A urologist has shared what he considers to be within the range of ‘normal’ when it comes to testicles, while encouraging men to carry out regular self-checks.
Although bodies vary from person to person, doctors say there are several differences that are typically harmless, alongside some warning signs that should never be ignored.
Men do not always feel comfortable discussing testicular health, but being aware of changes and speaking openly about them can be important for catching serious issues as early as possible.
Dwayne Johnson recently opened up about a worrying moment after he noticed a lump on one of his testicles.
The Moana actor said he developed a painful lump on his left testicle, and when the discomfort failed to ease after several days, he decided to get medical advice.
Doctors told him the cause could be either epididymitis — inflammation affecting the tube at the back of the testicle — or cancer.
Thankfully, Johnson later learned that it was not cancer.
According to Dr. Jamin Brahmbhatt, a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida’s College of Medicine, a lump like that should always be checked by a doctor, and Johnson made the right call by seeking help.
He noted that while Johnson’s lump was painful, a lump that causes no pain at all can actually be even more concerning.
He penned for CNN: “A firm, painless lump on the testicle itself is a red flag. It is the classic presentation of testicular cancer.”
Dr. Brahmbhatt added: “If you find a firm lump, you should get to a doctor right away, even if you feel fine. Most testicular cancers are painless, but pain doesn’t rule cancer out.
“Very easily, an exam, ultrasound and/or lab work can help sort a benign tumor from cancer.”
As for what counts as normal, Dr. Brahmbhatt explained that it is common for one testicle — often the left — to sit lower than the other. A slight size difference between them is also usually nothing unusual.
He further explained: “What’s that soft, lumpy wormlike structure along the top and back of each testicle? That’s the epididymis, not a tumor.
“A cordlike structure extending from the top of each testicle is the spermatic cord. Cysts can form on the testicle or epididymis, but they are usually benign.”
He also said enlarged veins in the testicle area are often not a major concern and may simply be a varicocele, which is a swelling of the veins inside the scrotum. Even so, if the change is new or causing pain, it is still sensible to have it assessed by a medical professional.
Testicular cancer is relatively uncommon overall, but it is one of the most common cancers in younger men, especially those in their late teens, 20s and 30s. For that reason, doctors often encourage men to know what is normal for them and to seek advice promptly if anything changes.
There is no routine screening program for testicular cancer in men without symptoms, but many clinicians still advise testicular awareness. That means knowing the usual feel, size and position of your testicles so you are more likely to notice a new lump, swelling, heaviness, firmness or difference in shape.
Many doctors suggest checking after a warm shower, when the scrotal skin is relaxed and the testicles are easier to feel. The exam should be gentle: roll each testicle between the thumb and fingers, looking for a hard lump, an area that feels different from the rest of the testicle, or any swelling that does not go away.
Some changes are more likely to be benign. These can include a smooth cyst, a softer lump at the back of the testicle that is actually the epididymis, or a collection of enlarged veins known as a varicocele. But any new, persistent or unexplained lump should still be checked.
Other red flags include a feeling of heaviness in the scrotum, a dull ache in the groin or lower abdomen, a testicle that suddenly changes size, or fluid buildup around the testicle. Sudden severe pain in the scrotum is an emergency and needs immediate medical attention, because it can be a sign of testicular torsion, which can threaten the testicle if it is not treated quickly.
Risk factors for testicular cancer include having had an undescended testicle, a family history of the disease, a personal history of testicular cancer, and certain fertility-related concerns. But the disease can still happen without any obvious risk factors, which is why men should not dismiss a lump simply because they feel otherwise well.
The good news is that testicular cancer is highly treatable, especially when it is found early. If caught promptly, most men do very well after treatment, which is usually why doctors stress not waiting to “see if it goes away” when a hard lump or other lasting change appears.
In short, a testicle that hangs a little lower, feels slightly different in size, or has a soft structure at the top or back is usually normal. A firm lump on the testicle itself, however, is not something to ignore.