Testicular Self-Examination (TSE) Procedure

• While standing in front of a mirror, place the thumbs on the front side of the testicle and support it with the index and middle fingers of both hands.
• Gently roll the testicle between the fingers and thumbs. The testes can move around a little in the scrotum, but cannot usually move enough to twist round fully.
• Feel for lumps, hardness or thickness. Compare the feelings in each testicle. Normal testes feel like smooth and slightly spongy balls inside the baggy scrotum. It is normal for one testis to be slightly bigger than the other, and for one to hang slightly lower than the other.
• You can normally feel the spermatic cord through the skin of the scrotum just above the testis. It feels like a thick piece of string.
• If you find any swelling, lump, unusual tenderness or other abnormality, see your doctor as soon as possible.

What Is Epididymo-Orchitis?

Orchitis means inflammation of a testis (testicle). Epididymitis means inflammation of the epididymis (the structure next to the testis that is involved in making sperm). Because the testes and epididymis lie so close together in the scrotum, it is often difficult to know whether either or both are inflamed.

Most cases are due to an infection:

• Urinary tract infection – bugs that cause urinary tract infection can spread into the testes and epididymis, causing epididymo-orchitis.
• Sexually transmitted infections – in young men this is the most common cause. It is most commonly seen with chlamydia and gonorrhoea infections.
• Mumps – this used to be a common cause but is now uncommon thanks to the MMR vaccine. Mumps can cause epididymo-orchitis in about one in every five cases.
• Uncommon causes include other types of infections from other parts of the body that can, rarely, travel in the blood to the testes.

Symptoms come on over a day or so and include a swollen, tender and red scrotum. It may feel warm to touch as well as sore. You may have a temperature and generally feel unwell. There may be other symptoms, such as burning when passing urine, depending on the underlying cause. If a urinary tract or sexually transmitted infection appears to be the cause then a urine test or penile swabs will be done.

Treatment usually involves a course of antibiotics and symptoms normally resolve over a week or so. Supporting underwear sometimes helps to ease the pain. Complications are uncommon and a full recovery is the norm. However possible complications include:

• Reduced fertility in the affected testis
• An abscess that may form in the scrotum and may need surgical treatment
• Rarely, damage to the testes – resulting in gangrene of the testes requiring surgical removal