ANATOMY OF THE TESTES

The testicles (also called testes or gonads) are a pair of male sex glands. They
produce and store sperm and are the main source of testosterone (male
hormones) in men. These hormones control the development of the reproductive
organs and other male physical characteristics. The testicles are located under the
penis in a sac-like pouch called the scrotum.

TESTICULAR CANCER

Nearly all testicular cancers are one of two general types: seminoma or
nonseminoma. Other types are rare.
This disease occurs most often in men between the ages of 20 and 39. It
accounts for only 1 percent of all cancers in men.
Risk factors include having an undescended testicle, previous testicular
cancer, and a family history of testicular cancer.
Undescended testicle (cryptorchidism): Normally, the testicles descend
from inside the abdomen into the scrotum before birth. The risk of
testicular cancer is increased in males with a testicle that does not move
down into the scrotum. This risk does not change even after surgery to
move the testicle into the scrotum. The increased risk applies to both
testicles.
Congenital abnormalities: Men born with abnormalities of the testicles,
penis, or kidneys, as well as those with inguinal hernia (hernia in the groin
area, where the thigh meets the abdomen), may be at increased risk.
History of testicular cancer: Men who have had testicular cancer are at
increased risk of developing cancer in the other testicle.
Family history of testicular cancer: The risk for testicular cancer is greater
in men whose brother or father has had the disease.
Symptoms (most testicular cancers are found by men themselves) include
a lump, swelling, or enlargement in the testicle; pain or discomfort in a
testicle or in the scrotum; and/or an ache in the lower abdomen, back, or
groin.
Diagnosis generally involves blood tests, ultrasound, and biopsy.
Treatment can often cure testicular cancer
Surgery- orchiectomy
Radiation therapy (also called radiotherapy) uses high-energy rays to
kill cancer cells and shrink tumors
Chemotherapy is the use of anticancer drugs to kill cancer cells.

TESTICULAR SELF-EXAMINATION
- The testicular self-examination (TSE) is an easy way for guys to check their
own testicles to make sure there aren't any unusual lumps or bumps
which can be the first sign of testicular cancer.
- Testicular self-exam can help identify testicular cancer early, when
treatment is most effective.

When to do a TSE?

- The testicular self exam is best performed after a warm bath or shower.
(Heat relaxes the scrotum, making it easier to spot anything abnormal)
- Do a TSE every month so you can become familiar with the normal size
and shape of the testicles, making it easier to tell if something feels
different or abnormal in the future.

How to do a TSE?
- Stand in front of a mirror. Look for any swelling on the skin of the scrotum.
- Examine each testicle with both hands. Place the index and middle fingers
under the testicle while placing the thumbs on the top.
- Gently roll the testicle between the thumbs and fingers. Feel for lumps
and bumps. Remember that the testicles are usually smooth, oval shaped
and somewhat firm.
- If you find a lump, call the doctor as soon as possible. Signs and symptoms
of cancer include lumps, swelling, a heavy-feeling testicle and pain. Don't
be embarrassed about calling the doctor if you find a lump or other
problem. Early diagnosis is important over time, testicular cancer can
spread and it becomes more dangerous and difficult to treat.
OR
- It's best to do a TSE during or right after a hot shower or bath. The
scrotum (skin that covers the testicles) is most relaxed then, which makes
it easier to examine the testicles.
- Examine one testicle at a time. Use both hands to gently roll each testicle
(with slight pressure) between the fingers. Place the thumbs over the top
of the testicle, with the index and middle fingers of each hand behind the
testicle, and then roll it between the fingers.
- You should be able to feel the epididymis (the sperm-carrying tube), which
feels soft, rope-like, and slightly tender to pressure, and is located at the
top of the back part of each testicle. This is a normal lump.
- Remember that one testicle (usually the right one) is slightly larger than
the other for most guys this is also normal.
- When examining each testicle, feel for any lumps or bumps along the front
or sides. Lumps may be as small as a piece of rice or a pea.
- If you notice any swelling, lumps, or changes in the size or color of a
testicle, or if you have any pain or achy areas in the groin, let the doctor
know right away.



PELVIC EXAMINATION
- Doctor visually and manually assesses the reproductive organs
- Is a relatively short procedure (takes only a few minutes)
- A Pap test, which screens for cervical cancer, may be performed during a
pelvic exam
- The exam is used to look at a woman's:
Vulva (external genital organs)
Uterus (the womb)
Cervix (opening from the vagina to the uterus)
Fallopian tubes (tubes that carry eggs to the womb)
Ovaries (organs that produce eggs)
Bladder (the sac that holds urine)
Rectum (the chamber that connects the colon to the anus)
When Are Pelvic Exams Done?
Pelvic exams are performed:
During a yearly physical exam.
When a woman is pregnant.
When a doctor is checking for an infection (such as chlamydia, vaginosis,
trichomoniasis, and others).
When a woman is having pain in her pelvic area or low back.
Why it's done
To assess the gynecologic health. A pelvic exam often is part of a routine
physical exam for women to find possible signs of a variety of disorders,
such as ovarian cysts, sexually transmitted infections, uterine fibroids or
early-stage cancer. The doctor can recommend how frequently you need
to be examined, but many women have a pelvic exam once a year.
To diagnose a medical condition. The doctor may suggest a pelvic exam if
you're experiencing gynecologic symptoms, such as pelvic pain, unusual
vaginal bleeding, skin changes, abnormal vaginal discharge or urinary
problems. A pelvic exam can help the doctor diagnose possible causes of
these symptoms and determine if other diagnostic testing or treatment is
needed.
How Often Should I Get a Pelvic Exam?
According to the American Cancer Society it's a good idea for women to begin
having yearly pelvic exams within three years of becoming sexually active or at the
age of 21, whichever comes first. The exam should also include a yearly Pap smear.
Some women who have a higher risk of cancer may need to have a Pap smear
more often. Women who have had normal Pap smear results for several years and
have only one sex partner may need a Pap smear less often. Talk to the doctor to
see what is right for you

Do I Need to Do Anything to Prepare for a Pelvic Exam?
You do not have to do anything special to get ready for the exam. When you arrive
at the office, the doctor may ask if you need to use the bathroom. This question is
asked so that you can stay comfortable during the exam. Sometimes, a urine
sample is requested.

What Can I Expect During a Pelvic Exam?
You can expect to feel a little discomfort, but you should not feel pain. The exam
itself takes about 10 minutes. If you have any questions during the exam, be sure
to ask the doctor.

What Tests Are Taken During the Pelvic Exam?
Pap Smear
Screening for STDs

PROCEDURE:

Position: Lithotomy position (lie on the back on an examining table, with knees
bent and the feet placed on the corners of the table or in supports called
stirrups)
External visual exam.
doctor visually inspects vulva, looking for irritation, redness,
sores, swelling or any other abnormalities.
Internal visual exam.
doctor uses a speculum a plastic or metal-hinged instrument
shaped like a duck's bill to spread open the vaginal walls and
view the vagina and cervix.
Often, the speculum is warmed before it's inserted.
Inserting and opening the speculum can cause pressure or
discomfort for some women.
Relax as much as possible to ease discomfort, but tell the doctor
if you're in pain.
Pap test.
If the pelvic exam includes a Pap test (Pap smear). Pap Test is
done.
Manual exam.
Because the pelvic organs, including the uterus and ovaries,
can't be seen from outside the body, the doctor needs to feel
(palpate) the abdomen for this part of the exam.
The doctor inserts two lubricated, gloved fingers into the
vagina with one hand, while the other hand presses gently
on the outside of the lower abdomen.
This is to check the size and shape of the uterus and ovaries
and identify tenderness and unusual growths. After the
vaginal examination the doctor also inserts a gloved finger
into the rectum to check for tenderness, growths or other
irregularities.

PAP SMEAR
- The Pap smear is named after Dr. George Papanicolaou (1883-1962).
(GREEK)
- A Pap smear (also known as the Pap test) is a medical procedure in which
a sample of cells from a woman's cervix (the end of the uterus that
extends into the vagina) is collected and spread (smeared) on a
microscope slide.
- The cells are examined under a microscope in order to look for pre-
malignant (before-cancer) or malignant (cancer) changes.

Pap Smear At A Glance
A Pap smear is a simple, quick, and essentially painless screening test.
Cells collected from a woman's cervix are spread on a microscope slide for
examination.
The cells are evaluated for abnormalities, specifically for pre- cancerous
and cancerous changes.
Pap smears are recommended for all women starting at age 21 years or
within 3 years of becoming sexually active, whichever comes first.
Most women over age 30 who have had reliable Pap screening with
persistently normal results can be screened less often than yearly.
Pap smears should not be performed in women who have had a total
hysterectomy for benign conditions and had prior normal Pap smears.
The Pap smear is read (analyzed) according to a uniform standardized
system known as the Bethesda System.
A recording of the woman's menstruation status and whether and when
she had abnormal Pap smears previously, is essential to the reader of the
current Pap smear.
Screening guidelines recommend that most women over 65-70 years old
who have had regular Pap screening with negative results can stop having
Pap tests, because abnormal Pap smears are very unusual in this setting.
Up to 80% of women diagnosed with invasive cancer of the cervix have
not had a Pap smear in the past 5 years.
Cancer of the cervix is a preventable disease

CERVIX
The cervix is the lower third portion of the uterus which forms the neck of the
uterus and opens into the vagina which is also called the endocervical canal. The
narrow opening of the cervix is called the os. The cervical os allows menstrual
blood to flow out from the vagina during menstruation. During pregnancy the
cervical os closes to help keep the fetus in the uterus until birth. Another important
function of the cervix occurs during labor when the cervix dilates, or widens, to
allow the passage of the fetus from the uterus to the vagina.
CERVICAL CANCER
Cancer that forms in tissues of the cervix (the organ connecting the uterus and
vagina). It is usually a slow-growing cancer that may not have symptoms but can be
found with regular Pap tests (a procedure in which cells are scraped from the cervix
and looked at under a microscope).

RISK FACTORS:
HPV: The principal risk factor is infection with the genital wart virus, also
called the human papillomavirus (HPV), although most women with HPV
infection do not get cervical cancer. (See below for details). About 95%-
100% of cervical cancers are related to HPV infection. Some women are
more likely to have abnormal Pap smears than other women.
Smoking: One common risk factor for premalignant and malignant
changes in the cervix is smoking. Although smoking is associated with
many different cancers, many women do not realize that smoking is
strongly linked to cervical cancer. Smoking increased the risk of cervical
cancer about two to four fold.
Weakened immune system: Women whose immune systems are
weakened or have become weakened by medications (for example, those
taken after an organ transplant) also have a higher risk of precancerous
changes in the cervix.
Medications: Women whose mothers took the drug diethylstilbestrol
(DES) during pregnancy also are at increased risk.
Other risk factors: Other risk factors for precancerous changes in the
cervix and an abnormal Pap testing include having multiple sexual
partners and becoming sexually active at a young age.

Who should have a Pap smear?
Pregnancy does not prevent a woman from having a Pap smear. Pap smears can be
safely done during pregnancy.
Pap smear testing is not indicated for women who have had a hysterectomy (with
removal of the cervix) for benign conditions. Women who have had a hysterectomy
in which the cervix is not removed, called subtotal hysterectomy, should continue
screening following the same guidelines as women who have not had a
hysterectomy.
The screening guidelines of several key medical organizations are summarized in
the table below.
Organization
When to start
Pap smear testing
Frequency of Pap
smear testing
At what age to stop
having Pap smears
American Cancer
Society 2004
3 years after
vaginal
intercourse, no
later than age 21
Yearly with
exceptions:
every 2
years if
liquid-
based kit
every 2-3
years if
three
normal
tests in a
row in
women
>30 years
old
1. Total
hysterectomy
for benign
disease
2. > 70 years old
with at least
three normal
Pap smear
results and no
abnormal Pap
results in the
last 10 years
United States
Preventative
Services Task
Force 2003
Within 3 years of
onset of sexual
activity or age 21,
whichever comes
first
At least every 3
years (no evidence
that every year is
better than every
3 years)
1. Recommend
against doing
Pap smears in
women older
than 65 years of
age, if adequate
screening with
normal results
and otherwise
not at risk for
cervical cancer.
2. Recommend
against doing
Pap smears in
women who
have had a total
hysterectomy
for benign
disease.
American College
of Obstetrics and
Gynecology
3 years after first
sexual
intercourse or
age 21,
whichever comes
first.
Yearly until age 30
years. Beginning
at age 30, if three
normal annual Pap
results, can do a
Pap alone every 2-
Difficult to set an upper
age limit-
postmenopausal women
screened within the prior
2-3 years have a very low
risk of developing
3 years abnormal Pap smears.

How is a Pap smear done?
A woman should have a Pap smear when she is not menstruating. The best time
for screening is between 10 and 20 days after the first day of her menstrual period.
For about two days before testing, a woman should avoid douching or using
spermicidal foams, creams, or jellies or vaginal medicines (except as directed by a
physician). These agents may wash away or hide any abnormal cervical cells.
A Pap smear can be done in a doctor's office, a clinic, or a hospital by either a
physician or other specially trained health care professional, such as a physician
assistant, a nurse practitioner, or a nurse midwife.
With the woman positioned on her back, the clinician will often first
examine the outside of the patient's genital and rectal areas, including the
urethra (the opening where urine leaves the body), to assure that they
look normal.
A speculum is then inserted into the vaginal area (the birth canal). (A
speculum is an instrument that allows the vagina and the cervix to be
viewed and examined.)
A cotton swab is sometimes used to clear away mucus that might interfere
with an optimal sample.
A small brush called a cervical brush is then inserted into the opening of
the cervix (the cervical os) and twirled around to collect a sample of cells.
Because this sample comes from inside the cervix, is called the
endocervical sample ("endo" meaning inside).
A second sample is also collected as part of the Pap smear and is called
the ectocervical sample ("ecto" meaning outside).
These cells are collected from a scraping of the area surrounding, but not
entering, the cervical os.
Both the endocervical and the ectocervical samples are gently smeared on
a glass slide and a fixative (a preservative) is used to prepare the cells on
the slide for laboratory evaluation.
A bimanual (both hands) pelvic exam usually follows the collection of the two
samples for the Pap smear. The bimanual examination involves the physician or
health care practitioner inserting two fingers of one hand inside the vaginal canal
while feeling the ovaries and uterus with the other hand on top of the abdomen
(belly).
The results of the Pap smear are usually available within two to three weeks. At the
end of Pap smear testing, each woman should ask how she should expect to be
informed about the results of her Pap smear. If a woman has not learned of her
results after a month, she should contact her health care practitioner's office.
What are the risks of having a Pap smear?
There are absolutely no known medical risks associated with Pap smear screening.
(However, there are medical risks from not having a Pap smear.)