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There are very few physical sensations that match the thunderous pain and awesome power of a swift kick to the testes. Everything seems to go in slow motion as you double over in agony… and then the gut-wrenching throb sets in. If you've ever discovered a new pothole with your ten-speed, you know exactly what we're talking about: Pain with a capital "YEOUCH!"

Since the testes are among the most sensitive (and enjoyable) parts of a man's body, it should hardly be surprising that few men are inclined to do a little exploring "down under." Sadly, most men are not aware of the high incidence of testicular cancer and other troubles that originate in the scrotal sac - dangers that are much easier to cure if caught early on. To do so, all men should learn how to perform a proper Testicular Self-Examination (TSE) - it could save your scrotum. Performing the exam is well worth your while… and not as traumatizing as you think.

Know why you should perform a TSE

The Testicular Self-Exam is a risk-free, pain-free way to check your testes for potential cancers and other problems. It's really the first line of defence against cancer because testicular cancer comes with virtually no obvious symptoms or pain. No fever. No deep, booming voice from your crotch. Not even your lover would notice (though a popular women's magazine just published a "How-to-check-his-balls-without-him-knowing" column, so don't freak out if your girlfriend asks you for a mid-coital cough). A monthly testicular self-exam is the best - if not the only - way to find out if your boys are in good shape.

That said, the TSE should not be considered a substitute for a clinical examination conducted by an experienced physician: A doctor's diagnosis is almost always going to be better than yours. The TSE functions more like a warning light on your body's dashboard than some sort of at-home diagnostic tool for cancer. If the warning light goes off, then it's time to make a doctors appointment; that's the only thing this test will tell you. (We knew you guys would like the car analogy.)

A word on testicular cancer

The main purpose of the TSE is to familiarize yourself with your body when it's healthy so you'll be able to recognize it immediately when something unusual is going on. Most testicular tumors (called seminomas) occur in the cells responsible for sperm production. As cancers go, these tumors grow pretty quickly; an untreated seminoma could double in size in under a month. So needless to say, you can't waste time being squeamish about squeezing the Charmin, because time is really of the essence.

Indeed, by the time they're discovered, nearly half of all testicular malignancies will have spread to other parts of the body, like the abdomen or lungs. And while cancer at that stage is still often curable, we bet our left testicle that you'd like to avoid all that by discovering abnormalities as early as possible. What the TSE will do for you is lower your chances of having to undergo the often painful and draining treatments associated with more advanced cancers (such as surgery, chemotherapy and radiation). Detecting a testicular cancer early on typically allows the physician to prescribe a less trying therapy.

Statistics about testicular cancer

All in all, the numbers about testicular cancer aren't nearly as scary as one might think. Take a look:

· Testicular cancer will kill about 300 men this year.
· Roughly 6,900 men will develop a testicular malignancy this year. That's only about 0.3% of the projected readership of Maxim in 2000.
· According to the National Cancer Institute, testicular cancer is most common among younger men. In fact, it is the most common form of cancer developed by men between the ages of 20 and 35.
· Like we said before, catch it early, and you're pretty much in the clear. Testicular cancer is one of the most curable breeds out there. And although nearly half of all cases have spread to other parts of the body by the time they're discovered, the cancer is still often treatable in its later stages. But the danger of spreading is why you have to catch it early on.

Risk Factors

The research on predisposing factors for testicular cancer is rather thin, but there are a few variables that might change your odds of developing a malignancy, such as age, ethnicity, and personal and family histories.

Being Young. Believe it or not, the older you are, the less likely it is that you'll develop a testicular malignancy. Call it a trade-off for having to worry about prostate or colon cancer, but men over 40 are pretty much off the hook.

Being White. Caucasians have a 4.5 times greater incidence of testicular cancer than African Americans. White men may not be able to jump, but they'd better learn how to perform a TSE.

Being Born Unlucky. Guys who had developmental problems in their youth, such as an undescended testicle or an infection resulting in testicular atrophy, are also more likely to develop testicular cancer than your average Joe.

Being Related. If you're dad had testicular cancer, there is some evidence that you're more likely to develop a tumor, too. Here's where it gets weird: The papers say that you're at an increased risk for cancer in the opposite testicle. In other words, if pop had a malignancy in his right testicle, you'll want to keep tabs on your left one.

Being John Malkovich. We're just kidding, John. But you might one to perform one anyway.


At this point, you and your testicles should be pretty excited about performing the TSE. Try to contain yourself (or all three of you) and read over the next section carefully. Men between the ages of 15-40 should perform monthly TSEs around the same time each month. If you've never performed a TSE before, it's certainly normal to feel some anxiety during your first time. Just try to relax and think about the favor you're doing for your testes. We're sure they'd thank you if they could.

Performing the TSE

1. Draw a warm bath. This is the best way to relax both you and your scrotum. If you haven't cleaned the tub in… uh… ever, then you can also take a hot shower. Warm water is key for relaxing the scrotal structures.
2. Get familiar with your body. Let's be honest: Aside from your Spiderman underpants, no one knows your testicles better than you do. Maybe one's a little larger or hangs a little lower; these are normal differences. So, while in the tub, continue to take notice of the weight, shape and coloration of each testicle and report any noticeable changes to your doc. While testicular cancer is not necessarily reflected in changes in scrotal skin, a change in color could be a warning sign for something else, so it's a good idea to mention any differences to your physician.
3. Mount up. Place your right leg on an elevated surface, like your sink or toilet, giving yourself clear and easy access to your scrotum. Hint: Make sure the surface is dry. Slipping would suck. Trust us.
4. Do the deed. If you're right-handed, then place your left hand under your right testicle, lightly supporting it. Next, using your right hand, gently roll that testicle between the thumb and index finger, feeling for anything unusual. It should feel smooth and firm, but not hard. There should not be any bumps or lumps. Repeat for the left testicle, elevating your left leg instead. (If you are left-handed, simply reverse hands.)

Keep in mind that the above steps are general guidelines for the TSE put forth by the National Cancer Institute and physicians, and they may be adapted on an individual basis. For instance, heavier guys may find it easier to do the procedure laying on their backs or sitting down "Indian style." You should feel free to change to procedure as you see fit, so long as you're able to thoroughly inspect the contours of each testicle with your hand.

The real idea behind the testicular self-examination is to establish a good degree of familiarity with your testes. It's important to know your scrotum well enough to notice any changes that seem suspicious. Here are a few dependable signs that suggest something shady is going down:

· Hard lumps. Rock-hard lumps on the testicles can vary in size from a pea to a golf ball. These abnormal lumps will often feel as hard as bone and will almost always be present on only one testicle. It's very common for Joe Sixpack to mistake a harmless, congenital cyst for a malignancy; that's because it's impossible to tell the difference between the two during a TSE. It's best to let your doctor decide by using more sophisticated tests (See Step 4).
· Tenderness or general discomfort. A tender testis is rarely a sign of cancer, but anytime your testicles hurt without being bumped, it's a good idea to have them checked out by a doctor. Cancer-related testicular pain is usually associated with some bleeding, but an overly sensitive testicle could also suggest an inguinal hernia or epididymitis, an infection of the sperm-storing tube attached to the testicle. Either problem is treatable by a physician.
· Hardness in the entire testicle. This is usually the result of a hydrocele, a cystic mass in the testicle. A leaky hernia, prior trauma or infection could cause one of these fluid-filled sacs to show up where you'd like it the least, but fear not: Hydroceles are easily treatable, too.
· Discharge from the penis. Though rarely an indication of cancer, a non-ejaculatory discharge from the penis during TSE could suggest a sexually transmitted disease (STD), in which case you should consult a physician-not to mention your lover.

If you exhibit any of the telltale signs from Step 3, then go directly to your doctor. Hey, these are your testicles we're talking about. And while it's true that most abnormalities found during a TSE turn out to be benign, do you really want to risk losing your balls-or your life-simply because the doctor's office gives you the jitters? We didn't think so.

· In most cases, a TSE-prompted visit to the doctor will include a physical exam very much like the TSE itself, except conducted by the physician.
· If the doctor shares your suspicions, then the next step is usually an ultrasound of the testicle-in-question. An ultrasound is a very hi-tech, very expensive machine that uses sound waves to look inside your scrotum and take snapshots. Doctors look at these images and try to determine whether or not the bump is a solid tumor or just a fluid-filled cyst. This is completely painless – it’s not even uncomfortable.
· If the bump isn't a cyst and looks threatening, then the doctor may also order a blood test to check for "cancer markers" in your bloodstream. These markers are just proteins that are by-products of a testicular malignancy; they won't hurt you, but they'll usually blow your cancer's cover.
· If all signs point to still point to cancer at this point, then the physician will usually recommend a radical inguinal orchiectomy. In other words, you will probably have to lose the afflicted testicle. But hang tough (if not a little to the left): If the cancer is localized, then the procedure shouldn't really change your life in any noticeable way. One testicle in your sac will make more than enough gametes to pass on your original family recipe of As, Cs, Ts and Gs. And though you might find sex a little awkward at first, rest assured, your prowess in the other sack shouldn't decline in the least. There are even saline prosthetics available to make you feel more like your old self.

In the event that the cancer has already spread out beyond the scrotum, the treatment becomes more involved. The longer you ignore cancer, the more likely you are to have to face chemotherapy or radiation treatments to kill off the cancer cells.

So you're out of excuses. Just do it!