Lopsided Crown Jewels

Dear Dr G,

I am a 26-year-old fitness fanatic and used to be overweight.

Last year, I started going to the gym regularly and lost weight gradually.

Although I am pleased with my progress of fitness, I have recently encountered some issues with my balls.

About two months ago, I started noticing slight discomfort of my left scrotum, which tends to get worse after a strenuous workout.

I also realised recently that the size of the testicle had increased a little.

I don’t usually get so hung up about my balls, but I noticed that the scrotum is also getting uncomfortable upon ejaculation.

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?

I read somewhere that younger men are more likely to have testicular cancer, is that true? I am really worried I might need to have surgery and lose my testicle.

Can you clarify things for me please?

Regards

Heng

Most men are born with unequal size testicle. The vast majority of men are born with slightly smaller testes in the left that is positioned slightly lower in the scrotal sac.

This is due to the nature of blood circulation that results in more stagnation of veins around the left testicle.

Although the sizes of both testicles may have disparity, when the size of the testicle changes over a short period of time, this can be a cause of concern.

Gradual enlargement or swelling of the testicles are generally benign in nature, however, the possibility of cancer still exist, especially in younger men.

Therefore it is crucial for men, in fact men of any ages, who are worried about testicular lumps to seek medical attention. On most occasions, simple examination or scan can identify the exact cause or abnormality.

Most testicular swellings are benign in nature and largely harmless. These may include varicoceles, hydrocele, epididymal cysts or even hernia.

Although some men may be terrified of the thought of having their crown jewels operated on, the vast majority requires no intervention, unless painful or harmful.

For a self-proclaimed fitness fanatic like Heng, the likelihood of the scrotal swelling caused by abnormal veins in the sac is quite high.

The varicoceles are soft lumps developed gradually, on the upper part of the testicle, predominantly affecting the left testes.

Sometimes, men with this condition describe the emergence of the dragging sensation caused by “a bag of worms”, especially after prolonged exercise or standing.

Most men with varicocele require no intervention, unless the condition is causing pain or male infertility. Definitive diagnosis is often what is required.

The other possibility of the gradual swelling of the scrotum may be due to build up of fluid in the sac.

Hydrocele is the accumulation of clear fluid in the sac surrounding the testicle, which is called tunica vaginalis. The primary hydrocele is generally caused by the defective absorption mechanism of the tunica vaginalis.

A secondary hydrocele can emerge after infection or cancer of the testicle. Most hydrocele can be easily confirmed by shining the torchlight on the scrotum surface in the dark room, as the clear fluid will light up the scrotal sac like a lantern.

Although this is a simple maneuver to confirm hydrocele, it is better for men to carry such examination in the privacy of their own room, to avoid embarrassment.

The other common scrotal swelling affecting men after strenuous exercise may be inguinal hernia. Such 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 hernia is generally painless, it can become suddenly painful if the blood supply of the tissue is trapped in the hernia causing strangulation.

Inguinal hernia may occur due to strains on the abdominal muscles such as weight lifting, constipation or coughing.

Therefore, one of the easiest ways to establish the presence of the hernia is identifying the protrusion of the lump when coughing.

There is no doubt that the presence of scrotal swelling can be both embarrassing and worrying. The thought of another person “fondling” with your crown jewels may be embarrassing and uncomfortable, but this is generally the way to exclude cancer.

Dr G is often put on the spot about testicular cancers. Indeed, cancers of the balls predominantly affect men under the age of 40, however, 68% of men are usually presented with a stage 1 disease, with 99% chances of survival.

Even though the other 32% of men with such cancer which may have spread to lymph nodes on presentation, the survival rate is still as high as 96% after treatment.

Although Heng’s “lopsided crown jewel” is most likely to be benign in nature, it is definitely worth the “fondle” to have a peace of mind!