Understanding Testicular Health

Dr. Jamin Brahmbhatt is a urologist and robotic surgeon affiliated with Orlando Health, and he also teaches at the University of Central Florida’s College of Medicine.

Recently, a man came into my clinic with his girlfriend. He had noticed something unusual in his testicle a few months back. After she found out, she insisted he see me.

After a physical exam and an ultrasound, I confirmed it was a benign cyst, not cancer. Thankfully.

The man turned to his girlfriend and said, “See? I told you I was fine.” I remarked that he should actually thank her, since this visit could have led to a very different outcome.

While most testicular lumps aren’t cancerous, some can be. The only way to determine what’s going on is to get checked. Delaying care can lead to complications that could easily be addressed in a matter of minutes—or it could lead to a life-saving diagnosis.

During my urology rotation in medical school, I checked my own testicles for the first time. I found something that concerned me and made an appointment. Like the patient I just treated, it turned out to be a benign cyst—something I likely had my whole life. Until that moment, I hadn’t been sure what “normal” felt like.

This is why I suggest that people make a habit of performing regular self-exams. There’s no need to be obsessive about it, and formal guidelines don’t mandate monthly checks. But getting familiar with your anatomy can help you catch any changes more easily. The process takes only about two minutes.

The more you know your baseline, the easier it is to spot if something feels off.

Two Main Functions of Testicles

The primary role of testicles is to produce sperm. A healthy male generates millions of sperm daily, which take about three months to fully mature before being released in ejaculation.

The second important function is producing male sex hormones, mainly testosterone. Leydig cells are responsible for generating most of the testosterone in a man’s body. This hormone is crucial for muscle mass, bone density, libido, mood, and energy—essential aspects of male health.

Though having two testicles is ideal, men can lead healthy lives, including fathering children, with just one.

In the womb, testicles begin developing near the kidneys. As pregnancy progresses, they descend through a canal into the scrotum, where they will reside for the rest of a man’s life.

This descent is why testicles hang outside the body and why any pain can radiate up into the abdomen, as sperm production is most efficient at temperatures slightly below core body temperature.

The scrotum acts as a temperature-regulating chamber, bringing the testicles closer to the body when it’s cold and lowering them when it’s warm. This explains why things can look a bit different in, say, a chilly pool versus a warm shower.

Each testicle is oval-shaped, smooth, and firm—about the size of a small egg. Inside, they’re filled with tightly packed seminiferous tubules, where sperm is produced.

Each testicle is attached to a soft structure called the epididymis, where sperm matures. From there, sperm travel up through the vas deferens into the ejaculatory ducts. This same tube is the one cut during a vasectomy.

The spermatic cord, which contains arteries, veins, nerves, and lymphatics, runs alongside the vas deferens, keeping the testicles functional. You can feel the cord rising from the top of each testicle, and muscle surrounds it to help regulate their movement.

In general, one testicle is slightly lower than the other, often the left one, and one tends to be a bit larger. That soft, lumpy structure on each testicle is the epididymis, not a tumor. Cysts can form in these areas, but they’re usually benign.

You might notice enlarged veins above the testicle that feel like a small bag of worms. This could be a varicocele—a common, typically harmless condition—but if it’s new, painful, or raises concerns about fertility, it’s worth mentioning to your doctor.

It’s also normal for testicles to move up and down based on temperature, exercise, or arousal.

However, a firm, painless lump on a testicle is a concerning sign. It’s commonly associated with testicular cancer. In fact, about 9,800 men in the U.S. are expected to be diagnosed with testicular cancer in 2026, according to the American Cancer Society. This type of cancer is often most prevalent in younger men, particularly those in their 20s and 30s, and it’s one of the most treatable when caught early—survival rates can be about 99% with early detection.

If you discover a firm lump, it’s essential to see a doctor immediately, even if you feel fine. Most testicular cancers don’t cause pain, but the absence of pain doesn’t exclude cancer. A simple exam or ultrasound can differentiate between benign and cancerous tumors.

Testicular cancer gained more public awareness after Lance Armstrong’s diagnosis in 1996. More recently, Dwayne “The Rock” Johnson had a similar concern. His lump was painful but turned out to be epididymitis, inflammation of the epididymis—not cancer.

Signs like tender swelling, redness, or warmth—sometimes accompanied by painful or frequent urination or fever—may indicate epididymitis, which is usually treatable with antibiotics, anti-inflammatories, and rest.

Then there’s testicular torsion, which involves the spermatic cord twisting and cutting off blood supply. This condition is a medical emergency. If not addressed within hours, the testicle could be lost.

When you visit a urologist, the consultation will likely start with a discussion about when you noticed something unusual, its characteristics, any accompanying pain or urinary issues, and your medical background. During the physical exam, the doctor will assess the scrotum, testicles, epididymis, and spermatic cord—looking for the same things you would check yourself, just with more experience.

Following the exam, the next steps will depend on the findings. The urologist may recommend a scrotal ultrasound for a clearer view of the testicle and nearby structures—similar to what Johnson described experiencing after his health scare.

Doctors might also check your urine if they suspect infection, conduct blood tests for tumor markers if cancer is a possibility, or assess hormone levels if testosterone comes into play. Occasionally, an MRI might be necessary for a more detailed examination of the anatomy within the testicle.

For self-exams, I recommend doing them in the shower. The warm water helps relax the scrotum, making the testicles easier to feel.

Take a few minutes to examine one testicle at a time. Gently roll it between your thumb and fingers—you’re not squeezing, just feeling for its shape, size, and surface.

Locate the epididymis along the back and notice the spermatic cord extending upward.

If you notice anything unusual—a lump, a hard area, a size change, or persistent pain—don’t hesitate to seek medical advice. Early intervention is crucial. Proactive healthcare is the best kind.