Testes and Scrotum

The testes are important parts of male reproductive system. They are two oval organs located between upper thighs in a skin pouch called scrotum. In the unborn child the testes develop in the abdomen and then descend to their permanent position about 3 months before birth.

The testicular temperature is about 3-40 C below the internal body temperature. Each testis produces male hormone testosterone (a steroid hormone) and sperm (spermatozoa). Each testis is subdivided into hundreds of coiled tubules known as seminiferous tubules (STs) which are production houses of spermatozoa (also called sperms). Each tubule is lined with germ cells which progress to become sperms. STs also contain special cells called Sertoli cells which support the lining of ST and help in maturation of spermatozoa.

Epididymis: The epididymis is a coiled tube that serves to store, mature and transport spermatozoa between the testis and the vas deferens.
Vas deferens: Tube carrying sperms from testis to prostate

What is the role of testosterone?

Testosterone and its product Dihydrotestosterone are called androgens. Androgens help with sexual differentiation in embryo. Later in life they help to mature the male sexual organs and develop the male sexual characteristics. Androgens increase bone density and muscle mass. They also stimulate the self-confidence and aggressiveness typical of the male gender. They also influence red blood cell production.

Diseases of the testes

What are the disorders of the testes and scrotum?

Testis and Epididymis:

1. Developmental: Birth defects like absent testis, undescended testis, chromosomal abnormalities, absent vas and sexual differentiation; Cysts of epididymis: Blockage of the tubes leading to collection of fluid
2. Inflammatory and infections:
   Viral: mumps, Coxsackie, Marburg, choriomeningitis, Dengue
   Specific bacterial: Gonococcal, Syphilis, Chlamydia trachomatis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus and Streptococcus species
   Nonspecific: auto-immune, urinary infections
3. Trauma: Testicular Injury: Blunt or sharp
4. Torsion: Twisting of the cord and the testis
5. Hydrocele: Collection of fluid around the testis
6. Varicocele: Varicose veins of cord
7. Infertility: Inability to impregnate
8. Tumours: Benign and malignant tumours (Cancers) of the testis

Scrotum

Sebaceous cysts: infection, cancer

What are the symptoms of testicular diseases?

Pain in the testis; Testicular/ Scrotal swelling; Infertility; Non-testicular symptoms like enlargement of breasts, erectile problems, blood in the semen

The assessment is done by clinical examination which includes – Body proportions, skeletal structure, hair and fat distribution, breasts followed by abdomen and testes examination. Depending on the clinical assessment the doctor may arrange ultrasound and blood tests.

What are the symptoms (manifestations) of testicular diseases?

Local manifestations: Testicular pain, swelling
General manifestations: Nausea and vomiting, lower abdominal pain

What are the acute conditions of testis?

• Acute Epididymitis: Inflammation of epididymis It produces swelling, pain and tenderness in the testis and epididymis. There may be associated discharge from the penis and blood in the semen. Most common cause of epididymitis is urinary infection. Antibiotics usually relieve the symptoms.
• Torsion of testis: Torsion is a condition when testis twists within the scrotum which may completely cut off blood supply to that testis. It is an emergency and should be corrected surgically. It is commonly seen in adolescents but can present at any age.
• Testicular cancer: Although cancerous growth may be silent it can present as sudden testicular pain or swelling.
• Acute swelling due to rupture as a result of injury to testis
• Haematocele: Collection of blood around the testis as a result of direct injury
• Pyocele: Collection of pus around the testis usually follows infection of testis or epididymis

Chronic Testis conditions:

• Chronic epididymitis: This may result from recurrent acute epididymitis or on its own. Symptoms tend to of low grade without many
• Undescended testis: Arrest of descent of testis
• Hydrocele: Collection of fluid around testis
• Varicocele: Dilatation of veins coming from testis

What are the symptoms of testicular cancer?

• Heavy feeling in scrotum
• Uneven surface of testis
• Testicular pain
• Testicular swelling: Painless or painful
• Enlargement of breast (gynaecomastia)

Note: This information on testis and scrotum is not a substitute for clinical assessment and treatment

Vinod Nargund

Mr Vinod Nargund is a Consultant Urological Surgeon specialising in Urological cancer, male sexual and fertility problems. He was trained in Urology at the City Hospital Belfast, the Royal Infirmary Bradford and the Churchill and John Radcliffe Hospitals in Oxford. You can view all of his qualifications on his biography page.