The Ins and Outs of Gay Sex (33 page)

Figure 8.
1:
Testicular Examination

Testicular lumps might mean cancer and should never
be ignored.
Testicular cancer is the most common cancer in men between the ages of twenty and thirty-four, and it affects whites more often than blacks.
Because it attacks men at an age when most never think of their own mortality and the possibility of any cancer seems remote, the diagnosis is often delayed until the tumor is too large to ignore and the cancer has already spread.
If you had an undescended testicle, you are almost fifteen times more likely to develop a cancer in that testicle even if it was surgically brought down into your scrotum.
If you have some vague memories of some type of testicle surgery, find out what was done.
(It might have been a hernia operation or hydrocele repair.
) You need to know whether you had an undescended testicle so that you can be extra vigilant in guarding against cancer.
Besides cosmetic improvement, the main advantage of an orchiopexy (sewing an undescended testicle into the scrotum) is that it places the abnormal testicle in a location where it can be examined easily.

For most men, a painless lump is the first sign of testicular cancer.
Although pain, if present, usually signifies an infection, it can also mean cancer.
Occasionally young men are treated with antibiotics for months because their doctor erroneously suspects chronic epididymitis.
I know of a patient who, fed up with his persistent pain despite antibiotics, stopped returning to his urologist for further evaluations.
The next time he saw a doctor was because he coughed up blood—from cancer that had spread to his lungs.

If your doctor confirms the presence of a lump in your testicle, you will need a sonogram.
This painless examination utilizes sound waves to paint a picture of your testicle.
Tumors differ in consistency from normal tissue, and the sonogram picks up this difference.
If the sonogram confirms a tumor, prepare for surgery.
To prevent the spread of cancer,
your doctor will remove your testicle through an incision in your groin rather than your scrotum.
A prosthetic testicle can be inserted in its place.
A seminoma is the most common type of testicular cancer, and it is highly sensitive to radiation and chemotherapy.
Radiation treatments often are used after surgery to improve cure rates to close to 95 percent.

After you’ve examined your testicle, move toward the back and feel your epididymis, which drapes over the top and back of your testicle like a comma.
It is even more sensitive than your testicle, so be extra gentle.
Be sure it’s free of lumps or undue tenderness.
Small lumps are usually fluid-filled cysts, not tumors.
Milky white fluid indicates a spermatocele (a cyst containing sperm).
Most cysts are pea size, but occasionally they can grow large.
No treatment is necessary unless they cause pain, and in that case the doctor can remove the cyst through a tiny incision in your scrotum.

At the top of your scrotum, feel your spermatic cord.
It should be no thicker than your index finger, and you can recognize it by the hard tube running within it—your vas deferens.
The spermatic cord exits the top of your scrotum and runs in your inguinal canal for several inches before diving through the muscles of your abdominal wall.

An enlarged spermatic cord can signify a varicocele, which means varicose veins of your cord.
(See
Figure 8.
2
.
) A varicocele often feels like a bag of worms (medical imagery, not mine) that you can squish between your fingers.
When you stand, these veins are sometimes visible in a tangle just beneath your skin surface.
Varicoceles are more common on the left side but may affect both sides.
They raise the temperature inside your scrotum by keeping extra blood around the testicle.
With time and increased temperatures, the testicle will atrophy (shrink) and become infertile.
For gay men this is usually of little consequence.
Have your varicocele fixed if you have symptoms of back pain and heaviness in your scrotum.

Figure 8.
2:
Testicle Abnormalities

Testicular torsion occurs when a testicle twists around on your spermatic cord.
You have every right to wince, because this is an extremely painful (emphasis on extremely) situation.
When the spermatic cord twists, the blood flow to your testicle cuts off and the testicle strangles.
Onset of severe pain is sudden, and most men begin to vomit.
Your twisted testicle is often higher in your scrotum than normal, and pain makes it impossible to touch.
You need emergency surgery to untwist the testicle.
Delay, and your doctor will probably have to remove it.
Although testicular torsion can strike at any age, it is far more common in men between puberty and their mid-twenties.

An enlarging testicle does not necessarily mean cancer.
A hydrocele is a painless collection of fluid around a testicle; it may be small or may reach enormous proportions.
(We’re talking grapefruits.
) (See
Figure 8.
2
.
) Unlike a tumor, a hydrocele is uniform in size and consistency.
(Think of your testicle lying inside a water balloon.
) An easy trick to use to diagnose a hydrocele yourself is to shine a flashlight against your scrotum while in a darkened room.
The fluid in a hydrocele lights up like a globe, but tumors or normal testicles won’t transmit light.
Hydroceles are not dangerous and need to be surgically removed only in those instances when their size becomes a problem.
Except for pressure from fluid buildup, they are usually painless.

An inguinal hernia is a hole in the abdominal muscles through which abdominal organs protrude.
The hole usually lies somewhere along the path the testicle traveled on its way into your scrotum before birth.
If ignored, a hernia can grow so large that it ends up in your scrotum.
Hernias should be surgically repaired, because abdominal organs can get stuck in them (incarcerate) and even strangulate and die.
Then what would have been a simple outpatient surgery
becomes a life-or-death emergency requiring hospitalization.

I once treated a man who had a huge hernia (the size of a small melon) in his left scrotum.
Although he had ignored it for years, for some reason he suddenly wanted it repaired.
(Summer was coming and maybe he wanted to wear shorts for the first time in years.
) His hernia was so large that I could not feel his testicle, which had been undescended and brought into his scrotum when he was five.
During surgery, I pushed his hernia back into his abdomen, and then I could feel his testicle.
Although shrunken and probably nonfunctional, it had a tiny rock-hard nodule in it.
I took a biopsy and it turned out he had a seminoma.
I removed his entire testicle and spermatic cord.
Fortunately, the tumor was found early and had not had a chance to spread.
If he had not suddenly wanted his hernia repaired, his testicle never could have been felt, and the tumor undoubtedly would have spread.

Women have been conditioned to go to their gynecologist for routine checkups, but men avoid urologists.
I hope you’ve learned from these pages how complex our male anatomy really is.
We take it for granted when instead we need to afford ourselves the same care women have come to expect.

It isn’t enough to go to a urologist only when something is wrong.
Testicular tumors strike young men who never consider their own mortality.
As we age, our prostates become potentially lethal time bombs, and men over fifty must be checked regularly.
Don’t think of a trip to a urologist as an assault on your manhood.
They’re there to protect what you’ve got.
And if you’re too embarrassed to drop your pants, remember:
They’ve seen it all before.

Your doctor should examine any urethral discharge.


If you have urethritis, get HIV-tested.


Chronic prostatitis is very difficult to cure.
Don’t give up.


All men between fifty and seventy need yearly prostate examinations and PSA levels to screen for prostate cancer.


If you have prostate cancer, discuss treatment options with your doctor to determine which is best for you.


Get in the habit of regularly examining your testicles.


Show any scrotal lumps to your doctor.


Don’t ignore genital pain.