Can you get an erection without testicles

An orchidectomy is a surgical procedure that involves the removal of one or both testicles. There are several reasons why a man might have this operation, such as cancer, injury, or trauma to the area.

Regardless of the reason, the effects of this surgery on a man’s sex life depend on the number of testicles removed.

When one testicle is removed, there is usually no effect on a man’s sexual function. Most of the time, the remaining testicle produces enough testosterone and sperm to compensate for the testicle that has been removed. Therefore, the man should still be able to get an erection and ejaculate as he did before. He should also be able to father biological children.

Removal of both testicles does affect a man’s sexual function. In this case, his body cannot produce testosterone. Without this hormone, a man’s libido can decrease and it might be difficult for him to have erections. However, testosterone replacement therapy can help restore sexual function. (Click here to learn more about low testosterone and testosterone replacement therapy.)

Men who have both testicles removed also become infertile, as the body is no longer able to make sperm. Many men decide to bank sperm before surgery so that they may father biological children in the future, if they wish.

In addition to the physical aspects of sexual function, removal of one or both testicles can have some psychological and emotional effects as well. Some men develop body image issues because their genitals no longer look the same. (Some choose to have a testicular prosthesis – a false testis made of silicone – implanted at the time of surgery.)

Men who have had one or both testicles removed might also feel less masculine or anxious about how a sexual partner will react. These feelings can affect sexuality, too. Open, honest communication can help alleviate some of these anxieties. Men who need more help may benefit from seeing a counselor or sex therapist.

Do no testicles mean no erection? (Testicular torsion)

Dear Reader,

Testicular torsion is a painful condition that occurs when the spermatic cord — which includes the vas deferens, arteries, veins, lymphatics, and nerves — twists and cuts off blood supply to the testicle (where sperm and testosterone are produced). It happens when a small ligament that normally attaches a testicle’s base to the scrotum becomes loose, allowing the testicle to twist and turn. A man could be born with a loose ligament, and so have some predisposition for this, but testicular torsion can also be the result of trauma to the scrotum or really strenuous physical activity.

Most often occurring in males under the age of 30 years, testicular torsion is more common during infancy or adolescence. It is estimated that the condition affects about 1 in 4,000 males under 25 years of age in the United States.

Symptoms of testicular torsion include:

  • Onset of sudden pain in a testicle
  • Swelling or tenderness of the scrotum
  • Nausea, vomiting, and/or fever
  • Abdominal pain
  • Fainting and light-headedness
  • Elevation of the testicle on the affected side

Testicular torsion requires surgery. In most cases, surgery needs to be performed as soon as possible after the onset of symptoms — preferably within six hours — in order to save the testicle. A restriction of blood flow due to testicular torsion could, over time, lead to the atrophying (shrinking) of the testicle, or even infection.

Having one testicle removed need not diminish or reduce sex drive or erections. But because the testicles produce male hormones, men who have lost both of their testes may experience a reduction in sex drive and difficulty in getting and/or maintaining an erection. When both testicles have been removed, the next step is usually testosterone replacement therapy, which can be discussed with one’s primary health care provider or urologist.

Because the testicles produce sperm, losing both also means that a man can no longer have biological children. Your friend may want to talk with someone about how he feels about the surgery and its impact on his sex life and fertility.

Kudos to you for wanting to learn more about your friend’s situation — he’s lucky to have your support.

Alice!

What is the biology behind an erection? Can men have erections without testicles? Without a prostate?

The short answer to your question is that it is physically possible to have an erection without testicles or a prostate, but the removal of either makes it less likely that erections will occur.

Inside the shaft of the penis are three columns of erectile tissue the two corpora cavernosa, which run parallel to each other along the top of the penis, and the corpus spongiosum, which runs along the bottom of the penis and surrounds the urethra. Despite the fact that erections are often called “boners,” there are no bones within the penis. During an erection, the corpora cavernosa and the corpus spongiosum, which are rich in blood vessels, become engorged with blood and expand, making the penis larger and firmer. The fancy name for this is “vasocongestion.”

Vasocongestion is not caused by the testicles or the prostate; it’s caused by nerve impulses that are sent to and from the penis at two different locations in the spinal cord. The first, called the sacral erection center, is located at the base of the spine, and it responds to direct physical stimulation of the penis. The second, called the thoracolumbar erection center, is located higher in the spine, and it responds to nerve impulses from the brain sights, sounds and fantasies that are arousing to a particular individual. So, the nerve impulses that signal the body to get an erection can be caused by physical or by psychological stimuli. Reflexive erections that have nothing to do with stimulation can also occur, as anyone who’s ever had a wet dream or spontaneous hard-on can attest.

In addition to producing sperm, the testicles also produce male hormones, including testosterone. Testosterone has a sizable effect on sexual desire, and, in turn, sexual desire is often the first stage in sexual arousal and erection. If the testicles are removed and testosterone production slows or stops, then sexual desire typically decreases, and erections may be fewer or nonexistent.

The prostate is a gland that surrounds the urethra in men and produces about 30% of the fluid that makes up ejaculate or “cum.” It is also a gland that is particularly prone to cancer, especially as men age, which makes it important to get regular prostate examinations if you have a prostate and are 50 years or older. Treatments for prostate cancer, including surgical removal of the prostate, can cause erectile dysfunction (an inability to get an erection). This is not because the prostate is necessary to have an erection, but most likely because of the nerve or blood vessel damage caused by surgery or radiation treatments, or because of the psychological trauma associated with prostate cancer.

Want Laura to answer your questions in SEXpress? Send them to [email protected] Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.

Laura Anne Stuart has a master’s degree in public health and has worked as a sexuality educator for more than a decade. She owns the Tool Shed, an erotic boutique on Milwaukee’s East Side.

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with testicular cancer may experience a variety of symptoms or signs. Sometimes, men with testicular cancer do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer. So, having these symptoms does not mean that a man definitely has cancer.

Usually, an enlarged testicle or a small lump or area of hardness are the first signs of testicular cancer. Any lump, enlargement, hardness, pain, or tenderness should be evaluated by a doctor as soon as possible. Other symptoms of testicular cancer usually do not appear until after the cancer has spread to other parts of the body.

Symptoms of testicular cancer may include:

  • A painless lump or swelling on either testicle. If found early, a testicular tumor may be about the size of a pea or a marble, but it can grow much larger.

  • Pain, discomfort, or numbness in a testicle or the scrotum, with or without swelling.

  • Change in the way a testicle feels or a feeling of heaviness in the scrotum. For example, 1 testicle may become firmer than the other testicle. Or testicular cancer may cause the testicle to grow bigger or to become smaller.

  • Dull ache in the lower abdomen or groin

  • Sudden buildup of fluid in the scrotum

  • Breast tenderness or growth. Although rare, some testicular tumors make hormones that cause breast tenderness or growth of breast tissue, a condition called gynecomastia.

  • Lower back pain, shortness of breath, chest pain, and bloody sputum or phlegm can be symptoms of later-stage testicular cancer.

  • Swelling of 1 or both legs or shortness of breath from a blood clot can be symptoms of testicular cancer. A blood clot in a large vein is called deep venous thrombosis or DVT. A blood clot in an artery in the lung is called a pulmonary embolism and causes shortness of breath. For some young or middle-aged men, developing a blood clot may be the first sign of testicular cancer.

Many symptoms and signs of testicular cancer are similar to those caused by noncancerous conditions. These are discussed below:

  • Change in size or a lump in a testicle

    • A cyst called a spermatocele that develops in the epididymis. The epididymis is a small organ attached to the testicle that is made up of coiled tubes that carry sperm away from the testicle.

    • An enlargement of the blood vessels from the testicle called a varicocele.

    • A buildup of fluid in the membrane around the testicle called a hydrocele.

    • An opening in the abdominal muscle called a hernia.

  • Pain

    • Infection. Infection of the testicle is called orchitis. Infection of the epididymis is called epididymitis. If infection is suspected, a patient may be given a prescription for antibiotics. If antibiotics do not solve the problem, tests for testicular cancer are often needed.

    • Injury

    • Twisting

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

What Conditions Are Linked to It?

Researchers have found several things that seem to increase a man’s chances of getting this kind of cancer. They include:

Undescended testicle: Testicular cancer happens more often in men who were born with a condition called cryptorchidism.

Early in a pregnancy, the testes form in the male baby’s lower belly. Not too long before birth, they should “drop” down into the scrotum. But for about 3 or 4 out of 100 newborns, this doesn’t happen. And that rate goes much higher if the baby is born early.

Family history: It may also run through the generations, from parent to child.

Men with the genetic disorder Down syndrome have a higher chance of getting it.

Previous diagnosis: If you’ve already been cured of cancer in one testicle, you have a 4% chance of getting it again in the other one.

Fertility problems: If you have trouble making a woman pregnant, you are more likely to be diagnosed with testicular cancer. You should ask your doctor to screen you.

HIV infection: The virus that causes AIDS has been linked with it.

Issues before birth: Conditions related to your mother’s pregnancy could play a role as well. They include abnormal bleeding and estrogen, or hormone, therapy.

If you find a lump in your testicle, go to a doctor so he can check it.

What is testicular cancer?

Testicular cancer is a potentially deadly disease. Although it accounts for only 1.2% of all cancers in males, cancer of the testis accounts for about 11%-13% of all cancer deaths of men between the ages of 15-35.

Testicular cancer has two peaks according to age. The first peak occurs before the age of 45 and accounts for about 90% of cases of testicular cancer. A second much smaller peak affects men over 50.

What are the possible signs and symptoms of testicular cancer?

Testicular cancers are often (90%-95%) curable even if they are metastatic.

The first and early sign of testicular cancer is most commonly a little (“pea-sized”) lump on the testis (painless testicular lump). There may be no real pain, at most just a dull ache in the lower abdomen or groin, perhaps a sensation of dragging and heaviness. The signs and symptoms of cancer of the testicle may include…

  1. a lump in or on a testicle (testicular lump) is the most common sign;
  2. any enlargement or swelling of a testicle and/or scrotum;
  3. shrinking of a testicle;
  4. a feeling of heaviness in the scrotum (scrotal heaviness);
  5. a dull ache in the lower abdomen (lower abdominal pain) or in the groin (groin ache);
  6. a collection of fluid in the scrotum;
  7. discomfort or pain in a testicle or in the scrotum;
  8. enlargement or tenderness of the breasts;
  9. lower back pain due to retroperitoneal disease spread; and
  10. enlarged or swollen lymph nodes or masses due to disease spread.

The best hope for early detection of testicular cancer is a simple three-minute self-examination once a month. The ideal time for this exam is after a warm bath or shower, when the scrotal skin is most relaxed.

Gently roll each testicle between the thumb and fingers of both hands. If any hard lumps or nodules are felt, a man should see a doctor promptly. A lump may not be malignant, but only a doctor can make the diagnosis.

What Sex Is Like After Testicular Cancer

To raise funds for men’s health, including testicular cancer, men grow mustaches every “Movember.”

Of all the harrowing medical setbacks a guy can live through, testicular cancer might actually be the easiest. Not only is it highly treatable; it tends to affect younger men aged 20-39, who are otherwise in good enough health to fight the disease, which—when caught early—boasts a survival rate of 99 percent, according to the American Cancer Society.

The body only needs one testicle to function. Like one kidney.

The aftermath of testicular cancer, however, proves less comforting. In all cases, treatment calls for the removal of the tumor-ridden testicle, a prospect that can seem emasculating, confounding, and downright scary. For such an intimate part of your anatomy to disappear like that—well, it’s no wonder so much of the disease is shrouded in taboo and fear. But for the majority of TC survivors, that fear ends up being misguided.

Tim*, a 48-year-old designer living in New York, discovered his tumor by accident, when his partner, a Grindr hookup, noticed one of his balls felt harder than the other. He looked it up online, saw that it was a potential match for early indications of testicular cancer, and, though he told himself it was probably nothing, made a doctor’s appointment just to be safe. “As soon as (my doctor) felt it, he said ‘I want you to get an ultrasound right away.’ I could tell he knew there was something there.”

After surgery—which involved the removal of one testicle (the procedure is called an orchiectomy), and the simultaneous insertion of a prosthetic testicle—Tim says he felt “renewed.” This is common: For patients of this particular disease, life tends to pick up right where it left off, with minimal interruption. Meanwhile, New York-based Adrian, 30, who was diagnosed in the fall of 2015 with Stage I testicular cancer, said he was able to resume sexual activity within just two weeks of his treatment. “I noticed I wasn’t any less horny, and perhaps even more horny than I was before treatment.”

The explanation for this may have more to do with anatomy than psychology. Aside from the initial shock of having a testicle removed, the physical bounce-back for patients with testicular cancer is surprisingly quick. “The body only needs one testicle to function,” Tim explains. “Like one kidney. Eventually, the remaining one grows a little bit because it’s doing more work.”

Tim, like many others, opted to insert a prosthetic ball (the procedure was done on the same day as his orchiectomy), hoping it would provide a semblance of normalcy to his cancer-warped physique. After all, unless you’re a urologist, or you happen to be looking really, really closely, there’s virtually no way to distinguish Tim’s scrotum from one carrying a pair of original testicles. “There’s nothing different. If I’m with somebody, I won’t even say anything unless they notice first.”

Of course, Tim isn’t so easily fooled. Prosthetic balls, he says, “aren’t as squishy,” so when he’s feeling around down there, the difference on his own body is obvious. Yet, for Tim, that outcome was preferable to becoming a monorchid, the scientific term for individuals with just one testicle. “I would have felt more self-conscious if I hadn’t gotten the prosthetic. I definitely wanted that, because (the appearance) wouldn’t be so obvious.”

The same was true for 27-year-old Kevin, based in Austin, who lived the first 14 years of his life as a monorchid. That’s because when he was just an infant, doctors found a hard mass on his left testicle, and suspecting it to be cancerous, performed surgery to remove it. As it turned out, there was no cancer.

“(When I was a teenager), I became more aware of it. I knew there was a difference between me and the other boys,” Kevin said. So, using a small inheritance he got from his grandfather, at age 14 he spent $3,000 to get a prosthetic implant.

The fake ball, he says, has a slightly different texture than his biological one. “Sort of like rubber,” he describes, “Like a good bouncy ball, not a super soft one. It doesn’t give that much, but it gives a little bit.”

As for the bedroom, he says he’s “never encountered a negative reaction” about his prosthetic ball. “Some people don’t care or notice; others are excited about it.” Interestingly, testicles have become one of the most enticing parts of sex for Kevin, who is gay. “I’ve always had this fetish about testicles. Having someone’s mouth on my balls, or having my mouth on theirs. It consistently gets me off.” He pauses. “I guess it’s a very convenient fetish to have.”

There are a few things that men understand and women never can. There’s that one long, awkward step in the middle of a normal walking gait. There’s the confusion of waking up every morning with a massive erection for no reason. And, there’s the unique pain and frustration of blue balls. We all experience it at some point, and even as we get older, it can come back to haunt us on occasion. Today, we’re going to conquer the challenge of blue balls together. No, not like that. We’re going to learn a little more about what causes blue balls and what you can do to cure it. On your own.

What Causes Blue Balls

We’re going to breeze through this, but it’s important to discuss the cause if we’re going to learn about cures. The medical term for blue balls is epididymal hypertension. The very short version is that arousal can cause a buildup of pressure in your testicles. This is what causes the pain associated with blue balls, and in some cases, the increased blood flow to the area can actually create a blue hue. The blue coloring is pretty uncommon, and blue balls affects adolescent males much more than adults, but it can be a problem for anyone, and that’s why you’re here.

Before we get into solutions, it’s important to dispel a common myth. Blue balls will not hurt you. There has never, ever been a recorded medical incident where blue balls led to any lasting harm in a male. That said, there are other sources of testicular pain that can be related to something serious. If these cures don’t help your blue balls, something else is happening, and you should talk to a doctor. Curing blue balls is just about comfort and convenience, not health.

Get Rid of the Boner

If blue balls are caused by arousal, it seems pretty obvious that getting rid of the boner is the best way to solve the problem. And, that’s exactly what medical science has discovered. Once your boner is gone, the pressure build up subsides and the pain goes away. That doesn’t mean that relief will be instantaneous. The pressure can cause a lasting ache that will hurt up to a couple of hours after you get rid of your hard-on. That variance is why there are a number of different methods to cure the ache of blue balls.

That’s the gist of it. Some of you are confident in your erection control. For the rest of you, these tips will help you manage arousal. These aren’t just blue ball cures; they can also give you a little more control over your sex life and sexual competency.

Ejaculate

When we’re talking about blue balls, the best cure by far is to get the juice out. This usually brings the erection down pretty quickly. It also helps release some extra fluid pressure that is built up for reproductive purposes. While medical scientists think that the bulk of blue ball pressure comes from blood, some of it definitely comes from that milky white substance your balls produce. Relieving both pressures is usually the fastest way to solve the problem.

As for how to ejaculate, you might occasionally be lucky enough to do it the fun way, but most of the time you’re just going to be rubbing one out. Most doctors will agree with this notion even if they don’t advertise the solution. There’s still a bit of stigma around telling adolescent boys to masturbate. Regardless, this is easily the number one solution to blue balls.

Take a Cold Shower

There are times and places where you won’t have the freedom to ejaculate. Those don’t often include the shower, but whatever. If you have a reason not to free your boner in the easy way, a cold shower is a fast solution. It also works on two fronts. The cold water is great and diminishing hard penises. This is actually a survival technique that your body deploys instantly.

When you’re aroused, the increased blood flow gets cooled by a cold shower at a very fast rate. In a matter of minutes your entire body temperature can drop a few degrees. Your body’s defense mechanism to prevent this is to go flaccid downstairs. A cold shower will have you at your smallest in no time.

There’s a second advantage to the cold water. It reduces swelling. If your blue ball scenario caused a little irritation in the process, cold water is going to soothe that pretty quickly. It’s why a cold shower often kills the throbbing faster than just thinking away the boner. And, if nothing else, the pain of the cold water is a great distraction from the discomfort in your loins.

Think About Baseball

This is a classic old adage, but it has some merit. There are mental techniques to controlling boners, and they mostly involve thinking about anything other than sex. This is not the most comfortable or easiest way to deal with blue balls, but if you get a sudden strike in an awkward setting, this is your most reliable tool. The key to mentally defeating blue balls is to come to the battle prepared. Surely you have a nice spank bank built up by now. You need to also invest into an alternate bank — a bank of boner-deflating images.

A little time on Google can give you tons of ammo. If you want to go hard, browse WebMD for 10 minutes and look of pictures of the random diseases you find. If you’re less hard core, just think about images of one of your hobbies. Not too many guys get turned on by fishing flies.

Distract Yourself

The easier alternative to mentally deflating an erect penis is to participate in a physical distraction. Exercise is the go-to method. It does more than just distract your mind from perpetual horny thoughts; it also diverts some of the blood from your penis to better uses.

As good as exercise is as a cure, it can be tricky. You’re usually only going to blue ball when you’re really hard up. It can be tough to get to a position to exercise without flashing your rock-hard member at a bunch of people. This is where distraction can be implemented in stages. Try to get caught up in a conversation, funny videos or anything at all to take the edge off. Then you can do a little adjustment in the shorts and try and burn some calories to really kill the problem.

Health

Hopefully that was a little entertaining, but we should all take a moment to be a little serious. Blue balls suck, but like you already read, they’re completely harmless. It’s important to be able to distinguish between harmless ball aches and a serious problem. Here are a few tells that you need to keep in the back of your mind.

If your balls ache when you haven’t been aroused recently, then your issue isn’t blue balls. There are a lot of possibilities, and they range from innocuous to deadly, so at least ask your doctor about it to prevent any problems.

Similarly, if the pain is beyond recognition, go get help. You’ve undoubtedly experienced blue balls before reading this. If the pain is suddenly much worse, or if it feels indescribably different from your experience, then it probably has a new source. Don’t mess around with the boys. Get them the love and attention they deserve.

Ok guys. That about covers things for today. You’ve hopefully learned enough to conquer your blue balls. As for sexual competency, you should already understand how to apply some of these techniques. Having more control over your arousal and erections is only a good thing in the bedroom, so make sure to prepare and practice. You, and your partner, will thank me later. So, until next time, take it easy out there and keep your junk feeling great.

I talk about Matt’s lack of balls as if I was there when he lost them. I was not.

I actually hadn’t seen him in the 10 years since high school during which, four years ago, he survived testicular cancer. But we’d been flirting over text message for three months, sending drunken haiku poems and jokes about eloping to Mexico. He was as slyly sarcastic as I’d remembered from high school. And attractive, and smart, and kind. Why was he still single? Particularly in Ohio, where everyone our age was already three babies deep in an unhappy marriage. It had to be the balls. At what point in a relationship can you ask a guy if his dick works?

The answer was, naturally, at a bar, six pints in. Standing next to him, I let my eyes wander downward. “So, the cancer… ” He turned to face me.

“Did you… I mean… does it… ” I cringed at my awkwardness.

“Can I get it up?” he asked for me. “Is that what you’re asking?” Then, the longest pause in the history of drunken conversations about penises.

The answer was yes, which Matt barely uttered before I pounced like a makeout attack cat. Our breathless face-sucking got us kicked out of the bar and subsequent taxi; we felt no shame over either. He was capable of erections with no family jewels! I didn’t care about the logistics of how. This was a miracle of modern science in action.

Later I saw the oval-shaped patch on his thigh, and the red marks where patches had been on his back and inner arms. The testosterone patches are not just for sex. With no natural way to produce testosterone, they’re also fuel for energy and building muscle. Without them, Matt says, he’d be “a pile of pud.”

That drunken night we proved their effectiveness, several times, and soon after became the first two people in humankind to experience real true perfect love. (Or that’s how we saw it.)

It wasn’t until Matt moved to New York for me that I experienced what we now called The Monthly Nightmare. Thanks to its popularity amongst doping pro athletes, testosterone is a controlled substance. Every 30 days, we meet a new wrinkle in the process to getting the testosterone prescription filled.

A new doctor suspicious of our need for a controlled substance prescription. A new insurance rep who says his cancer is a pre-existing condition or requiring he experiment with an ineffective generic drug. (Without insurance, the patches cost $400 a month.) Twenty new pharmacies that don’t carry the drug and won’t order it. A new drug maker that decided, without warning, to stop packaging the drug in a certain dosage, forcing us to start the whole process again from scratch. A new state, or federal, or local law that shortens the number of days we have to fill the prescription, which must not overlap with our existing supply.

This is life with a boyfriend who has no balls.

Our ability to have sex relies on these stupid patches. We have no control over them, and we need them to stay the same, forever. When a new roadblock stretches Matt’s monthly supply of patches a few extra days, he gets hot flashes and sometimes faints. There are tearful breakdowns. And — the scariest of all — Matt can’t let any mental or emotional factors interfere. Every new medication brings a plethora of new surprises. Lately, we’ve experimented with a new, higher-dosage gel, which has increased Matt’s sex drive and given him more chest hair.

Yes, I have perspective. I know relying on a medication is not as nightmarish as the testicular cancer that got him here. It doesn’t compare to the surgery that removed Matt’s guy parts, or the chemo. And hey, it is physically impossible for him to impregnate me, so we save money on birth control. (When he has an orgasm, nothing comes out. That part makes sex incredibly convenient.)

Even with the patch, though, there’s no promise he’ll magically get erections. Luckily he does, but someday, I fear, his body could just decide that he’s done. It’s a possibility that I feel sick thinking about three years into our relationship.

Each month, when the Nightmare returns, I ask myself if I would love a very different Matt. What if he became that pile of pud? What if, without a physical outlet like running and balanced hormones, he becomes depressed, and his mood swings push me away? And most important, what if he can’t satisfy my physical needs, and no longer has any needs for me to satisfy?

Last week, over dinner at a Mexican restaurant near our apartment, Matt was shoveling rice into his mouth like a starved monster. I laughed to myself; his horrible table manners are a running joke. But instead of cracking about it, I inexplicably blurted out the impossible question.

“What’s going to happen if the boner patches stop working?”

His chewing slowed as he looked up at me. “I don’t know.”

We stared at each other in silence for a beat and went back to our enchiladas. I thought forcing myself to address uncomfortable hypotheticals was something all mature, serious adults must do. Maybe it is. But there’s something to be said for occasionally embracing naïveté, for simply ignoring the things we can’t stand to think about. I wasn’t there when he lost his balls; what matters is that I’m here now.

Photo Credit: Gallerystock

I look at women forlornly – they’re amazing. I was diagnosed with testicular cancer 23 years ago, when I was 31, and both balls were removed. I had been in a relationship for six months, but it ended soon after and there’s been no one since. I was treated with a hormone replacement therapy which caused relentless erections; lonely and horny is a miserable combination. I started watching pornography because it was safe and there was no fear of humiliation, but it only reinforced my sense of isolation.

The treatment was withdrawn because of its side-effects – obesity, aggression, sexual rampancy – and since being put on a “safer” type of testosterone, I’ve been impotent. I began visiting escort girls for a kiss and a cuddle, lying with them in my arms. I’d call a chatline and have fake phone sex, pretending to orgasm at the appropriate point in the charade. I’ve fantasised about fantasies, acted out roles of virile masculinity, wretchedly impersonated a man. Recently I began making politely inept passes at gorgeous girls, emboldened by inevitable dismissal; another sham pantomime.

I have nothing else to declare – I’m a sexual nonentity. I began counselling in January and wish I had been referred 20 years ago. The anguish never stops, so I’ve learned to repress dangerous emotions. I admire women abstractly but occasionally one slips through my defences and destroys me; I’ll find her incredibly attractive, want her desperately, but have no outlet for the powerful feelings that surge up within me. I weep uncontrollably when I imagine being with her, sweet desire unleashing all the shame, rage and despair inside me.

• Each week, a reader tells us about their sex life. Want to share yours? Email [email protected]

Testicular Disorders

What are testicles?

The testicles (also called testes) are part of the male reproductive system. The testicles are two oval organs about the size of large olives. They are located inside the scrotum, the loose sac of skin that hangs behind the penis. The testicles make the male hormones, including testosterone, and produce sperm, the male reproductive cells. Disorders of the testes can lead to serious complications, including hormonal imbalances, sexual dysfunction and infertility.

What disorders affect the testes?

Some of the more common disorders that affect the testes include the following:

Testicular trauma

Because the testes are located within the scrotum, which hangs outside of the body, they do not have the protection of muscles and bones. This makes it easier for the testes to be struck, hit, kicked or crushed, which occurs most often during contact sports. Males can protect their testicles by wearing athletic cups during sports.

Trauma to the testes can cause severe pain, bruising and/or swelling. In most cases, the testes—which are made of a spongy material—can absorb the shock of an injury without serious damage. A rare type of testicular trauma, called testicular rupture, occurs when the testicle receives a direct blow or is squeezed against the hard surface of the pelvis. This injury can cause blood to leak into the scrotum. In severe cases, surgery to repair the rupture—and thus save the testicle—may be necessary.

Testicular torsion

Within the scrotum, the testicles are secured at one end by a structure called the spermatic cord. Sometimes, this cord gets twisted cutting off the testicle’s blood supply. Symptoms of testicular torsion include sudden and severe pain, enlargement of the affected testicle, tenderness, and swelling.

This disorder, which occurs most often in young males between the ages of 12 and 18, can result from an injury to the testicles or from strenuous activity. It also can occur for no apparent reason.

Testicular torsion is an emergency. Treatment usually involves correction of the problem through surgery. Testicular function may be saved if the condition is diagnosed and corrected immediately. If the blood supply to the testicle is cut off for a long period of time, the testicle can become permanently damaged and may need to be removed.

Testicular cancer

Testicular cancer occurs when abnormal cells in the testicles divide and grow uncontrolled. Testicular cancer can develop in one or both testicles in men or young boys. Symptoms of testicular cancer include a lump, irregularity or enlargement in either testicle; a pulling sensation or feeling of unusual heaviness in the scrotum; a dull ache in the groin or lower abdomen; and pain or discomfort (which may come and go) in a testicle or the scrotum.

The exact causes of testicular cancer are not known, but there are certain risk factors for the disease. A risk factor is anything that increases a person’s chance of getting a disease. The risk factors for cancer of the testicles include:

  • Age — Testicular cancer can occur at any age, but most often occurs in men between the ages of 15 and 40.
  • Undescended testicle (cryptorchidism) — This is a condition in which the testicles do not descend from the abdomen, where they are located during development, to the scrotum shortly before birth. This condition is a major risk factor for testicular cancer.
  • Family history — A family history of testicular cancer increases the risk.
  • Race and ethnicity — The risk for testicular cancer in Caucasian men is more than five times that of African-American men and more than double that of Asian-American men.

Testicular cancer is a rare form of cancer, and is highly treatable and usually curable. Surgery is the most common treatment for testicular cancer. Surgical treatment involves removing the cancerous testicle through an incision (cut) in the groin. In some cases, the doctor also may remove some of the lymph nodes in the abdomen. Radiation, which uses high-energy rays to attack cancer, and chemotherapy, which uses drugs to kill cancer, are other treatment options.

The success of treatment for testicular cancer depends on the stage of the disease when it is first detected and treated. If the cancer is found and treated before it spreads to the lymph nodes, the cure rate is excellent, greater than 98 percent. Even after testicular cancer has spread to the lymph nodes and other parts of the body, chemotherapy is highly effective, with a cure rate greater than 90 percent.

To prevent testicular cancer, all men should be familiar with the size and feel of their testicles, so they can detect any changes. The American Cancer Society recommends monthly testicular self-examinations (TSE) for men over age 15. A TSE is best performed after a warm bath or shower, when the skin of the scrotum is relaxed. After looking for any changes in appearance, carefully examine each testicle by rolling it between the fingers and thumbs of both hands to check for any lumps.

Epididymitis

Epididymitis is inflammation of the epididymis. The epididymis is the coiled tube that lies on and behind each testicle. It functions in the transport, storage and maturation of sperm cells that are produced in the testicles. The epididymis connects the testicles with the vas deferens (the tubes that carry sperm).

Epididymitis often is caused by infection or by the sexually transmitted disease chlamydia. Symptoms of epididymitis include scrotal pain and swelling. In severe cases, the infection can spread to the adjacent testicle, causing fever and abscess (collection of pus).

Treatment for epididymitis includes antibiotics (drugs that kill the bacteria causing the infection), bed rest, ice to reduce swelling, the use of a scrotal supporter, and anti-inflammatory medicines (such as ibuprofen). The use of condoms during sex can help prevent epididymitis caused by chlamydia. If left untreated, epididymitis can produce scar tissue, which can block the sperm from leaving the testicle. This can cause problems with fertility, especially if both testicles are involved or if the man has recurring infections.

Hypogonadism

One function of the testes is to secrete the hormone testosterone. This hormone plays an important role in the development and maintenance of many male physical characteristics. These include muscle mass and strength, fat distribution, bone mass, sperm production, and sex drive.

Hypogonadism in men is a disorder that occurs when the testicles (gonads) do not produce enough testosterone. Primary hypogonadism occurs when there is a problem or abnormality in the testicles themselves. Secondary hypogonadism occurs when there is a problem with the pituitary gland in the brain, which sends chemical messages to the testicles to produce testosterone.

Hypogonadism can occur during fetal development, at puberty, or in adult men. When it occurs in adult men, hypogonadism may cause the following problems:

  • Erectile dysfunction (the inability to achieve or maintain an erection)
  • Infertility
  • Decreased sex drive
  • Decrease in beard and growth of body hair
  • Decrease in size or firmness of the testicles
  • Decrease in muscle mass and increase in body fat
  • Enlarged male breast tissue
  • Mental and emotional symptoms similar to those of menopause in women (hot flashes, mood swings, irritability, depression, fatigue)

There are various causes of hypogonadism, including:

  • Klinefelter’s syndrome — This syndrome involves the presence of abnormal sex chromosomes. A male normally has one X chromosome and one Y chromosome. The Y chromosome contains the genetic material with the codes that determine the male gender, and related masculine characteristics and development. Males with Klinefelter’s syndrome have an extra X chromosome, which causes abnormal development of the testicles.
  • Undescended testicles — The testicles develop inside the abdomen and usually move down into the scrotum before birth. Sometimes, this does not occur. However, in most cases, the testicles descend by the child’s first birthday. An undescended testicle that remains outside the scrotum throughout childhood can result in abnormal testicular development.
  • Hemochromatosis — Hemochromatosis, or too much iron in the blood, can cause the testicles or the pituitary gland to malfunction.
  • Testicular trauma — Damage to the testicles can affect the production of testosterone.
  • Cancer treatment — Chemotherapy or radiation therapy, common treatments for cancer, can interfere with testosterone and sperm production by the testicles.
  • Normal aging — Older men generally have lower levels of testosterone, although the decline of the hormone varies greatly among men.
  • Pituitary disorders — Problems affecting the pituitary gland—including a head injury or pituitary tumor—can interfere with the gland’s signals to the testicles to produce testosterone.
  • Medications — Certain drugs can affect testosterone production. Commonly used psychiatric drugs and some medicines used to treat gastroesophageal reflux disease (GERD) may cause hypogonadism.

Treatment for hypogonadism depends on the cause. Male hormone replacement (testosterone replacement therapy or TRT) often is used to treat disorders of the testicles. If the problem is related to the pituitary gland, pituitary hormones may help increase testosterone levels and sperm production.

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