Testicular Health: What Men Need to Know About Their Balls

Testicles are confusing. Men tend to understand their penises, which serve a clear purpose, function more or less predictably, and don’t send a message to your brain that the world is ending every time they’re slightly perturbed. The same cannot be said for the sack and its sensitive contents. Men’s main non-erotic interaction with their testes comes in the form of self-examinations, which can be awkward or unwieldy because this is a part of the male anatomy that never quite feels totally normal. Still, a testicular understanding helps men monitor their health, react appropriately to nutshots and consider fertility issues. There’s no need for the scrotum to be a black box.

Fatherly is here to help. To save you time, we asked leading urologists all the critical and awkward questions about testicle we could brainstorm. Here’s what every man needs to know about his balls.

When should I worry about testicular pain?

Dr. Robert J. Valenenzuela, Icahn School of Medicine at Mount Sinai Medical Center: It’s normal to have pain. Just like a headache, it’s normal to get intermittent testicular pain and we don’t worry as much about that. What we’re looking for is consistent pain, an ache in the same area, delicate to the touch. We worry if there’s a change in the color of the skin, redness or swelling, or a lump on the testicle that doesn’t go away or continues to grow.

Dr. S. Adam Ramin, Urology Cancer Specialists in Los Angeles: If the trauma is not very significant, the pain may last five to ten minutes. If the pain is ongoing, or there is swelling or bruising, it is important to seek medical help.

Dr. Jim C. Hu, Weill Cornell Medicine and New York-Presbyterian Hospital: Certainly you can get a sense that something is wrong when you see swelling and bruising. That’s when you need to get to the emergency room.

How hard do you have to get smacked in the nuts to impact your reproductive health?

Dr. Valenenzuela: It’s less about how hard you get hit, and more about where you get hit. If you get hit in just the right place, even a small trauma can cause rupture or bleeding in the scrotum. If the testicle is hit right against the bone and has nowhere to go, it can rupture. If the testicles have space to move, they won’t be traumatized as badly.

Why don’t my kids seem to mind when their friends ‘nut tap’ them?

Dr. Valenenzuela: The testicles are not as low in children, and their scrotums are not as well-developed. Their testicles have more space to move, they’re not as large, and they’re retractile. They are not as sensitive as adults.

Retractile? Is this that “balls dropping” business we’re always hearing about?

Dr. Valenenzuela: Yes. When you’re young, you have retractile testicles. They tend to ride, they can go up and down easily. As you get older they form their stalk, and the weight of the testicle helps the development of the scrotum.

What about “blue balls”? Is that real? What’s happening physiologically?

Dr. Valenenzuela: It is not really a discoloration of the scrotum. It is not the color, per se, but the fullness or pain they feel associated with sexual activity without ejaculation. That can be easily relieved by ejaculating. We think that what’s going on, physiologically, is that in sexual stimulation there is an increase in blood supply to that area. Engorgement of the testicles and penis and scrotum. And this gets backed up, so men feel that fullness and perceive it as pain or discomfort. It’s not dangerous, it’s not going to kill him. But it can be uncomfortable.

Why is does one testicle hang lower than the other?

Dr. Valenenzuela: There is normal asymmetry in our bodies. Everything that’s double has some asymmetry. With the testicles, the asymmetry is because the blood supply, or what drains the testicle, is different on the right side and the left side. The right side is a straight shot from the vessel to the kidney, and the left is at an angle, so the right one tends to hang a little bit higher. It is also completely normal for one testicle to be larger than the other.

Does the size of the testicles have any impact on reproduction?

Dr. Valenenzuela: Only at the extremes. We know guys who have very, very small testicles, who have primary testicular failure, where they produce testosterone, but not sperm. Steroids can also cause testicles to stop functioning and get smaller and shrink. But for the general population, testicle size does not really matter.

Will my testicles change significantly as I age? What should I be prepared for?

Dr. Hu: The body’s testosterone production can go down so, over time, testicles can feel like they’re smaller in size or softer. That’s what happens with natural aging. There’s nothing else too terrible that you might notice.

How common are varicose veins in testicles? What should be done about it?

Dr. Hu: Varicose veins of the testicles can cause pooling of blood, which may result in elevated temperature and decreased sperm quality. Oftentimes, it feels like a bag of worms around your testicle. You’ll feel some tubular structures or cords. Surgery often resolves the problem, when we tie off those veins.

Is there a future in plastic surgery for testicles? What’s with “scrotox”?

Dr. Valenenzuela: There are a lot of people trying to cash-in on genital plastic surgery and, yes, some people are doing “scrotox” to make the skin of the scrotum look softer, younger, or get rid of the wrinkles. Some guys who have very low-hanging testicles or a very large scrotum can have a scrotal reduction, to hang a bit higher. It’s all about aesthetics, personal preference. In terms of comfort, though, some of these guys feel their scrotum gets in the way. Sometimes a scrotal reduction helps them by lifting up the testicle a little bit more.

Will propping my computer on my lap harm my reproductive health?

Dr. Valenenzuela: Not really. The computer generates heat so, if you spend four hours a day with the laptop on your lap, it’s going to increase the temperature of the testicles, but if it’s a transient thing I don’t think it’s much of an issue. It’s the equivalent of sitting in a hot tub on a regular basis. That might affect your fertility or sperm production, because the testicles are outside of the body to maintain sperm at a lower temperature.

Is heat, in general, bad for my testicles?

Dr. Hu: Too much time in the heat is detrimental for production of sperm. That’s the whole function of the scrotum, to hold the testicles away from the body so that it produces sperm at lower temperatures. In general, however, spermatogenesis happens every 72 days so what’s being produced now is a reflection of at least a couple of months ago. So if u have a bad batch, just fire some blanks 72 days later. And things should go back to normal.

Dr. Valenenzuela: Short periods of time are not a big deal, like 15 minutes of a half an hour. But if you’re going into the hot tub for an hour or two every day, that can be harmful. Remember, anything u do to your testicles today will not result in changes immediately. Sperm produced today won’t be ejaculated for another two or three months.

How much planning should a man do, before getting a vasectomy?

Dr. Ramin: He should definitely think about it long and hard, and not consider it something reversible. Although it’s technically reversible, the results may not be satisfactory. In terms of preparation, you need to see a urologist to go over the pros and cons and have a physical examination but, on the next visit, they can have their vasectomy done. Once they have their vasectomy, it’s important to rest one or two days, with no heavy lifting or sexual activity for about a week. Normally, they’re ready for a semen analysis after about 20 ejaculations.

Dr. Valenenzuela: Unlike women, who get a tubal ligation and are immediately infertile, a man needs to plan to use protection for at least three months, about the time it takes for the sperm in the seminal vesicles to be completely ejaculated. They should also plan to have a semen analysis before resuming sexual activity without protection.

What should men worry about when grooming or “manscaping”?

Dr. Ramin: With grooming, one of the biggest problems is when they clip their hair very short all the way down to the skin and the skin tries to grow, a follicle may get trapped. If that happens, we have an ingrown hair which can cause a skin infection or an abscess. And actually, we’ve been seeing more of this lately, and a lot of times it requires a surgical intervention. The best way to avoid it would be to trim, not shave. And, if you’re going to trim, make sure not to use a setting so short that it cuts the hair right at the skin line.

Dr. Valenenzuela: I tell my diabetics to be extremely careful because if they use a razor even a little cut, if their sugar is out of control, can cause an abscess. Any microabrasions that don’t heal spontaneously, see a doctor and go on antibiotics. Trauma to the testicles during or after manscaping should be looked at very carefully. A small scratch on the scrotum is an area for bacteria to enter and cause severe infection, especially with sexual activity.