I have noticed a few hard very small pea shaped objects around my penis inside the scrotum. I am very concerned and would like to know if I have a problem and if so what I should do?

A. It is difficult to be certain exactly what you are describing.

Small pea shaped objects in the scrotal skin are likely to be sebaceous cysts which result from blockage to the oily glands that lie around the hair follicles in the scrotal skin. These are not serious, but if large may sometimes require removal. They can occasionally become infected.

Pea shaped objects within the scrotum itself might be caused by cysts in the epididymis. Again, these are not serious but can enlarge and cause discomfort.

An exact diagnosis is difficult in this case and for reassurance you should see your GP for a thorough examination.

Pain in testicle

Q . For about 3 days now I have had tenderness in my right testicle, the tenderness is concentrated at the top nearest to the base of the penis. I am very concerned about it. It is uncomfortable to touch and also when I have an erection and my right testicle is drawn upwards. I do not know of anyway I could of injured myself, unless at work when I lean against the fitting which is at pelvic height. I do not wear tight underwear either. I have thought about giving it a few days before I consult my doctor to see if the problem eases. Thank you

A. First, relax as there is unlikely to be anything life threatening going on. It sounds as though you may have an infection of either the testicle or the duct which carries sperm from them to the penis. Generally there is a feeling of heat and tenderness with possibly blood or pus mixed in the sperm or urine.

It is unlikely to be torsion, where the testes twists on itself cutting off its own blood supply as the pain is unbearable and comes on over an hour maximum. Testicular cancer is generally painless until the later stages. A lump on the testicle is often the first and only sign. You should see your doctor who will probably prescribe antibiotics.

Mushy testicles

Q . It seems that both of my testicles are not swollen but are filled with something inside, more on one testicle than the other though. It feels spongy, mushy. I think I have had it for years but I never looked into it. I used to lift heavy objects before and that is the approximate time this happened. I've looked at other websites but they keep talking about a hernia in the lower stomach area. Another thing is that it does not feel lumpy nor hard. Sorry I could not get more specific, that's as good as I can get. Thank you.

A. I don't think that your "problem" is anything to do with the lifting, it doesn't really sound like a hernia.

I don't really have much to go on, and without the benefit of examining you a diagnosis is difficult.

You appear to have had this "problem" for a number of years, which makes it most unlikely to be anything very serious. For a full diagnosis I regret that you will probably need to see your own GP.

Slight swelling of scrotum

Q . I am an 81 year old male and have just become aware of a slight swelling of the scrotum. I have had a sharp pain in the groin area very very occasionally

A. I regret that I don't have a lot to go on here - if you are concerned you should see your GP for an examination. If there is any difficulty with the diagnosis then an ultrasound scan should resolve the issue and relieve any anxieties.

Blood in semen

Q . I find traces of blood in my semen. What is the cause of this? I don't seem to have damaged myself to have caused this, and sexual relations have been sparse lately.

A. There should never be blood in your semen. Having said this, when it does happen it is easily treated especially if you see your doctor early. A good dig in the groin with a football boot or a crossbar of a bike will often cause sufficient trauma to cause bleeding into your semen. It can also result from infection, although you would be aware of this as it is very painful. Testicular cancer is a candidate and the good news is that it is one of the most treatable of all cancers. In older men problems with the prostate are also possible. Whatever your age and possible cause, you need this checked out, so nip down to your GP.

Swollen scrotum

Q . My scrotum has become swollen after some sexual activity. Although I feel little pain, I am aware that the scrotum has become larger, tender, and seemingly filled with fluid. Should I be concerned?

A. It is difficult to know how sexual activity may have caused this problem. It may be coincidental and the scrotum may be swollen for another, unrelated, reason.

Unfortunately it is difficult to give a comprehensive answer to this on the basis of the information given. I would suggest a visit to your general practitioner for a check up. This will also reassure you as to the cause of your symptoms.

Cyst on testicle

Q . I have had an ultrasound of my testicles and been told I have a cyst on my left testicle. What can I do about this, and could it cause my penis to get smaller and not become fully erect? It feels like another testicle attached to the left one, and is much larger when I sleep.

A. I suspect that the scan has shown a cyst in the epididymis, which is the tube around the testicle (and transports sperms away from the testicle).

Epididymal cysts are common, but are innocent. They most commonly cause symptoms of discomfort. They are usually quite small but can become quite large (the size of an orange, or larger).

Unless they are causing symptoms it is reasonable to leave them alone. Epididymal cysts can be removed by surgery under a general anaesthetic. This can be done as a day case. Although the procedure is a fairly minor one you should be aware that any surgical procedure on the epididymis may compromise the fertility on that side. This is because the transport of sperms down the very fine tubes on that side may be impaired. The other side should continue to work as normal.

Baby with swollen testicle

Q . My 3 months old has a swollen right testicle. Will he need an operation?

A. This is most likely to be a hydrocele which is a collection of fluid around the testicle. Hydroceles are more common on the right side. Nearly all hydroceles in babies disappear by the age of one year.

If you are concerned or if the swelling is still present at the age of one year you should seek the advice of your GP. An operation and drainage for this condition in babies is very rarely needed.

Retracted testicle

Q . During sexual arousal, my right testicle retracts up into my groin. It is not painful and I can push it back down again - but it just goes back up. This lasts until the end of sexual arousal when it returns to its normal position.Advice please. Thanks.

A. First of all relax. This completely normal. It is possible, with a bit of practice, to get both testicles to disappear into the safety of the abdomen. Ask any Sumo wrestler - politely. The problems start when they don't come back down again. This is very rare and testicles are more likely to fail to descend into the scrotum just after birth, not later in life once they have successfully made the journey. During intercourse, or even masturbation, the scrotum tightens as the penis pulls skin away from it. This pushes the testicles upwards, and they can disappear, only to return later. It is normal and there is absolutely nothing to worry about. I would strongly advise against any 'treatment'. If you previously had an undescended testicle there is an increased risk from testicular cancer so you should check them every month or so.

Lump in testicle following kick

Q . I was kicked playing football in the testicles two years ago, I developed a lump which I have had scanned twice and been referred to clinics to have it checked out. This was in Sheffield when I was in university a year ago. The lump is still present, and they said that it was a blood clot and it should dispurse. Now I have moved to london and I'm not registered anywhere and it is concerning me.

A. Relax. If you have been scanned and it happened two years ago it is nothing serious like testicular cancer. The problem with trauma to the testicles is that it can cause bleeding into the testicles themselves which normally never come into direct contact with blood. This can cause a destructive reaction as the body doesn't recognise the testicular tissue as its own and attacks it. Blood clots which form tend to take a long time to disperse and can form a cyst which will remain until removed by surgery. At the same time lumps from epididymal cysts can arise which have nothing to do with the original trauma. These can be drained and rarely cause any serious problems. It is wise to keep an open mind as testicular cancer can also arise without any connection to the original event so continue to check yourself and if the lump is changing in shape or hardness, becoming tender or you have a discharge of blood in your urine or semen you need to see your GP.

If the blood clot is refusing to resolve you can have it removed surgically although it will do little harm where it is.

Undescended testis

Q . My baby son has an undescended testicle — what will happen?

A. Undescended testicles (UDT) are a common problem. The testes are usually present in the scrotum at birth although if the baby is born prematurely this may not be so. The degree of prematurity may need to be taken into account before deciding whether there is a problem or not.

Spontaneous descent of the testes is rare after the age of one year and a decision to operate is usually made around this time when the diagnosis has already been made.

The operation to bring the testicle down into the scrotum is called an orchidopexy, and is usually performed when the child is out of nappies (to reduce the risk of wound infection), mostly before the age of two years.

The operation is usually performed as a day case under a general anaesthetic. A cut is made in the lower part of the groin and the tissues which are 'tethering' the testicle up in the groin are cleared away. The testis is then brought down to the scrotum and fixed to the scrotal skin with a dissolvable stitch.

Sometimes the problem is only discovered in later life. If the diagnosis is made before puberty then the testis would be brought down into the scrotum by an orchidopexy operation as described above. If the problem is discovered in adulthood then there is an argument to be made for removing the testicle (orchidectomy) completely. This is because such testicles never produce sperms and are at a slightly higher risk of developing cancers. Bringing the testicle down to the scrotum does not reduce the risk of the cancer developing, but it does make it easier to feel the scrotum and detect a cancer early if it occurs. Many urologists would suggest removal of the testis to prevent any further problems occurring.

Varicocele

Q . I've been told I have a varicocele — what exactly is it and how can it be treated?

A. A varicocele is an abnormal collection of dilated veins within the scrotum. The condition is said to occur in 1 in 10 normal men and is predominantly seen on the left side of the scrotum (in 15% of cases both sides of the scrotum are affected). The varicocele is usually much more prominent when you stand up.

A "dragging" feeling in the scrotum is common. Many men who turn out to have a varicocele are sometimes referred to a urologist because of difficulty conceiving a child with their partner. There is an association between having a varicocele and a reduced sperm count in some cases.

Treatment is usually advised for men in two main circumstances

• Where there is evidence of significant discomfort which the patient wants alleviating
• Where a man is found to be sub fertile and a varicocele has been detected.

When fertility is not an issue and the pain is not very severe then the general advice would be that the varicocele is not serious and no treatment is required. This is always open to reassessment if the varicocele becomes more painful subsequently.

There has been a recent trend to offer treatment to younger men and teenage boys before any suspicion of subfertility becomes evident. This is because it is now believed that earlier intervention to treat a varicocele might reduce the chances of problems with fertility in the future.

Available treatments include:

• Varicocele ligation
• Embolisation of the varicocele
• Laparoscopic surgery

Varicocele ligation - This term refers to a surgical operation to ligate (tie off) the distended veins as they run through the groin into the scrotum (from the abdomen). A cut is made in the left groin approximately 5 to 10 cm long. The veins are identified and tied off and the wound closed with absorbable sutures.

The procedure is usually performed as a day case under a general anaesthetic, and takes approximately 45 minutes to perform. You will normally need two weeks or more away from work (depending on your job).

Complications of a varicocele ligation include;

• A collection of fluid (known as a hydrocele) may develop around the testicle in up to 15% of cases. If this is quite large it may need a subsequent operation to deal with it effectively
• There is a risk of damage to the testicular artery, which supplies the testicle.

This artery runs along with the veins and can be very difficult to spot during surgery. It is likely that in the majority of cases it is tied off along with the veins. This usually does not matter because the testicle can get a good enough blood supply from the artery that runs with the vas deferens (which is left intact). In some cases this other artery is not large enough to supply the testicle. If this happens the testicle may become inflamed after the operation, and may subsequently shrink (atrophy). If you are an older man who has finished having a family this might have very few consequences for you, but if you are still considering having a family you should understand that this complication might lessen your chances of fathering a child. The exact rate of occurrence of testicular atrophy after this operation is not known but is thought to be less than 10%

• Recurrence of the varicocele occurs in anything between 0.6 and 45%

Embolisation of a varicocele - does not involve an operation. This procedure is performed in the x-ray department by a Radiologist under a local anaesthetic. A small cut is made over the groin on the right side. The Radiologist then passes a small wire up the large leg vein and then eventually guides it into the veins draining the left scrotum. Usually a small metal coil is placed into this vein to block it off. This has the same effect as the surgical procedure to tie off the veins.

This procedure is also done as a day case stay but occasionally patients need to stay overnight.