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​What Exactly Happens When You Pop a Testicle and How to Fix It

With equal parts morbid curiosity and dedication to public service journalism we called a genital urological surgeon to find out what happens when you pop a ball.

Brian Moylan

Brian Moylan

An antique ball from an 1899 anatomy book

Every man with at least one functional ball has taken a hit to the junk, a jab to the jock, a plundering of the family jewels. The universal pain and hilarity of the situation has kept America's Funniest Home Videos in business for over 25 years. Balls are more durable than you might think, and most of the time a little sack tap results in nothing more than a few moments of stomach-churning pain.

But sometimes, when the planets align and a nut is knocked hard enough or in just the right spot, it can rupture. What then? How do you put a ball back together after it breaks and will it ever be the same? Who are the faceless heroes who operate on man's most sensitive (and perhaps important) organ? Dr. Simon McRae, a genital urological and oncological surgeon at St. Vincent's Hospital in Western Massachusetts, is one of those heroes. With equal parts morbid curiosity and dedication to public service journalism we called Dr. McRae up to find out what happens when you pop a ball and how to fix it.

VICE: What is the worst ball injury you've ever seen?
Dr. Simon McRae: I can remember one guy was playing hockey and got whacked with a puck in that area and it ruptured his testicle. We did the usual diagnostic evaluation and we decided he needed surgery. That wasn't the worst, though, because he was fine. You couldn't even tell a couple of weeks later that it had happened.

OK, so what was the worst?
There was a cop who had a gun in his pocket. He fired the gun and the rebound from the butt of the gun crushed his testicle between the gun and his pubic bone and it popped a bit. His situation was messier because it was a more complicated rupture than the guy with the hockey puck. He probably lost half the volume of his testicle, so that was disconcerting for him because he was a macho guy.

Can you die from a ruptured testicle?
They're not life threatening. The worst case is that you lose a testicle or both testicles. But I've never had a situation where a guy loses both.

But you've treated people who lost one testicle?
There was a mountain biking accident, and that guy ended up losing his testicle. It was completely annihilated. He came down with the full force of his considerable weight on the center bar of his mountain bike. There was no capsule left to stitch it back together to hold the innards in. We just removed it and put in a prosthesis.

You're talking about capsules and innards. What exactly is a ruptured testicle? The testicle has a parenchyma, which is the meat of the testicle. It's a somewhat soft gelatinous rubbery consistency. Then it is bound by a thin capsule called a tunic. So you have a blunt force trauma, and it sort of ruptures the capsule that binds the innards. It looks like a cracked egg or a disrupted egg and the stuff is pushing out through the defect in the capsule and you see this oozy material popping out. You have to remove the stuff that is oozing out and then sew the capsule shut.

How do you diagnose it?
There are people who show up with swollen nut bags all the time that we don't do anything to. Differentiating those from people that need treatment is the first thing. The diagnostic test is an ultrasound and there are a few things you're looking for. You want to see good blood flow to the testicle. If it's twisted you have to untwist it and if it's not you have to remove it. The other thing you need to see is that the capsule is intact in all areas and there is no evidence of the parenchyma oozing out. It can look awful on the outside, all black and blue and swollen, but if the blood flow is good and the capsule is intact, it can be the most awful thing in the world, but you don't touch it.

Image via Flickr user Jake Guild

What can you do for a bruised nut that doesn't require surgery?
A few weeks of good scrotal support as well as anti-inflammatory medicine and ice on and off for a few days. Then transition to heat therapy, like sitting in a hot bath, for a week or so.

How long does it take to recover from testicle surgery?
Usually a week. It is still going to be sore or swollen for four to five weeks, but it won't be limiting for that amount of time. They won't want to do much and will be too sore to go to work for about a week.

How long before you can have sex again?
Whenever they're ready. There is nothing about sex that could hurt them unless they're doing something crazy with a cock ring or something. Otherwise, I leave it up to them. No one is really in the mood to do it in the first week. They're too hesitant to do it.

Are there any long-term effects to rupturing a ball? Does it affect testosterone or fertility at all?

None for hormones, even if they lose the whole testicle.You have one on the other side to compensate. There are plenty of guys with one who have plenty of testosterone and plenty of kids. No one has any functional deficit from testicular repair or the loss of a testicle.

How many of these have you seen?
Not that many. Maybe only four or five in the ten years I've been working as a doctor.

Is there any way to prevent a popped ball?
The way to avoid it is prevention or avoiding dangerous things. Otherwise there is nothing else you can do.

So don't carry a gun in your pocket, even if you're a cop?
Exactly.

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