Testicle removal, medically termed orchiectomy, is a surgical procedure to remove one or both testicles. This operation is performed for various medical reasons, including the treatment of testicular or advanced prostate cancer, managing severe infection or trauma, or as a component of gender-affirming care. Understanding the recovery process, both physically and emotionally, helps individuals prepare for the significant changes that follow. The effects of the procedure range from the immediate physical healing of the surgical site to long-term hormonal adjustments and psychosocial adaptations.
Immediate Post-Operative Recovery
The initial recovery phase focuses on the physical healing of the surgical area, typically spanning the first one to three weeks after the orchiectomy. Many patients are discharged on the same day or after an overnight stay. Mild to moderate discomfort at the surgical site is expected and managed effectively with prescribed oral pain medication, often for the first week or two.
Swelling and bruising of the scrotum are common side effects, generally starting to subside within two to four weeks. Applying a cloth-wrapped ice pack to the area for 10 to 20 minutes during the first few days can help reduce swelling. Wearing snug-fitting underwear or a scrotal support garment is recommended for several weeks to provide support and minimize movement.
Activity limitations are necessary to prevent strain on the incision site and ensure proper healing. Patients should avoid strenuous activities, such such as jogging or intense exercise, for about two to three weeks. It is important to avoid lifting anything over 10 pounds for the first four to six weeks. Light activities, like daily walking, are encouraged to promote blood flow and aid recovery.
Wound care involves keeping the incision clean; patients are often allowed to shower 24 hours after the procedure, letting warm, soapy water run over the site. Dissolvable stitches are commonly used and break down on their own over two to three weeks. Excessive redness, drainage, or pain not controlled by medication should be reported immediately, as these may indicate an infection.
Managing Hormonal Changes
The long-term hormonal consequences following an orchiectomy depend heavily on whether one or both testicles were removed. If a unilateral orchiectomy (removal of one testicle) is performed, the impact on overall testosterone levels is often minimal for most individuals. The remaining testicle typically compensates for the loss by increasing its own testosterone production.
Despite this compensatory mechanism, regular monitoring of testosterone levels is recommended, particularly in the first year after a unilateral procedure, as some patients may still develop a deficiency. For those undergoing orchiectomy due to testicular cancer, a pre-existing hormonal imbalance may increase the risk of low testosterone. In a bilateral orchiectomy (removal of both testicles), the body’s primary source of testosterone is eliminated, leading to an immediate and rapid decline.
A significant drop in androgens after a bilateral procedure necessitates the initiation of Testosterone Replacement Therapy (TRT) to manage the subsequent symptoms of hypogonadism. Symptoms of low testosterone can include:
- Fatigue
- A decrease in libido
- Mood changes
- Decreased muscle mass
- The experience of hot flashes
TRT is administered through various methods, including injections, transdermal gels, or patches, designed to restore hormone levels to a healthy range.
Restoring sufficient androgen levels alleviates many physical and psychological symptoms, leading to an improved sense of well-being. Patients receiving TRT should have their hormone levels checked regularly to ensure appropriate dosage. While TRT is generally safe, this long-term treatment requires careful medical supervision to monitor for potential side effects, such as changes in prostate size.
Physical and Aesthetic Changes
Following an orchiectomy, observable physical changes occur in the scrotum and surrounding area. The incision site, often made in the groin, will leave a scar that tends to fade and flatten over time. If only one testicle was removed, the remaining tissue and testicle will be visible, though the scrotum may appear slightly asymmetrical.
For individuals who undergo a bilateral orchiectomy, the scrotum will feel empty, which can be a significant aesthetic and emotional adjustment. To address these cosmetic concerns and improve body image, patients have the option of receiving a testicular prosthesis. These implants are designed to mimic the size, shape, and feel of a natural testicle.
Testicular prostheses are typically made of silicone and can be implanted either during the orchiectomy or in a separate, delayed procedure. The decision is highly personal, but placement can significantly improve body image and self-esteem. While prostheses are generally well-received, some patients occasionally report that the implant feels too firm or that its positioning is not ideal.
The presence of a prosthesis does not negatively affect sexual function, and patient satisfaction with the cosmetic outcome is generally high. Surgeons strive to select an appropriate size and ensure proper positioning. Patients should discuss the pros and cons, including potential complications like shifting or infection, with their urologist before deciding on implantation.
Emotional and Psychosocial Adjustment
The emotional journey after a testicle removal can be complex, involving a range of feelings that extend beyond the physical recovery. Individuals may experience anxiety, sadness, or a sense of loss related to the procedure and the underlying reason for the surgery, such as a cancer diagnosis. Concerns about body image are common, as the testicles are often connected to cultural perceptions of masculinity and identity.
Feelings of a reduced sense of masculinity or changes in self-perception can be pronounced, especially in younger individuals. While most patients adjust well, some may struggle with a negative body image or feel self-conscious. This emotional adjustment can be compounded by the physical effects of hormonal changes if they are not adequately managed with therapy.
Addressing concerns about intimacy and sexual function is an important part of the psychosocial recovery. While the physical ability to have sex is generally maintained, especially with effective TRT after a bilateral procedure, psychological factors can impact confidence and libido. Openly discussing the surgery with a partner can help alleviate anxieties about intimacy and foster a supportive environment.
Seeking professional support is beneficial for navigating these emotional and psychological adjustments. Counseling, therapy, or joining a support group provides a safe space to process feelings, address body image concerns, and learn coping strategies. Pre-operative counseling is also helpful in mitigating anxiety by providing clear expectations about the procedure and its potential long-term effects.