Common Urological Concerns: Testicle Size, Fertility, and Circumcision

Genital issues

1.
Is it normal for the size and shape of the left and right testicles to be different? It feels like the left is smaller and the right is larger.

2.
If the sperm count is low, is it impossible to conceive naturally?
3.
I can easily retract the foreskin to the coronal sulcus when not erect, but during an erection, I need to use my hand and it feels tight.
Do I need a circumcision?

Xiao A, 20~29 year old female. Ask Date: 2020/10/13

Dr. Li Xinyi reply Urology

1.
It is true that many people have asymmetrical features, but it is essential to have a physician examine it to confirm.

2.
Not necessarily; theoretically, the ability to conceive may be reduced.

3.
There seems to be a slight phimosis, but it is important to consult a urologist for an examination and further discussion with the physician to confirm.

Reply Date: 2020/10/13

More Info

When it comes to common urological concerns, it's important to understand that variations in anatomy and function can be quite normal. Let's address your questions one by one.

1. Testicle Size and Shape Differences: It is completely normal for the testicles to differ slightly in size and shape. Most men have one testicle that is larger or hangs lower than the other. The left testicle is often found to be lower than the right in many men. This asymmetry is usually not a cause for concern unless accompanied by pain, swelling, or other unusual symptoms. If you notice significant changes in size, shape, or any discomfort, it would be wise to consult a healthcare professional for a thorough evaluation.

2. Sperm Count and Natural Conception: A lower sperm count can indeed affect fertility, but it does not necessarily mean that natural conception is impossible. The World Health Organization defines a normal sperm count as being 15 million sperm per milliliter of semen. If your sperm count is below this threshold, it may reduce the chances of conception, but many men with lower counts can still father children. Factors such as sperm motility (the ability of sperm to swim) and morphology (the shape of sperm) also play critical roles in fertility. If you have concerns about your sperm count, it may be beneficial to undergo a semen analysis and consult with a fertility specialist who can provide personalized advice based on your specific situation.

3. Circumcision and Foreskin Tightness: The ability to retract the foreskin easily when not erect but experiencing tightness during an erection may indicate a condition known as phimosis. Phimosis is when the foreskin cannot be easily retracted over the glans (the head of the penis). If this condition causes discomfort, pain, or hygiene issues, circumcision may be recommended. However, many men live with phimosis without any problems. If you are experiencing discomfort or have concerns about your foreskin, it’s best to discuss this with a urologist. They can evaluate your situation and recommend the best course of action, which may include options other than circumcision, such as topical treatments or stretching exercises.

In summary, variations in testicle size are normal, and while a lower sperm count can affect fertility, it does not eliminate the possibility of natural conception. If you are experiencing issues with your foreskin, consulting a healthcare professional can help determine the best approach for your situation. Regular check-ups and open discussions with your healthcare provider can help address any concerns you may have and ensure your reproductive health is in good standing.

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