A lot of men will go to the GP for a sore knee but won't go for the lump on a testicle. Urology is one of those specialties most men encounter only when something has gone obviously wrong. The questions below come up in clinic constantly — usually preceded by "this is probably nothing, but…" — and they're worth answering plainly so fewer people sit on something for six months that should have been a five-minute conversation.

Is this lump on my testicle something?

Maybe, but most aren't cancer. The most common findings on self-exam are:

  • The epididymis. A coiled, slightly squishy tube at the back of each testicle. It feels different from the testicle itself. It is not a tumour. Many men only "find" it once they start checking.
  • Cysts. Smooth, round, fluid-filled, usually painless. Often above or behind the testicle. Common, benign.
  • Varicoceles. A "bag of worms" feeling, usually on the left, more obvious when standing. Dilated veins. Sometimes affect fertility, occasionally need treatment.
  • Hydroceles. Painless swelling around the testicle from fluid build-up. Usually benign, sometimes treated if uncomfortable.
  • Testicular cancer. Usually a firm, painless lump on or within the testicle itself. Most common in men 15-40. Highly treatable when caught early.

The rule of thumb: any new firm lump that feels like part of the testicle itself, any painless swelling, or any change in size or weight gets seen. Testicular cancer treated early has cure rates above 95%. Sitting on it for six months changes that conversation.

My penis curves. Is that a problem?

Most penises curve a little — up, down, left or right — and always have. That's normal anatomy. The concern is Peyronie's disease: a new curve that develops in adulthood, often with a palpable hard plaque under the skin and sometimes pain on erection. It's caused by scar tissue in the tunica albuginea (the fibrous sleeve around the erectile tissue), often from minor injury during sex.

If your curve has been there forever and isn't getting worse and doesn't hurt — it's probably just yours. If it's new, progressing over months, painful, or interfering with penetration, see a urologist. Treatments range from oral medications and injections (collagenase) early on, to traction devices, to surgery in severe cases. The earlier you intervene, the better the outcomes.

I can't pull my foreskin back. Or it gets stuck.

Two different problems with similar vibes:

  • Phimosis. Foreskin won't retract over the head. Common in young boys; usually resolves naturally. In adults, can be physiological (always been that way) or pathological (caused by scarring, infection, or lichen sclerosus). Topical steroid cream resolves a meaningful percentage. Surgery (preputioplasty or circumcision) is the option if it doesn't.
  • Paraphimosis. Foreskin retracted and now stuck behind the head, swollen, painful, can't be pulled back forward. This is a urological emergency. Get to A&E. Don't wait. Tissue can become ischaemic.

Recurrent infections under the foreskin (balanitis), persistent itching, white patches or scarring also warrant a urology visit — lichen sclerosus needs identification and treatment.

My ejaculation has changed. Is that fine?

Depends what changed.

  • Less volume than you used to have. Often age-related and benign. If sudden or dramatic, can suggest a blockage or retrograde ejaculation (semen going back into the bladder). Worth a check if persistent.
  • Blood in semen (haematospermia). Alarming to see. In men under 40, almost always benign — small inflammation in the seminal vesicles or prostate, often resolves without treatment. In men over 40 or persistent over weeks, gets a workup.
  • Painful ejaculation. Can indicate prostatitis (prostate inflammation), seminal vesicle infection, or pelvic floor dysfunction. All treatable; none something to ignore.
  • Premature ejaculation that's new. If you used to last and now you don't, anxiety and relationship stress are common drivers, but thyroid issues and prostatitis can also contribute. Worth a basic check.
  • Delayed or absent ejaculation. SSRIs are the obvious culprit, but diabetes, alcohol, and certain blood-pressure medications can do it too.

Why do I get up to pee three times a night?

Night-time urination (nocturia) becomes more common with age and is the single most common complaint that brings men over 50 into urology. The big drivers:

  • Benign prostatic hyperplasia (BPH). The prostate enlarges with age, narrowing the urethra. Symptoms include weaker stream, hesitancy, dribbling, and frequent urination day and night. Treatable with medication (alpha-blockers, 5-alpha-reductase inhibitors) and, if needed, minor procedures.
  • Drinking fluid in the wrong window. Coffee at 7pm, two glasses of wine at 9pm — both increase night urine production.
  • Untreated sleep apnoea. Counterintuitive, but apnoea drives nocturia by altering hormone signalling overnight. Worth screening if you snore heavily or wake unrefreshed.
  • Diabetes. High blood sugar pulls fluid into urine. New nocturia, especially with thirst and fatigue, gets a fasting glucose test.

Is masturbation frequency a problem?

Almost never on its own. The science here is unambiguous: regular ejaculation is associated with mildly lower prostate cancer risk in large prospective studies, and there's no health threshold above which masturbation is harmful. The exception is when it's interfering with the rest of your life — sleep, work, relationship, ability to function with a partner — in which case the issue is the compulsion, not the act.

If porn use specifically is creating arousal issues with partners (the so-called "porn-induced ED" pattern, which the research debates but clinicians see), reducing visual stimulation for a few weeks and rebuilding partnered arousal usually helps. It isn't a permanent rewiring.

Should I worry about prostate cancer?

Eventually, yes — most men over 75 will have some prostate cancer cells if you look hard enough on autopsy, and most won't have died from it. The clinically meaningful question is whether you have an aggressive prostate cancer that wants treatment now.

The screening conversation in 2026 is more nuanced than it used to be. PSA blood testing has high false-positive rates and can lead to over-treatment. Current guidance:

  • Men 50-70 with average risk: discuss PSA testing with your GP. Family history of prostate cancer or being of African descent shifts the start age earlier (often 45).
  • Black African men have notably higher prostate cancer incidence and mortality. Earlier and more proactive screening conversations are warranted.
  • Symptoms like new urinary changes, blood in urine or semen, or bone pain in older men get worked up directly.

The conversation to have with your GP

If something on this page describes you, the script is straightforward:

"I want to talk about a urology issue. It's [the lump / the curve / the night peeing / the ejaculation change]. It started [when]. Can we work out whether this needs a referral?"

South African GPs see this every week. They are not going to be embarrassed and you don't need to be either. If you'd rather skip the GP step, sexual health clinics (Marie Stopes, some Clicks Pharmacy Clinics) and private urology practices accept self-referrals.

See a clinician urgently if

  • Sudden severe testicular pain (could be torsion — a six-hour window before damage).
  • Foreskin retracted and stuck (paraphimosis).
  • Inability to pass urine at all.
  • Visible blood in urine.
  • A new firm lump on or within a testicle.

The bottom line

The problem with avoiding urology questions isn't embarrassment — it's that the conditions that genuinely matter (testicular cancer, torsion, paraphimosis, aggressive BPH, prostate cancer in higher-risk men) are time-sensitive, and the ones that are nothing are reassuring once you know they're nothing. The five minutes of awkward at the GP buys you the rest of the year of not wondering.