Dear Dr. G,

I am a fit and healthy man in my early thirties, and I have recently encountered some issues with my testes which I hope you can help me with.

About two months ago, I started noticing slight discomfort in the left of my scrotum, especially after a strenuous workout.

I am usually not hung up about my testes, but as I realized the size of the testicle had increased a little, it began to worry me a great deal

While I am really embarrassed to put Dr. G on the spot about my “lopsided crown jewel” but can you tell me what can possibly be wrong with me?

It also might be worth noting that my right testicle has actually been a bit bigger since an early age and I am wondering if it is normal to have a testicle that is bigger than the other?

What are the possible causes of swelling testicles, and is it a bad sign if my testicle tends to get bigger and uncomfortable after intense exercise?

Additionally, I have read that younger men are more likely to have testicular cancer and I would like to ask if that is true?

I am really worried and embarrassed about someone “fondling” my testicles, and can you please help clarify the risks posed by my swollen crown jewels?

Swelling Steven

Despite the common belief that all testicles are born equal, most men are born with testicles that are of an uneven size. The vast majority of men are born with slightly smaller testes in the left, positioned slightly lowered in the scrotal sac.

This is due to the nature of blood circulation that results in more stagnation of veins around the testicle. The pooling of the veins in the sac has the impact of higher temperature, resulting in the reduction in testicular size. Although the sizes of both testicles may have a slight disparity, most men are generally oblivious to this.

However, when the shape and size of a testicle changes over a short period of time, this can be a cause of concern.

In general, the gradual enlargement or swelling of the testicles tends to be benign in nature. Having said that, the possibility of cancer still exists, especially in younger men. It is crucial for men of any age to perform a self- examination on a regular basis and those who are worried about testicular lumps should seek medical attention as a simple examination or scan can identify the exact cause or abnormality.

There are several types of testicular swelling that are benign in nature, and these types include varicoceles, hydrocele, epididymal cysts or even a hernia. And while some men may be terrified of the thought of having their crown jewels operated on, the vast majority of cases requires no intervention.

Varicoceles are the dilation of the venous systems of the scrotum. These are soft lumps developed mostly on the upper part of the testicle, predominantly affecting the left testes. Sometimes, men with this condition describe the emergence of the dragging discomfort caused by “a bag of worms”, especially after prolonged exercise or standing. However, most men with varicoceles require no intervention, unless the condition is causing pain or male infertility and therefore reassurance after definitive diagnosis of often what is required.

The other possibility of the gradual swelling of the scrotum may be due to a build-up of fluid in the sac surrounding the testicle, which is called a hydrocele; a primary hydrocele is caused by a defective absorption mechanism of the tunica vaginalis, while a secondary hydrocele can emerge after infection or cancer of the testicle.

Most hydroceles can be confirmed by shining a torchlight on the surface of the scrotum in a dark room, as the clear fluid will light up the scrotal sac like a lantern.

This is a procedure men can carry out in the privacy of their own room if they wish to avoid embarrassment.

The other common scrotal swelling affecting men after strenuous exercise may be an inguinal hernia. Such a condition occurs when the fatty tissues or part of the abdominal content pokes through a weak spot in the groin at the top of the inner thigh. Although an inguinal hernia is generally painless, it can become suddenly painful if the blood supply of the tissue is trapped in the hernia causing strangulation.

Another benign cause of testicular swelling is epidimal-orchitis. This is caused by an infection of the testicles and the surrounding structures. The origin of the infection is generally a sexually-transmitted infection or dehydration.

Indeed, there is no doubt that the presence of the scrotal swelling can be both embarrassing and worrying. Furthermore, the thought of another man (or woman) “fondling” with your crown jewels may also be unwelcoming and uncomfortable and this may result in some men suffering in fearful silence. However, knowing that a simple examination by a doctor can easily determine the origin of the swelling and getting some tips on self-examination for future assurance should really be a great relief for more men to come forward.

The sports icon and testicular cancer survivor Lance Armstrong once said that “there comes a point in every man’s life when he has to say enough is enough”. At the age of 25, Armstrong was diagnosed with testicular cancer that spread to his lungs, brain and abdomen but was declared cancer-free two years after beginning treatment

Men who are embarrassed and yet terrified about swelling of the crown jewels often put Dr. G on the spot with such a dilemma, but knowing that most swelling in the sac should be benign in nature should come as a great relief.

Having said that, even though testicular cancer predominantly affects men under the age of 40,68% of men usually present with a Stage I disease, with the chances of survival approaching 99% and even for late-stage testicular cancer, the survival rate is still as high as 96% after treatment. This should offer further reassurance.

On that note; “there comes a point in every man’s life where he says enough is enough and gets his swollen crown jewels ‘fondled’ as that could potentially save his life”.

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