Testy testicle

Dear Intrigued,

You are correct that men often have asymmetrical testicles. Just like other parts of the body (hand, foot, pectoral muscle, breast and so on) one is usually slightly larger than the other. Often (but not always) the left testicle is a bit larger and hangs a bit lower inside the scrotum. 

Several reasons could explain why your boyfriend's testicles are significantly different sizes. Perhaps the smaller testicle is underdeveloped. Perhaps the smaller testicle is actually normal size and the other one is just bigger. Perhaps the testicle that looks larger is swollen. 

You could ask your boyfriend if this one testicle has always been bigger and if he has always felt this "pinching" sensation, or if this is a new development. If his testicles look the same as they have always looked and if the pinching is not bothering him, then you likely have nothing to worry about. Just encourage your boyfriend to continue (or start) performing regular monthly testicular exams, so he will notice any changes in his testicles right away. Things to keep an eye out for during testicular self-exams are swelling of the testicle, a firm pea-sized lump anywhere in the scrotum, or pain or a dull ache anywhere around the testicles. These are typical symptoms of testicular cancer, which often affects men between the ages of 19 and 44 years old. If your boyfriend finds any of these signs it's critical that he see his health care provider right away — when testicular cancer is caught and treated early it's almost always curable. (You could even help with these self exams, which could make them more fun for you both!)

If this "pinching" or swelling is not normal for your boyfriend, then several conditions could be causing these symptoms including:

• Spermatic cyst — a benign (harmless) cyst which develops next to the epididymis near the top of the testicle.
• Hydrocele — a collection of fluid around the testicle. Hydroceles are a common cause of scrotal swelling (most often in older men) and may accumulate around one or both testicles.
• Epididymitis — an infection in the tubular coil (the epididymis) that collects sperm from the testes. This infection causes fever, swelling and pain in the top and rear of the scrotum. The pain develops gradually over several hours/days and becomes severe.
• Orchitis — inflammation of the testicle which is often due to a bacterial infection or the mumps virus. Symptoms included swelling and pain along with a feeling of added weight in the scrotum. Orchitis can permanently damage one or both testicles resulting in diminished size of the testicle and possibly infertility.
• Varicose veins — cause painless swelling (the area feels like a bag of worms). Varicose veins aren't harmful for the man’s health, but they could contribute to infertility.
• Cancer of the testicle (among other conditions) could also cause these symptoms.

As you can see, some of these conditions can cause infertility and other permanent damage. So if your boyfriend has any concerns whatsoever, he may want to see a health care provider or a urologist to check it out. It may be worth making the visit just for his peace of mind. Hope this helps!