Testicles of different sizes

Although the two testicles lie together in the scrotum they are biologically to be regarded as two separate organs. Therefore it is quite possible that there is a difference in size between the two sides. This is not a cause for concern at first and, to a small extent, usually has no disease value.

However, it is always best if a one-sided increase or decrease in size is noticed and a one-time clarification by a physician should always be carried out to exclude possible diseases as a cause. Especially testicular carcinomas often do not cause any symptoms for a long time during their growth. In order to be able to recognize and treat them early on, it is therefore very useful to have changes in the testicles examined by a physician.

Signs that can indicate a disease are, for example, pain or redness, a very pronounced difference in size, palpable hardening or nodules in the testicles, a change in size within a short period of time or an indeterminate feeling of heaviness in the entire scrotum or restricted to one of the two testicles. Causes of unilateral testicular swelling can be, in addition to inflammation or injury, e.g. a water or testicular hernia, testicular varicose veins or testicular torsion. A unilateral testicular hypertrophy can also be the result of injuries or torsion of the testis. Furthermore, circulatory disorders are a possible cause for a difference in size of the testicles.

Diseases of the testicles

Due to their anatomical structure and location, the testicles are very susceptible to external influences such as heat or injuries. The most common injury is the twisting of a testicle (testicular torsion). Causes for a twisted testicle are usually traumatic events (for example a kick in the testicle).

But there are also congenital twisted testicles. This happens already in the womb. If a testicle is twisted, it wraps itself with the epididymis around the testicular stalk (spermatic cord).

The main problem here is the lack of blood supply. The vessels that supply the testicle run parallel to the spermatic cord. A testicular torsion is a medical emergency and should be treated by a doctor as soon as possible, as the lack of blood supply can lead to the death of the testicle and thus to infertility.

In contrast to other organs, the male testicles are not created at their later location in the scrotum, but are only transferred there in the later stages of development before birth. However, this can lead to errors or interruptions. As a result, one or both testicles remain in the abdominal cavity at a point between the point of formation and do not reach the actual location in the scrotum.

This is called undescended testicles. The most common place where the testis is located instead is the inguinal canal. It is then called the inguinal canal.

Another form is the so-called sliding testis. Here the testicle also lies in the inguinal canal but can be moved back into the scrotum by hand from outside. The reason for this is usually a too short spermatic cord or a too strong cremasteric muscle.

A special form of the undescended testicle is the pendulum testis. In this form, the testicles are completely lowered into the scrotum during development, but the testicles can spontaneously move out of the scrotum. In contrast to the other forms of undescended testicles, therapy is not absolutely necessary as long as the testicle is located in the scrotum for the majority of the time.Since the misalignment of the testicles can also only be delayed, it can be waited up to the completion of the 1. year of life whether the lowering still happens by itself.

From the 3rd month of life onwards, a supportive therapy with hormones, which normally initiate the relocation of the testicles in the body, can be carried out. If this is not successful, the testicles should be surgically relocated to avoid infertility. More detailed information can be found under undescended testicles.

Inflammation of the testes is usually caused by pathogens that have been carried over, e.g. as part of urinary tract infections. Since the expected pathogens also differ depending on the localization of the actual cause of the infection and this is decisive for the choice of the appropriate therapy, in the case of an inflammation of the testes other infections in the body should also always be looked for. Typical symptoms of an inflammation of the testis are sudden, severe pain in the testis, swelling as well as redness and overheating of the affected testis.

Furthermore, a very pronounced feeling of illness with fatigue and weakness as well as fever usually occurs. Since more serious clinical pictures such as testicular torsion or testicular tumors with similar symptoms can also occur, a physician should always be consulted. The therapy is usually carried out by bed rest, cool compresses, testicular elevation and antipyretic medication.

If the infection is caused by bacteria, additional treatment with antibiotics is necessary. Typical symptoms of testicular inflammation are sudden, severe pain in the testicles, swelling as well as redness and overheating of the affected testicles. Furthermore, a very pronounced feeling of illness with fatigue and weakness as well as fever usually occurs.

Since more serious clinical pictures such as testicular torsion or testicular tumors with similar symptoms can also occur, a physician should always be consulted. The therapy is usually carried out by bed rest, cool compresses, testicular elevation and antipyretic medication. If the infection is caused by bacteria, additional treatment with antibiotics is necessary.

A hydrocele is an accumulation of fluid between the tissue layers that surround the testicle. These tissue layers are mainly formed by a part of the peritoneum, which bulges around the testicle when the testicle descends from the abdominal cavity and is pushed into the scrotum with it. Normally, the connection to the abdominal cavity forms back in time so that there is no open connection anymore.

If this does not happen completely, it can happen that fluid from the abdominal cavity passes into the testicle, accumulates there and leads to a swelling of the testicle. However, this is usually painless. The diagnosis is usually made by palpation of the testicle and an ultrasound examination.

Small, symptom-free hydrocells can be observed. However, if there is a strong increase in size, surgical treatment should be performed. So-called secondary hydrocele, i.e. an accumulation of fluid as a concomitant of another disease, can occur, for example, in the context of inflammation or testicular injuries.

First of all, the underlying disease should be treated. If the fluid accumulation is very large or if additional symptoms occur, surgical removal should be considered here as well. A testicular hernia is not an injury of the testicles, as the name might suggest, but a shifting of parts of the intestinal loops into the scrotum.

This can happen if a part of the peritoneum is pushed outwards through a weak point in the connective tissue of the abdominal wall. Due to the weight of the organs located in the abdominal cavity and pressure from within, the bulge can become larger and spread through the inguinal canal via the outer inguinal ring to the scrotum. The scrotal hernia is therefore a special form of inguinal hernia.

As a rule, a testicular hernia becomes noticeable by a swelling of the testis without any recognizable signs of inflammation. This may be accompanied by pulling pain in the area of the testicle and the groin. The diagnosis of a testicular hernia is mainly made by physical examination, supported by ultrasound imaging.

Therapeutically, testicular hernias are treated by surgical repositioning of the intestinal loops and closure of the tissue hernia. As a rule, the procedures are performed in a minimally invasive manner.Small testicular hernias, which do not cause any discomfort, do not need to be treated immediately but can be observed. However, since there is always the risk of entrapment of the intestinal loops, surgery may be advisable in this case as well.

If a testicular hernia is suspected, a doctor must be consulted. Testicular cancer (testicular carcinoma) is the most common type of cancer in men. Meanwhile, there are good treatment options available, so that patients can often be cured.

The most important thing with testicular cancer is early detection. Because especially in the early stages many patients can be helped well. Symptoms of testicular cancer are mainly nodular changes or an increase in the size of the testis.

If the testicle feels heavy or painful, this can also be an indication of testicular cancer. However, especially pain is very rare, especially in the early stages. If the testicle is painful, one should therefore exclude other diseases or injuries such as testicular torsion.

If there is a suspicion of testicular cancer, the doctor can quickly palpate the testicle and confirm it with an ultrasound examination, so that in the best case the therapy can begin immediately. This significantly increases the chances of recovery. Through regular self-examination of the testicles, every man himself can contribute to the early detection of testicular cancer and, if necessary, increase his own chances of recovery.

Similar to the veins of the legs, varicose veins can also occur in the veins that are responsible for the outflow of blood from the testicles. This is called varicocele. The cause of a primary varicocele is too weak venous valves in the spermatic vein.

This leads to a backflow or insufficient outflow of blood and a backflow into the venous plexus of the testis. This leads to the typical symptoms of a feeling of heaviness in the scrotum and an increasing swelling of the testicles, especially when standing. As a rule, primary varicoceles occur on the left side.

Secondary varicocele are secondary varicocele, which are caused by an obstruction in the drainage of the veins from the outside, such as a narrowing due to a tumor. As a rule, primary varicoceles are only treated if there is a very clear difference in the size of the testicles, severe symptoms or impaired fertility. The therapeutic measures available are sclerotherapy of the vessels by means of a catheter or surgical sclerotherapy or ligation.

Secondary varicoceles are treated by treating the triggering disease. Testicular atrophy is the reduction of the testicular volume or the functional testicular tissue. The normal volume of a testicle is approximately between 15-35 ml.

However, a reduced volume does not mean that the functionality of the testis is also impaired. As a rule, a volume of up to 1 ml can still detect a production of sperm and sex hormones, albeit limited. Below this limit, synthesis usually does not take place any more because the proportion of functional testicular tissue is too low.

In most cases, the reduction of the testicle can already be detected during the inspection of the scrotum or palpated during the examination. An exact determination of the volume is done with the help of ultrasound. In order to check the functionality of the testicle and to find an indication of possible causes, the levels of sex hormones are determined.

These are LH and FSH, which are responsible for the stimulation of the testicles, and testosterone, which is produced in the testicles. The possible causes of testicular atrophy are manifold. On the one hand, genetic changes may be behind it, such as Klinefelter’s syndrome.

On the other hand, previous damage such as circulatory disorders, testicular hernias, inflammation or testicular torsion can lead to a subsequent testicular atrophy. The consumption of certain substances such as alcohol or anabolic steroids can also be a possible cause. Like the causes, the therapies are also very different and essentially consist of the elimination of the cause, e.g. the surgical restoration of blood circulation or treatment of the inflammation with medication.

Here you can read the main article testicular atrophy. Mumpsorchitis is an inflammation of the testicles which occurs in the course of an infection with mumps. Mumps is one of the typical children’s diseases, since over 80% of the patients are between six months and 15 years old.Although an effective vaccine against the disease has been available since the 1970s, there is still insufficient immunization in the population in Germany, which means that the first diseases are increasingly spreading into adulthood.

Up to one third of the men who become infected with the disease in adulthood develop an accompanying inflammation of the testicles. This manifests itself mainly by a very strong swelling of the testicles, mostly on one side, and a significant difference in the sides. In addition, the affected testicle is very sensitive to touch and very painful under external pressure.

In addition, the testicle is usually reddened and overheated. In mumps disease there is also fever, fatigue and, usually before the onset of testicular inflammation, inflammation and swelling of the parotid gland. Therapy usually consists of bed rest, testicular elevation, cooling compresses, and anti-inflammatory and antipyretic medication.

The consequences of the disease can be a decrease in testicular size and in rare cases infertility. As a result of blunt force trauma to the testicles, they may burst. This is called a testicular rupture.

To cause such a rupture at all, a great deal of force is required. This force is about 50kg. In the course of the injury the inner testicular sheaths are torn, especially the so-called tunica albuginea.

This forms the innermost of the tissue layers and is responsible for the strength of the testicles due to its connective tissue composition. In consequence of the tear it can come to massive bleedings. These are usually visible from the outside as bruises.

Furthermore, a testicular rupture manifests itself with massive pain and reactions of the body such as nausea and vomiting. To determine the extent of the injury, an ultrasound examination or an MRI is performed. This can also determine the amount of accumulated blood and the necessity of an operation. Except for very limited injuries, the therapy then usually consists of surgical exposure of the testicle to remove the accumulated blood and seal the testicular sheath.