What every man should know about his testicles, according to a urologist

By Dr. Jamin Brahmbhatt, CNN

(CNN) — A guy recently walked into my clinic with his girlfriend. He had felt something in his testicle months earlier. She found out and dragged him to see me.

I did a physical exam and confirmed what I felt with an ultrasound. The lump turned out to be a benign cyst, not cancer.

He leaned over to her and said, “See. I told you so. I’m fine.” I told him he should thank her instead as this visit could have gone very differently.

Most testicular lumps are not cancerous, but some are. And the only way to know is to get checked. When a man waits, he delays care — often for something a physician could clear up in minutes. Or a doctor could find something that could save his life.

During my urology rotation in medical school, I checked my own testicles for the first time. I found something, freaked out and made myself an appointment. Like my recent patient, it turned out I had a benign cyst — almost certainly there my whole life. I just never knew what my “normal” felt like before that milestone moment.

That’s why I recommend that patients get in the habit of doing regular self-exams. You don’t need to obsess, and there are no formal guidelines requiring monthly checks. But getting familiar with your normal anatomy — by checking periodically while showering — helps you recognize change when it happens. The whole exam takes less than two minutes.

The more you know your baseline, the easier it is to notice when something is off.

Testicles have 2 main functions

The testicles’ first key task is making sperm. A healthy man produces tens of millions of sperm every day. These sperm can take about three months to grow, mature and make it out into the ejaculate.

The testes’ second essential job is making male sex hormones — primarily testosterone. Specialized cells called Leydig cells produce most of the testosterone in a man’s body. Testosterone is responsible for muscle mass, bone density, libido, mood, energy — all essential to a man’s function.

It’s ideal to have two testicles, but men can function with one. A man can live a full life, including fathering children, with a single testicle.

The testicles do not start where they end up

While a male fetus is developing in the womb, testicles originate in the abdomen near the kidneys. In the final months of pregnancy, the testicles descend through a passage called the inguinal canal to land in the scrotum, the pouch that protects them for the rest of a man’s life.

That descent is the reason testicles hang outside the body and why testicular pain can radiate up the abdomen. Sperm production works best at a temperature slightly cooler than core body temperature.

The scrotum is a temperature-controlled chamber that adjusts itself — pulling the testicles closer to the body when it’s cold and lowering them when it’s warm. That’s why everything looks different in a cold pool versus a hot shower.

What’s actually down there

The scrotum usually contains two testicles. Each one is an oval organ, smooth and firm, roughly the size of a small egg. Inside, the testicle is full of small, packed tubules called seminiferous tubules, where sperm is produced.

Attached to the back of each testicle is a soft, wormlike structure called the epididymis, where sperm mature. From there, sperm travel up through the vas deferens, a long tube that runs out of the scrotum into the lower pelvis to enter the ejaculatory ducts. This vas is the same tube that gets cut during a vasectomy.

Everything that keeps the testicle alive and functional runs through the spermatic cord — arteries, veins, nerves and lymphatics, bundled together along with the vas deferens. You can feel the structures of the cord rising from the top of each testicle. The cord is surrounded by muscle that helps the testicle move.

What’s normal

One testicle is typically slightly lower than the other, usually the left. One is slightly larger than the other, which can be on either side. What’s that soft, lumpy wormlike structure along the top and back of each testicle? That’s the epididymis, not a tumor. A cordlike structure extending from the top of each testicle is the spermatic cord. Cysts can form on the testicle or epididymis, but they are usually benign.

You may find enlarged veins above the testicle that feel like a small bag of worms. This may be a varicocele — a common and usually harmless condition — but it’s worth mentioning to a doctor if it’s new and painful or you have concerns about fertility.

Testicles that move up and down depending on temperature, exercise or arousal are also normal.

What’s not normal

A firm, painless lump on the testicle itself is a red flag. It is the classic presentation of testicular cancer. About 9,800 men in the United States will be diagnosed with testicular cancer in 2026, according to the American Cancer Society. The disease is most common in younger and middle-aged men, especially those in their 20s and 30s, and it is one of the most treatable cancers when found early — survival is about 99% when caught early.

If you find a firm lump, you should get to a doctor right away, even if you feel fine. Most testicular cancers are painless, but pain doesn’t rule cancer out. Very easily, an exam, ultrasound and/or lab work can help sort a benign tumor from cancer.

Cyclist Lance Armstrong’s 1996 diagnosis made testicular cancer a household conversation. Earlier this year, Dwayne “The Rock” Johnson had a similar scare. His lump was painful and turned out to be epididymitis or inflammation of the epididymis — not cancer.

Tender swelling, redness or warmth — sometimes with painful or frequent urination or fever — may be epididymitis, the condition Johnson had. It’s treatable, often with antibiotics, anti-inflammatories and rest.

Sudden, severe pain in one testicle could be testicular torsion — the spermatic cord twisting on itself and cutting off blood supply. Torsion is a medical emergency, full stop. If the testicle is not untwisted within hours, it can be lost.

What happens at a doctor’s visit

Your visit with the urologist will start with a conversation about when you noticed something off, what it feels like, any pain or urinary symptoms, and relevant medical history. During the physical exam, the physician will check the scrotum, the testicles, the epididymis and the spermatic cord. The doctor is checking for the same things you would feel for at home, just with more experience.

From there, the workup depends on what a doctor finds. The urologist may order a scrotal ultrasound to get a clearer picture of the testicle and the surrounding structures. It’s the same basic test Johnson described having after his scare.

Doctors may check your urine if they suspect infection, blood work for tumor markers if cancer is on the differential, or hormone levels if testosterone is part of the conversation. Occasionally, urologists will order an MRI if they want a closer look at the anatomy within the testicle.

How to check yourself

I recommend that patients do their self-exams in the shower. Warm water relaxes the scrotum, which makes the testicles easier to feel.

Take a couple of minutes to examine one testicle at a time. Roll it gently between your thumb and fingers. You are not squeezing. You are feeling for the shape, the size, the surface.

Find the epididymis along the back. Notice the spermatic cord rising up.

Remember, if you find anything new — a lump, a hard area, a change in size, persistent pain — in a self-exam, don’t drag your feet and delay care. Get checked early. Proactive care is the best form of healthcare.

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