How do I do a testicular self-exam?

Dear Need Help, 

A gold star to you for thinking about your sexual health and for reaching out for more information. First, it may be helpful to clarify some of the information in your question. A prostate exam can be complicated and may be difficult to do on your own. Generally, a health care provider will check your prostate health as part of a routine exam. The exam you can do yourself is a testicular exam. Both exams are an important part of sexual health and are used to detect any changes or irregularities that may indicate a larger health problem. These changes may include swelling, injury, infection, cysts, or specific types of cancer. 

A prostate exam is a test to detect any early signs of prostate cancer. Generally, prostate exams are recommended for people with penises beginning around age 50. In some cases, your health care provider may want to start the exam earlier than 50. In these instances, it’s usually because of increased risk due to factors such as a family history (particularly for those who have a brother with prostate cancer) or for those with African ancestry, including Black, African American, Caribbean, or Afro-Latino or Hispanic men. 

There are two parts to the prostate exam: a prostate-specific antigen (PSA) test, and a digital rectal exam (DRE). With the PSA, the provider will draw some of your blood and send it to a medical laboratory to be analyzed. This test is looking for certain proteins (called antigens) in the blood that are produced by the prostate. Along with the blood sample, the provider will perform a digital rectal exam. During a DRE, the provider will insert a finger into your rectum to check for lumps or other irregularities that may be an indication of prostate cancer. During these exams, the provider should be gloved, use a lubricant, and the exam should only take a few seconds to complete. 

While you can order an at-home PSA test to collect your own blood, it's not recommended to perform a DRE by yourself. If you have questions or concerns, consider talking to your health care provider. 

It’s possible (and even encouraged!), however, to regularly examine your own testicles. A testicular exam is also part of routine primary care or wellness exams. Monthly testicular self-exams (TSE) can help with early detection of changes in your testicles which may help in earlier detection of cancer as well. Testicular cancer and other conditions, when caught at an early stage, tend to have better outcomes. Unlike many kinds of cancer, testicular cancer is more common in young adults, it’s recommended to start performing monthly TSEs around age 14. 

To perform a testicular self-exam: 

1. Position yourself in front of a mirror and observe your scrotum—the sac that holds the testes under the penis—looking for any changes (e.g., swelling) in its appearance. You may consider performing this exam during or after a warm bath or shower, as heat can relax the scrotum. 
2. Gently rotate and inspect each testicle, by placing your fingers underneath the testicle and thumbs on top. Using a gentle rolling motion, feel for any hard lumps, smooth round bumps, changes in size or shape, or changes in texture. 
3. Continue examining the rest of the scrotum ensuring not to forget the epididymis. The epididymis is a long tube located near each testicle that transports sperm from the testicles. It can have a cord- or rope-like texture. When feeling this area, you’ll want to take note of any changes, particularly hard, small lumps. 
4. Pay attention to any discomfort or pain. Cancerous lumps are often painless, however, it’s still possible for pain in the genital area to be a symptom of cancer or other serious conditions and infections. 

List adapted from City University in New York 

Testicular cancer occurs when cells multiply in the testicle and form a lump or tumor. Factors that may increase the risk of testicular cancer can include: 

• Undescended testicle - Also known as cryptorchidism, this condition occurs when one or both testicles don’t descend from the abdomen into the scrotum before birth. 
• Family history - Having a family history of testicular cancer or Klinefelter syndrome increases the risk of testicular cancer, especially if the cancer was diagnosed in a close relative. 
• Human immunodeficiency virus (HIV) infection - Those with HIV, especially those with acquired immunodeficiency syndrome (AIDS), may be at an increased risk of testicular cancer. 
• Race and ethnicity - Those who are Caucasian have a greater risk of developing testicular cancer compared to others. 
• Personal history - Individuals who have already had testicular cancer in one testicle are at higher risk of developing cancer in the other testicle. 
• Age - Those aged 20 to 34 are at the highest risk, however, testicular cancer may develop at any age. 
  
  Both a prostate exam and a testicular exam are important parts of sexual & reproductive health and can be important tools for early detection of health problems. For more information on either of these exams, consider speaking with a health care provider. There’s no shame in asking for help, whether it’s from a parent, health care provider, or Go Ask Alice!. 
  In health,