Testicular Self-Examination Is NOT Recommended for Routine Screening in Adults
Testicular self-examination (TSE) is not recommended for routine screening in asymptomatic adult males. The U.S. Preventive Services Task Force (USPSTF) gives this a Grade D recommendation, meaning clinicians should actively discourage this practice in the general population 1.
Rationale for This Recommendation
Why Screening Provides No Net Benefit
Testicular cancer has excellent survival rates regardless of detection method: Over 90% of all newly diagnosed cases will be cured, even when detected at symptomatic stages 1.
The disease is rare: With an annual incidence of only 5.4 cases per 100,000 males, the absolute risk is extremely low despite being the most common cancer in men aged 15-34 years 1.
Most cases are discovered incidentally: Patients or their partners typically find testicular masses accidentally, and there is inadequate evidence that systematic TSE detects cancer at earlier or more curable stages compared to incidental discovery 1.
The sensitivity and specificity of TSE are unknown: No data exist to demonstrate that TSE performed by patients or clinicians improves detection accuracy 1.
Potential Harms of Screening
- False-positive results lead to unnecessary anxiety and additional testing 1.
- Diagnostic procedures carry their own risks when pursuing false-positive findings 1.
- While these harms are considered "no greater than small," they outweigh the minimal to absent benefits 1.
Consensus Among Major Organizations
The recommendation against routine TSE is remarkably consistent across professional societies:
- American Academy of Family Physicians: Recommends against routine screening 1.
- American Cancer Society: Does not recommend TSE 1.
- American Academy of Pediatrics: Does not include TSE in preventive health recommendations 1.
Important Exception: High-Risk Populations
The one notable exception comes from the 2025 European Association of Urology guidelines, which recommend TSE for men with testicular microlithiasis (TM) and associated risk factors 1. Specifically:
Men with TM should perform self-examination if they have additional risk factors such as infertility, cryptorchidism, testicular cancer history, or atrophic testes, as this may result in early detection of testicular germ cell tumors 1.
For men with isolated TM without risk factors, extensive screening (including TSE, ultrasound follow-up, or tumor markers) is not recommended 1.
Critical Clinical Caveat
This recommendation applies ONLY to asymptomatic screening. Any man who notices testicular symptoms (mass, swelling, pain, changes in size or consistency) should immediately seek medical evaluation 1. The recommendation against screening should never discourage symptomatic patients from appropriate care 1.
The Bottom Line for Clinical Practice
Do not routinely teach or recommend TSE to asymptomatic adult males in your practice 1. The low incidence of testicular cancer combined with its excellent prognosis—even when detected symptomatically—means that systematic screening provides no meaningful mortality or morbidity benefit 1. The exception is men with specific high-risk features like testicular microlithiasis plus additional risk factors, who may benefit from self-examination 1.