Testicular self-examination

Template:Infobox medical intervention Testicular self-examination (TSE) is a procedure where a man examines his own testicles and scrotum for possible lumps or swelling.<ref name="self-exam on MedlinePlus">Template:Cite encyclopedia</ref> It is usually undertaken at home while standing in front of a mirror and after having a warm bath or shower.<ref name="self-exam on MedlinePlus" /> Monthly self-examination of the testicles starting at puberty may be an effective way of detecting testicular cancer at an early, potentially treatable stage,<ref name="BAUS2017">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> which can lead to a 5-year survival rate of 98%.<ref name=":1">Template:Cite journal</ref> In men aged 15 to 40, testicular cancer is the most common cancer,<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> and the annual rate of increase over the last 10 years in cases of testicular cancer is approximately 1% each year.<ref>Template:Cite journal</ref> Testicular cancer typically presents with a painless testicular swelling or a lump or any change in shape or texture of the testicles.<ref name="NHSTesticularCa2017">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

TSE is also indicated if there are certain risk factors present, such as a family history of testicular cancer.<ref name="Shaw2008" /><ref name="Ilic2011">Template:Cite journal</ref> Additionally, outside of the possible early detection of testicular cancer, other "off label" uses of TSEs include detection of indirect inguinal hernias, varicocele, and infections that may affect the testicles, such as mumps.<ref name=":1" /> The efficacy of TSEs in detection of these pathologies relies on proper technique, but if done correctly, TSEs can be very beneficial to the health of the individual and have many public health benefits as well.Template:Citation needed

Uses

Monthly self-examination of the testicles, starting at puberty, may be an effective way of detecting testicular cancer at an early, and potentially treatable stage.<ref name=BAUS2017/><ref name="Shaw2008">Template:Cite journal</ref> Recommendations vary with some physicians recommending the use of monthly TSE for men ages 15 to 55.<ref name=Cancer.Net2015>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name=TUFTesticularCancer>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Practitioners may recommend testicular self-exam (TSE) when the following risk factors are present:

• Family history of testicular cancer<ref name="Shaw2008"/>
• Past testicular tumor<ref name=Ilic2011/>
• Undescended testicle<ref name="Shaw2008"/>
• Testicular atrophy<ref name=Ilic2011/>

Professional guidelines

There is no general medical consensus for recommendations on TSE. The effectiveness of performing TSE in reducing morbidity and mortality from testicular cancer is not known. Not all organizations endorse the procedure as a screening test, arguing that it may lead to unnecessary treatments and unnecessary anxiety.<ref name=Ilic2011/> The benefit of TSE is uncertain due to there being no randomized control trial studying the use of TSE.<ref name=Rovito2018>Template:Cite journal</ref> Many organizations have established guidelines regarding the utilization of testicular self examination as well as the use of testicular examination by a medical provider as a diagnostic tool. These guidelines can be found in the table below.

Current recommendations for testicular examination

Organization	Recommendation
US Preventive Services Task Force	Grade D rating, Not recommended to be conducted by clinician nor patient.<ref name=Ilic2011/>
American Urological Association	List TSE as a screening test in their “Men’s Health Checklist” for urologists and other clinicians <ref name=Rovito2018/>
American Academy of Family Physicians	citation	CitationClass=web }}</ref>
American Cancer Society	No defined recommendation but state it should be conducted when completing a thorough routine cancer screening.<ref name=Ilic2011/>
Royal Australasian College of General Practitioners	Recommend against screening since there is no evidence that those who routinely screen will be able to detect early-stage tumors.<ref name=Ilic2011/>
European Association of Urology	Recommend screening in those with clinical risk factors.<ref name=Ilic2011/>

Technique

For men who choose to perform TSE, it is recommended to perform TSE once monthly, at approximately the same time every month.<ref name="Shaw2008" /> Performing TSE during or after a warm bath or shower may help to relax the skin of the scrotum and make the structures within the scrotum easier to feel.<ref name="self-exam on MedlinePlus" /><ref name="BAUS2017" /><ref name=":0">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Existing guidelines indicate that TSE is best performed in the standing position. Individuals performing TSE may choose to stand in front of a mirror in order to visualize the scrotum and testicles from various angles. First, the scrotum and testicles may be visually examined for any skin changes or visible swelling.<ref name="BAUS2017" /> Then, with the thumb placed on the upper surface and the index and middle finger placed on the lower surface, each testicle can be rolled between the thumb and fingers to feel for potential findings.<ref name="Shaw2008" /> It is also recommended to locate and feel the epididymis, a soft, rope- or tube-like structure that runs behind each testicle, in order to avoid confusing this structure for a potentially abnormal finding.<ref name="BAUS2017" /><ref name=":0" />

Findings

Normal findings during TSE include testicles that feel round, smooth, and homogenous in texture, and that are mobile within the scrotum.<ref name="Shaw2008" /> It is normal and common for one testicle to be larger and hang lower in the scrotum than the other.<ref name="BAUS2017" /><ref name="Shaw2008" />

Findings that may be abnormal and should be discussed with healthcare providers include:

• Pain or tenderness to touch<ref name="self-exam on MedlinePlus" /><ref name="BAUS2017" /><ref name="Shaw2008" />
• Firm lumps<ref name="self-exam on MedlinePlus" /><ref name="Shaw2008" /><ref name=":0" />
• Swelling or fluid buildup<ref name="Shaw2008" />
• Changes in testicular size or the relative size of both testicles, compared to the individual's baseline<ref name="self-exam on MedlinePlus" />

Limitations

The effectiveness of performing routine TSE in men without symptoms in reducing morbidity and mortality from testicular cancer is not clear, and as such, not all organizations endorse the procedure as a screening test, arguing that it may lead to unnecessary treatments.<ref name="Ilic2011" /> Additionally, some signs and symptoms of testicular cancer found during TSE are common to other disorders of the male urinary tract and reproductive organs, including hydrocele testis, spermatocele, genitourinary system cancers, urinary tract infections, sexually transmitted infections, or testicular torsion, which may prompt medical attention to preserve reproductive and urinary function. These potential false positives may cause unnecessary concern or anxiety<ref>Template:Cite journal</ref> to patients.

Society and culture

Testicular self-examination has generally low rates of practice in part because young men have very low rates of health-seeking behaviors, leading to higher rates of mortality and morbidity.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> This is likely influenced by the fact that men face potential perceived societal pressures and judgement, which create obstacles to these patients seeking care.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

See also

• Breast self-examination
• Well-woman examination

External links

• Testicular Cancer. Orchid (2015)
• Testicular self-examination. WebMD