THE TESTIS

What is a Testis?

A Testis is one of a pair of organs (pleural is Testes)and part of the male reproductive system. They are the site of sperm production and are also the major producer of the male hormone Testosterone. Some people call these organs Testicles – which may have something to do with the fact that they hang down outside the body in a sack (scrotum) just as an icicle in a freezer does. Commonly they are just known as "balls" which is a fair description of their shape, although they tend to be more oval than round. Doctors generally use the term Testes.

 

The Male Reproductive System    

  1. Penis
  2. Urethra
  3. Bladder
  4. Vas Deferens
  5. Prostate
  6. Seminal Vesicle
  7. Epididymis
  8. Scrotum
  9. Testis

 

 

 

 

Where are the Testes?

When a  male baby is developing the uterus the testes grow and form inside the abdominal cavity until around the seventh month of pregnancy when suddenly over the next few weeks  like a yoyo falls out of your hand the testes descend out of the abdominal cavity via a small hole in the inner layer of the wall on either side -   called the inguinal rings -  and into the scrotum. As it moves down it takes with it the Vas deferens and its own blood and nerve supply. As the testis slides through the inguinal ring a part of the abdominal lining ( peritoneum)  slides with it as a sort of protective coat for the intrepid testis. This part of the peritoneum is called the   processus vaginalis ( we love names like that in medicine! ) and it gradually   withers and shrink wraps the testis and is usually only joined to the rest of the   peritoneum by a thin fibrous cord.  The reason I have gone into so much detail is that it makes understanding testis lumps so much easier if you can visualise the development of the organ.

Interestingly the left testis usually hangs lower than the right.

 

Why are the Testes outside the body in the scrotum?

Sperm production is most efficient at a temperature that is lower than inside the abdominal cavity. The   scrotum meets that need by keeping the testes cool and maximising sperm production capabilities.

 

What do the various parts of the Testes and surrounds do ?

The testis itself has two functions and is made up of two distinct cell types. One for sperm production and one for the male hormone ,Testosterone, production. In adults each testis weighs is around 25gm when fully formed - interestingly the right one is often heavier than the left. The testis is a bit like a golf ball ( if you've ever unravelled one) it is full of coiled tubules which form a production line for sperm manufacture. If these seminiferous tubules were placed end to end it is said they would be around 800m long !

The process from beginning to mature sperm usually takes around 90 days. It is , however a continuous process so sperm can be found at all different levels of maturity at any time within the testis.

The developing sperm then move to the incubator area - the epididymis ( epee-did-ee-mus) - where they learn to swim and get fed a nourishing diet produced by the cells of the epididymis. The epididymis is also coiled up tight and if unwound is said to be about 6 m long. The epididymis is shaped like a "c" and sits  on top  and behind  the testis and is connected to it.  You can feel this structure if you examine testes.

After they have passed their swim safe certificate they move on to the  transit lounge  area ( reminds me of Woody Allen - everything you wanted to know about sex but were afraid to ask - one hilarious movie! ) - the Vas Deferens. When the male ejaculates they are propelled on their way down the urethra and out into the world collecting a cut lunch on the way from the seminal vesicles which produce a special sugar substance for them to use as an energy source on their journey to the female egg.  The prostate produces the rest of the fluid that makes up semen so they have something to swim in.

My diagram above doesn't show the arteries and veins but they are all sheathed together with the Vas deferens in a protective cord.

 

 

What is testicular self examination and why should a guy do it ?

Every male should check himself for lumps in the testis ( see  section on cancer of the testis below) called Testicular Self Examination ( TSE) . It only takes a couple of minutes and can be done once a month in the shower. Each side is checked separately. The man holds his scrotum between thumb ,forefinger and middle finger. Using both hands he rolls the testicle . The normal testis is smooth firm and egg shaped. There should be no lumps on the testis itself - beware there are other contents of the scrotum ( see above) . If he notes a change from last examination he should have his testes checked by his doctor. Next time you visit your doctor ask for a testis examination and to be shown how to do TSE

What are some Testis problems ?

  1. Undescended testes  - in some people the decent process has not worked properly resulting in one or both testes   remaining inside the abdominal cavity. Every male child should be checked at birth to make sure  that both testes are down in the scrotum . Some may retract up temporarily but this may be a muscle reaction.  It is said that if they are not in the scrotum by the end of the first year they are unlikely to  descend on their own and they will need an operation to be brought down. A specialist should advise when is the best time to operate but it is usually done while fairly young.  If on the other hand the testes are appearing and disappearing ( like yoyos ) they will usually find their own way down but should nevertheless be assessed regularly by a doctor. The problem is that if the testes are not properly in the scrotum by puberty there is a risk that  sperm production will fail in the affected. There is also an increased risk of cancer of the testis in people who have undescended testes
  2. Torsion of testes - the testes hang in the scrotum on a cord which contains of vas deferens and blood vessels. It is possible for this cord to twist and cut off the blood supply to the testis . This is considered a medical emergency and requires an operation within a few hours of the onset of pain. It usually happens in young boys or teenagers but can happen at any age. The symptoms can be severe pain, then swelling and redness of the scrotal area. This condition requires emergency surgery to untwist the cord. Pain in the testis should be checked out by a doctor promptly.
  3. Epididymo-orchitis - this painful condition is due to an infection in the epididymis and/or  testis and requires antibiotics. It is important to rule out torsion of the testis .
  4. Cancer of the testes - once one of the top three causes of cancer death in young men has lately improved its status through   early detection a treatment advances .It is still however  the commonest cancer occurring in young men 20 -35 . Primary testis cancer is not common after 40. Testis cancer is VERY treatable. Its just very important to diagnose it as early as possible.No one should feel embarrassed or frightened to get a testis lump checked out by a doctor. Most times it turns out not to be cancer. But even if the diagnosis is not good modern treatment methods give excellent results in most cases. These lumps are usually painless and arise in the testis itself.
  5. Other Lumps in the scrotum  - All testis lumps should be checked by a doctor - self diagnosis is not good enough. Cancer needs to be excluded and more often than not lumps turn out to be something not so serious .                                                        

                      hydrocoele - These are what are commonly referred to as Cysts . They are filled with a watery substance and hence the name ! They are generally harmless but may give a dragging feeling . They  arise in the remains of the processus vaginalis and the real significance of them is that an ultrasound should be preformed to rule out something more serious like a tumour. Hydroceles can be treated if the patient has discomfort.

                    varicocoele - As the name implies these are really  varicose veins of the testis - the pedicle of veins that carry blood away from the testis get swollen and when examined have a characteristic feel - like a bag of worms. These occur on 8% of normal males and 98 % of them are on the left . There is said to be  an association with  fertility problems but the reason for association is controversial. Surgery may be required if there is discomfort or fertility worries.

                       hernia - Hernia is a general term meaning that contents of one internal body space poke through a wall into another.  One type of hernia occurs in the groin region if the processus vaginalis doesnt completely close its connection with the abdominal lining then it is possible for abdominal contents to slide through the inguinal ring into the scrotum . This sort of lump is called  an inguinal hernia and is commonly seen in young babies. Hernia may also occur later in life in this area as that part of the abdominal wall is its weakest point. Hernia can occur if undue pressure is put on the wall- the classic case is said to be the old man with the chronic cough who lifts heavy objects. Hernia may need surgery to correct especially if there is deemed to be a risk of twisting   and strangulation of the hernia contents and so  all herniae should be assessed by a doctor

                    haematocoele - this is a lump that has arisen from trauma - may be a sporting injury or such alike. It is a collection of blood and sits infront of the testis. Again proper investigation including an ultrasound is important with all lumps to rule out a lump of a different cause like cancer. A haematocoele will probably require an opinion form a surgeon as to whether it should be removed

                     spermatocoele   and epididymal cysts - these are fluid filled sacs that arise from the epididymis and feel separate from the testis. They are generally not much of a problem except for cosmetic reasons and the fact that As I have said before - any lumps need proper assessment by a doctor to rule out cancer.

 

IF YOU FIND A LUMP IN YOUR TESTIS PLEASE SEE YOUR DOCTOR .

 

PEACE OF MIND IS MORE IMPORTANT THAN SHYNESS.