Can a man remove his testicles?

Testicular Cancer: What Does It Mean For Sex Life?

Testicular cancer is the most common malignant tumor in young men between the ages of 20 and 40. In Germany there are over 4,000 new cases every year. The good news: testicular cancer is curable. But what are the consequences for sex life?

According to the Robert Koch Institute (RKI), testicular cancer, with a relative 5-year survival rate of 96 percent and a relative 10-year survival rate of 95 percent, is one of the easily curable tumors. The risk of death is low. Over 90 percent of testicular tumors are detected at an early stage and can be treated successfully. But the therapy is not always without consequences.

Testicular cancer and potency

The testes produce around 2,500 sperm per second. The sex hormone testosterone, which among other things regulates the production of semen and is responsible for libido, can also be found in the testes. If a malignant tumor forms, the therapy influences the function of the genital organ. The treatment can influence the production of testosterone, which can have consequences for libido and potency. The administration of special testosterone preparations, for example, can help many men against dwindling desire and erectile dysfunction.

Testicular cancer: fertility at risk

"The bigger problem, however, is fertility. Most men already have significantly reduced sperm counts at the time of diagnosis, "says Dr. Susanne Weg-Remers, Head of the Cancer Information Service (KID) at the German Cancer Research Center (DKFZ)." If a testicle has to be removed, the initial situation worsens additionally. Chemotherapy and radiation therapy can also have a negative impact on the quantity and quality of sperm. "

With more extensive operations there is an additional risk: namely that nerves that are necessary for ejaculation will be injured. According to the DKFZ, it can then happen that the ejaculation either no longer takes place at all or a so-called retrograde ejaculation occurs, i.e. the semen is diverted into the urinary bladder.

Cryopreservation: Freeze semen prior to therapy

According to the cancer experts, sperm may still be obtained for artificial insemination. Nevertheless, they advise their patients to save semen in advance: "Since the course of treatment cannot be foreseen, the doctors recommend that the men affected have their sperm frozen in a sperm bank," says Weg-Remers. "The costs are usually not covered by the health insurances, but you should ask about the options for reimbursement before treatment."

According to the German Society for Urology (DGU), the frozen sperm can be stored indefinitely in the freezer and later used for fertility treatment if the quality of the ejaculate has deteriorated permanently due to the treatment of testicular cancer.

Urologists want early detection measures

In order to detect testicular cancer at an early stage, urologists recommend an annual ultrasound examination. However, the men have so far had to dig into their pockets for this. Early detection measures such as those for colon cancer or breast cancer have not yet been offered.

"From a medical point of view, an early diagnosis of testicular tumors makes sense, since one could identify practically every testicular tumor early with simple, non-stressful examinations such as palpation, ultrasound or blood sampling," says Dr. Wolfgang Bühmann, urologist and scientific editor of the Professional Association of German Urologists (BDU). He would like special examinations to be offered as a health insurance benefit for the early detection of testicular cancer.

Bühmann does not see the danger of overtreatment: "You don't need to be afraid, on the contrary. With early detection, part of the testicle can be preserved in some situations or subsequent chemotherapy, radiation or surgery can be reduced or avoided."

Palpate the testicles regularly

The KID, on the other hand, is more cautious than the BDU when it comes to recommending testicular ultrasound for the early detection of testicular cancer: There are (still) no high-quality (randomized, controlled) studies that show that this examination is superior to self-examination - i.e. it saves more lives or is less invasive Treatments and the risks (overdiagnosis, false-positive diagnoses) are within an acceptable range.

In addition to the annual possible check-up, according to the KID, self-examination is an important measure for the early detection of testicular cancer. At least once a month men should carefully palpate their testicles in a relaxed position. "It is best to take a warm shower or bath in the morning or evening. Then the muscle tissue under the skin is particularly soft and changes can be felt more easily," explains Weg-Remers.

Don't ignore these warning signs of testicular cancer

The classic leading symptom is a painless hardening within the scrotum. An increase in size, accumulation of fluid and a certain feeling of heaviness in the testicle area are also among the warning signs. Pain in the testicle area, swelling and pulling should also be taken seriously. Anyone who would like to know how to do the palpation correctly can ask their doctor for "instructions" and let them show them what is important.

Testicular cancer: The foundation stone of the disease is laid before birth

The exact reason why testicular cancer develops has not yet been conclusively clarified. It is clear that genetic predisposition plays an important role. Experts assume that the basis for the disease is laid before birth. In the prenatal development phase, "incorrectly programmed" germ cells could develop in the testes of the unborn child, from which cancer cells later develop, explains the German Cancer Aid in its patient guide "Testicular Cancer". The hormonal surge during puberty would eventually lead to the precursor cells turning into cancer cells and eventually starting to grow.

The biggest risk factors for testicular cancer

As reported by the DGU, men who suffered from undescended testicles (inguinal testicles) in their childhood have an increased risk of the disease. This risk persists even with a later surgical correction. Confirmed risk factors are still a brother's testicular tumor disease (genetic disposition), the presence of cancer precursor cells in the testes and a fertility disorder.

The right to a second opinion

In the event of a cancer diagnosis, not only do the affected men have the opportunity to get a second opinion to be on the safe side, but also the doctors. As part of the "Second opinion testicular tumor" project funded by the German Cancer Aid, the doctor can anonymously send his examination results and therapy plan to the experts of the German Testicular Tumor Study Group (GTCSG) using an internet database and receive an assessment in a timely manner.

The aim of the project is to achieve optimal treatment results across Germany. According to evaluations, every sixth second opinion led to a significant adjustment of the therapy plan: In 40 percent of the men, the therapy could be reduced, in 26 percent it was made more extensive. Those affected who would like to hear a second opinion can ask their doctor to coordinate the diagnosis in a second opinion network. There are no costs for the doctor or the patient.

Thematic week testicular cancer of the German Society for Urology

Further important information on the subject is also offered by the awareness campaign "Urological Thematic Week Testicular Cancer", which is being organized by the German Society for Urology e.V. (DGU) from March 27 to 31, 2017. On the specially set up website, interested parties can find everything important on the subject at a glance. The expert chat, which will take place on March 31, 2017 between 2 p.m. and 4 p.m. on the homepage of the German Urologists at, offers space for personal questions.

Important NOTE: The information is in no way a substitute for professional advice or treatment by trained and recognized doctors. The contents of t-online cannot and must not be used to independently make diagnoses or start treatments.

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  • Subjects:
  • Health,
  • Testicular cancer,
  • artificial fertilization,
  • Sperm,
  • Testosterone,
  • Erectile dysfunction,
  • Fertility,
  • Undescended testicles,
  • Cancer,
  • Diseases & Symptoms