I Don't Mess with Testicles! (Part 1)

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I always perform a testicular exam at each well visit beginning at birth, much to the chagrin of my pre-teen and teenage male patients. Most are cooperative. I explain why it is important for the exam: 

• It lets me know where they are in pubertal development. 

• It tells me if both testicles are descended in the scrotum. 

• I educate regarding self-exams. 

• I explain that if they experience ANY testicular pain or abnormality, to come in for an appointment ASAP. I explain to them not to be embarrassed and that it is taken very seriously. Here is why: testicular torsion. Testicular torsion is a medical emergency and time is of the essence so the testicle doesn’t lose blood supply.

A patient of mine woke up in the middle of the night to testicular pain. He woke up his dad who gave him ibuprofen and my patient went back to bed. Dad called first thing in the AM for an appointment. My patient saw a colleague of mine and was sent for an ultrasound. Findings: testicular torsion. My patient was sent to the hospital and had emergent surgery. Unfortunately, it was too late to save one of his testicles. During surgery it was discovered that his other testicle was also in danger of torsion. Luckily that one was saved. My patient (14 years old) lost a testicle due to testicular torsion in the span of only 13 hours! 

Much of my role as a PNP in a primary care office revolves around preventative care and educating my patients and their families. I am an expert at educating my patients and their families by simplifying complex medical issues based on age, educational and cultural background, etc. 

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