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Why you should talk to your boys about their testicles

Hazel is a married mom of two sons who enjoys writing personal essays, eating really good food, drinking great wine and reading musty-smelling books. She travels with her family often and works part time as an Uber driver because she lik...

I never should have ignored my son's testicular pain

Three years ago, a 16-year-old boy named Michael Rushby died from testicular cancer because he was too embarrassed to tell his mom about a lump he'd found. He waited eight long months before speaking up, and unfortunately died of a disease that is easily curable with early detection.

Six years ago, before I'd ever heard of Michael Rushby or knew that young men were at risk for testicular cancer, my son mentioned having testicular pain. Stupidly, I didn’t think much of it. I figured his low-grade pain was normal, like the way breasts hurt during a woman’s monthly cycle. For whatever reason, I was convinced his ball pain was no biggie, and I was totally wrong.

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I am thankful that although I was ignorant about testicular cancer, I had fostered a relationship with my children that included open communication, which gave my son the confidence to tell me about the issue he was having.

A few days after my son mentioned the pain and things hadn't improved, I decided to call the doctor’s office. When I told the nurse my son’s testicles hurt, she said he would need to be seen immediately.

“Can he come in after school?” I asked.

“No, he needs to be seen right now,” she replied.

During the drive to the doctor, I remember fearing the worst. Was it testicular cancer? Wait, didn’t that happen to older guys? What if my lack of concern made whatever was wrong with my son even worse? Mom guilt quickly set in.

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At the appointment, the doctor did a basic exam, confirmed my son’s pain and then scared the living crap out of me. “I need you to take him to the emergency room right now,” he said. “I’ll call ahead and tell them you’re coming. He needs an ultrasound and it needs to be performed immediately."

I tried not to let my panic show, but I was pretty sure I had failed my son and that because of my horrible parenting, he was going to die.

The entire time we waited for my son’s ultrasound I kept thinking: Why didn’t I know that testicle pain was a really big deal?

Once his ultrasound was over, we met with an on-call urologist who reviewed his results. I could barely pronounce the diagnoses he gave: hydrocele, a collection of fluid in the testicles, and epididymal cysts (also known as spermatocele), which were tiny cysts in the testicles. These two conditions were not life-threatening like testicular cancer (which I learned was actually more common in younger men), and I was so relieved.

Aside from knowing that my son was healthy, I learned that testicle discomfort is not something to dismiss. When I spoke to friends who also had sons, I found that many moms were in the dark about testicle health, as I was. Not only that, many of us parents are too embarrassed to talk to our children about their bodies, and that can lead to situations like Michael Rushby's. No parent should lose a child to a treatable disease because they or their child was too embarrassed to talk about something that might be wrong.

That's why I reached out to Dr. Al Borhan, a Fellow of the American College of Surgeons who practices urologic surgery with a focus on preventative health, hormonal care and nutrition at Affiliated Urologists in Phoenix, Arizona; and Dr. Brian Keith McNeil, Vice Chairman and Associate Residency Program Director of SUNY Downstate Medical Center, Department of Urology and the Urology Chief of Service at the University Hospital of Brooklyn. I want to make sure other parents don't make the same mistake I did. Thankfully, these two doctors had a wealth of information about testicles to share.

SK: Is testicular pain normal? When should that pain be discussed with a doctor?

Dr. McNeil: Non-specific testicular pain is not normal. I think that testicular pain should be evaluated by a doctor as soon as possible. While there are relatively benign causes of pain that subside, several urologic conditions and permanent injury can result if not addressed properly. For example, testicular torsion (twisting of the testicular blood supply resulting in decreased blood flow and pain) is a condition that requires immediate surgical intervention. The longer one waits to see a physician, the greater [the] risk of losing a functional testicle because of decreased blood flow.

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SK: What possible conditions can be detected with a monthly self-check of the testicles, and when should boys begin?

Dr. Borhan: Approximately half of the diagnoses for testicular cancer are for younger men, which makes recognizing symptoms (such as swelling, a painless lump, low back pain and more) and performing testicular examinations important. Some testicular cancers are only noticed after a small injury, such as a kick or a punch, which leads to discovery. This is a very important opportunity to catch a tumor at an early stage. A few of the more common findings during self-examination can include hernias (where part of the bowel may be spilling into the scrotum through an opening which should've closed at birth), hydroceles, varicoceles (which are swollen veins that drain blood away from the testicle that may feel like a "bag of worms"), testicular torsion and infections.

Dr. McNeil: Thankfully, there is a great deal of awareness regarding testicular cancer amongst certain populations, but I think that we should discuss testicular conditions more. Males between the ages of 18 and 39 are encouraged to perform routine testicular exams per the American Urological Association’s men’s health checklist. Recommendations vary amongst practitioners, but I think that monthly testicular self-examinations should begin after the onset of puberty. To perform a self-exam, the testicles should be examined one at a time, during or after a bath or shower, when the skin of the scrotum is relaxed. The testicle should be held between the thumb and fingers and rolled gently to look and feel for hard lumps, rounded bumps or any change in the size, shape or consistency of the testicles.

SK: If a child sustains an injury to the testicles, such as impact from a kick or punch, should the doctor be notified?

Dr. Borhan: Testicular injuries are a serious matter, regardless of age, and can be classified into two categories: penetrating and blunt injuries. Penetrating injuries involve a sharp object going through the scrotal skin and always require medical evaluation. Blunt injuries can vary in intensity. Some minor injuries, such as a soft punch or kick, are accompanied by a few seconds of pain and resolve on their own. If there are any additional problems, including a bruise, lump, swelling, difficulty with urination, blood in the urine, fevers, chills or persistent pain, immediate medical attention is necessary. In general, pain in the testicles that lasts for more than a few minutes, particularly in pubescent males, should be treated as a serious matter and medical attention should be sought.

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Our bodies go through many changes in adolescence and puberty. The key points are to have good communication with your child, be involved, teach them self-exams and seek medical attention for any abnormal findings.

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