The testes are contained in the scrotal pouch that is purposely developed to hang away from the body. There is a muscular layer which contracts or expands with the surrounding temperature to keep the testes at a constant temperature slightly lower than the body temperature which is necessary for the production of sperm. The scrotum is divided into two separated sides, each one containing a testis and epididymis. The left testicle typically hangs a little lower than the right. The epididymis connects the tiny tubules in the testis and serves as a transportation system for the sperm. It sits on top and along the side of the testis and joins the vas deferens which runs up the scrotum and into the inguinal canal and enters the seminal vesicle on each side of the prostate. The sperm are stored here until ejaculation. The testes are egg shaped structures and have two functions:
The testes are also considered part of the urogenital tract in males because of their physical connection to the prostate through the vas deferens.
Disorders of the testes include congenital abnormalities, infection, cancer, and infertility. Initial evaluations of the testes can include blood tests, urine tests, examination of the seminal fluid, and ultrasound imaging.
Testicular cancer is one of the most common cancers in young men. It affects about 5000 males in the United States each year. This occurs primarily in younger men with a peak age being around 15-35.
A tumor of the testicle often becomes obvious by a fast enlargement of the testicle. It is an aggressive cancer which grows quickly and spreads early. The tumor is usually painless.
Several high profile individuals have helped to make the public aware of this disease and the importance of testicular self-exams. Just as women should do monthly breast self-exams, men should routinely exam their testicles to screen for cancer. The age to start monthly checking of the testicle for masses is at puberty, around age 15. The scrotum is looser and the testicle easier to feel in a warm environment such as the shower. Fortunately, this is one of the most treatable forms of cancer.
One of the more common masses felt in the scrotum is a varicocele. Varicoceles are enlarged veins in the scrotum, much like varicose veins in the legs. They often feel like a bag of worms. A varicocele is most common on the left side. Varicoceles occur in about 15 percent of all men. The majority of men have no problems, but about one in six men that have a varicocele have difficulty with fertility and testicular growth. Varicoceles are easily treated surgically if infertility or poor testicular growth is evident.
A hydrocele is a collection of fluid around the testis. It is often painless, but may grow to a large size and cause discomfort. It may occur in male infants but most of these will subside without treatment. Surgical drainage can be done as a quick outpatient procedure.
Spermatocele may resemble a hydrocele but is a cyst that develops in the epididymis and not around the testis. It requires surgical treatment when size or discomfort becomes a factor. These lumps are freely mobile from the testicle itself.
Infections of the testis and its neighboring structure, the epididymis, are common and are relatively easily treated with scrotal support, limited activity, and antibiotics.