Q. Hi. My husband, age 34, has had a lump on the lower side of his right testicle for at least 10 years now. It has bothered him from time to time, but he says it is not very painful. He has seen two different doctors, both of whom have either said keep an eye on it and/or its just a cyst...don't worry.
Well, in the last month he has been complaining of pain in the area between the testicle and the right hip. Is this considered the groin area?
Anyway, our family doctor saw him for the second time for this today and said, Let's try to find a urologist for you, maybe you can see someone this summer. After reading about testicular cancer, I am very concerned. I have suggested that we just call a urologist on our own and push for an appointment, but most see patients by referral only.
We need a good doctor, one who can show us he knows more than just wait and see and now what do you want to do?
Does this sound like we should push for the urologist and some type of ultrasound immediately (within a week) so that we make sure we don't miss anything. My husband has been searching the Net lately and I think he's getting nervous. I am the person who speaks up and I need to go in with all the information I can. Sally
Dear Sally
A lump on the testicle that occurs during a high-risk period in a male's life for testicular cancer should be treated seriously.
Two confounding factors of pain and a chronic lump should not keep you from a urologist since your husband has had a change in symptoms.
It's not clear whether the pain is related to his lump, but needs consideration. You may ask for an ultrasound before the urology visit. I would suggest that this be evaluated sooner rather than later. Good luck.
Q . My husband had testicular cancer one year ago; his surgeon removed a malignant tumor and a testicle. Six months ago, he started experiencing erectile dysfunction.
His urologist prescribed an anti-depressant and some other medication (I can't remember the name) both of which he cannot take legally or he would lose his job during random drug testing. (They would produce a false-positive for narcotics).
We tried the Muse injection. It didn't work. I hear there's a new pill on the market that you take orally. Can you tell me more about it. Also, I would appreciate any suggestions you have. Thank you in advance for your time! Nancy
Dear Nancy,
Thanks for your questions. It is doubtful that there is a physical cause for erectile dysfunction directly related to the treatment, except if testosterone production was affected.
Certainly an emotional cause needs to be considered. I would talk to your doctor regarding a full evaluation for impotence with hormonal levels, liver function, renal function and blood sugar levels as well as a complete physi-cal examination. Nocturnal penile tumescence testing and possibly a formal emotional evaluation by a sex therapist may be required.
There are several options available for treatment of erectile dysfunction. The new drug, Viagra, is meeting with great success. Taken one hour before intercourse, it helps achieve erections in most men. Other oral medications are on the way in the near future.
Other options include a non-invasive pump known as the vacuum erection device (VED). This cylinder is placed over the penis and creates a vacuum so the penis can fill with blood to become erect. A comfortable band is used at the base of the penis to keep the blood trapped in.
Muse can be used in doses of up to 1000 mcg.; try a higher dose before giving up on this product. There is also a tourniquet that keeps the medicine in the penis. Injectable agents are also effective and fairly easy to use, with only minimal pain for most patients.
There is also a surgical option that involves placing a device in the penis to foster erections. However, its unlikely your husband would need this. Your husband will likely regain his erectile ability. Once the cause is determined, its a matter of treatment choices.
It is important throughout all of this that your husband continue with his scheduled visits and X-rays/lab tests for his cancer.
Q. I am very concerned about the problem I have with my scrotum and testicle. I have a lump the size of a large gumball in my one testicle. I also have many lumps that resemble large pimples all over my scrotum. What might this be? Bryan
Dear Bryan,
Your question is a good one and one that is asked on a daily basis. It sounds as though you have sebaceous cysts of your scrotal skin, a non-cancerous condition akin to pimples.
Your finding involving your testis is of great concern and needs immediate urologic evaluation. The risk that this is a testis cancer is very real and should not be ignored. Certainly it may be a benign condition, but you must have it checked immediately.
Q . I am a 31 year-old male. In 1983, I underwent a physical examination and the doctor discovered that I had an undescended testicle. (I explained to the doctor that the testicle was once descended, but had ascended one night after I had slept).
Following the examination, I underwent surgery to remove the testicle. After the surgery, I was told everything was a complete success.
Recently, 15 years after my first surgery, I had yet another surgery to remove a tumor from my abdominal area. It seems in my previous surgery that the testicle was not removed at all! I am OK now, except that I am sterile. My question is, Why am I sterile? My current doctors give me conflicting answers. Some say it was the radiation treatments, others say it may have been the cancer itself and others say they are not sure.
I know this is rather long and complicated, but I would really appreciate any suggestions or comments. Thanks, Mr. Bunch
Dear Mr. Bunch,
Thanks for your questions. The undescended testis is believed to be abnormal on the cellular level and is at risk of having a tumor form in it.
We also know that the other testicle, proven by biopsy, is often abnormal and also at an increased risk of tumor development. Therefore, men with undescended testicles have a higher risk of being subfertile.
To better understand the cause for your sterility, an infertility work-up is required. This may include a semen analysis, hormone levels and possibly a biopsy of the other testicle or a rectal ultrasound to look at the prostate area where the semen ducts come into the urethra. If no cause is found, you may learn about your chances for successful in-vitro fertilization or other assisted reproductive techniques.
Unless your other testicle was irradiated (not shielded), the chance of becoming sterile from the radiation alone is rare. Chemotherapy has a higher occurrence of sterility than irradiation.
