Orchiectomy

An orchiectomy is a surgical treatment that consists of the removal of one or both testicles (bilateral orchiectomy). The testicles are the male sex organ which produce sperm and testosterone.1 Multiple reasons exist for undergoing an orchiectomy. Contrary to popular belief, removing one testicle does not decrease a male’s sexual drive. A single testicle is sufficient for both fertility and proper hormone production. In addition, removing one testicle does not cause impotence (the loss of the ability to have an erection). However, removing both testicles may affect one’s sex life. Some males choose to have a gel-filled prosthesis implanted in the scrotum to replace the missing testicle, but the majority of males find this to be unnecessary.

 

Reasons for an Orchiectomy

There are a number of reasons why a person would benefit from an orchiectomy. The following sections will outline these different conditions.

Cancer

An orchiectomy is considered the best treatment for testicular cancer, and can also be used to treat prostate cancer.1 Testicular cancer can be diagnosed through a scrotal ultrasound and serum tumor markers (high levels of certain proteins), but cannot be confirmed until an orchiectomy is performed.2 Testicular cancer is very curable but can be difficult to treat if the cancer has spread to other areas of the body. If diagnosed early and an orchiectomy is performed, survival rates are very high. When an orchiectomy is performed because of testicular cancer, it is called a radical inguinal orchiectomy.1 Different types of orchiectomies will be discussed later in the article. In early-stage testicular cancer, doctors may use a surveillance program to monitor a patient’s health after an orchiectomy is performed. Other types of treatments, such as chemotherapy and radiation, may be used in conjunction with an orchiectomy. Since radiation and chemotherapy negatively affect male fertility, testicular cancer patients may want to consider storing their sperm at a sperm bank.3 Doctors might also decide to remove the lymph nodes surrounding the groin area so that the cancer is less likely to spread to other areas of the body.

Although testicular cancer is not as common or as deadly as many other cancers that occur in males, such as prostate cancer, males should be aware of the symptoms and risk factors so that they can detect the disease in its earliest stages. Because testicular cancer is the most common form of cancer in young males, some individuals choose to regularly perform a testicular self-examination. This examination can easily be performed after a bath or shower. To examine yourself, face a mirror and hold the penis away from the testicles, so you can see them more easily. Then, one after the other, hold each testicle between your thumb and index finger and roll gently so that you can feel if there are any lumps or enlargements in the testes. If you feel any symptoms or have any concerns, see a doctor as soon as possible.

Gender Confirmation Surgery

Gender confirmation surgery, also called gender reassignment surgery, can be an important aspect for individuals transitioning from male to female or female to male. Orchiectomy can be performed for transgender patients who are transitioning from male to female. An orchiectomy may be followed by a vulvoplasty and vaginoplasty.4 Transgender patients who choose to undergo these surgeries usually undergo a bilateral orchiectomy to remove both testicles. This procedure also makes hormone therapy more effective since it removes the source of testosterone production from the body. This means that transgender patients could discontinue the use of anti-androgen medication (such as Spironolactone) and lower the amount of estrogen they take.5 Hormone therapy is different for each individual, therefore, transitioning individuals should consult with a doctor about the process. Ultimately, an orchiectomy provides transgender patients with a way to feel more comfortable in their body.

 

Surgery Specifics

With any surgery, there are multiple aspects to consider and understand before deciding if surgery is the best option. Some of these aspects include how the operation is performed, what the risks are, and what post-operation care will entail. Orchiectomy can be performed with local or general anesthesia in an out-patient setting or a short hospital stay.1 Full recovery is expected in two to four weeks. Following post-operation instructions from your doctor is crucial to ensuring that a full recovery can be achieved. Prosthetic testicles are always an option for males who undergo an orchiectomy and wish to have the impression of testicles afterwards. However, not all males decide that prosthesis is necessary.2 There are two types of orchiectomy that can be performed in the case of cancer:

  • Radical Inguinal Orchiectomy: In this procedure, both the testicle and spermatic cord are removed. They are removed through a small incision made in the lower abdomen.2
  • Partial Orchiectomy (Testes-Sparing Surgery): The implications for fertility and testosterone replacement have made this type of orchiectomy more realistic, although a radical inguinal orchiectomy still remains the standard. In this procedure, the spermatic cord and testicle are left in-tact. The mass on the testicle is carefully removed and sent to the lab to confirm a cancer diagnosis. If cancer is detected, then a radical inguinal orchiectomy is performed. A thorough consultation with a doctor should be done to discuss potential outcomes and expectations.6

Any surgery comes with risks, side effects, possible complications. Orchiectomy comes with relatively low risks but can result in reactions to anesthesia, infection, and bleeding.1 When a bilateral orchiectomy is performed, some of the side effects are heavily linked to the substantial decrease in testosterone. Some of these side effects are infertility, erectile dysfunction, loss of muscle mass, and decreased sexual drive.1 The biggest complications that can arise from an orchiectomy are bleeding into the scrotum, also called a hematoma.2 Nerve damage can also occur. This is characterized by decreased sensation in the thigh, scrotum, or base of the penis. Fortunately, this is only temporary and should improve within a few weeks or months.2

This potentially life-saving surgery carries many benefits that outweigh the risks. Talking with a doctor about the different aspects of surgery will give patients the opportunity to ask questions and gain a comprehensive understanding of what the surgery will entail.

 

Orchiectomy and Sex

The effect that an orchiectomy has on one’s sex life will depend on whether one or both testicles are removed. A bilateral orchiectomy will come with the previously mentioned side effects on fertility and sex life. Males who still want to have biological children after a bilateral orchiectomy should consider storing their sperm at a sperm bank for future use. For cancer patients who have also had their lymph nodes removed during the procedure, they may experience retrograde ejaculation due to nerve damage. Testicular cancer survivors may decide to undergo testosterone replacement therapy in order to counteract the low testosterone levels experienced after surgery. Hormone replacement therapy will help maintain a normal sex drive. For male-to-female transgender patients, an orchiectomy is a gender confirmation surgery. If patients do not wish to have vaginal intercourse, they may have a vulvoplasty performed. But, if patients want the ability to have vaginal intercourse, a vaginoplasty is the better option. Both surgeries include the creation of a clitoris using skin from the head of the penis, which contains many nerve endings. Through manual stimulation of the clitoris, transgender women can successfully achieve orgasm.

 

Concluding Remarks

For both cancer and transgender patients, an orchiectomy offers the chance at a new life. Fortunately, this procedure is relatively low-risk and has many benefits. Consulting with a doctor about surgical options, expectations, and side effects will offer the most comprehensive experience for patients who are considering this procedure.

References

  1. Healthwise Staff. "Orchiectomy for Testicular Cancer." Orchiectomy for Testicular Cancer | Michigan Medicine. 2018.  
  2. "Radical Orchiectomy." Johns Hopkins Medicine Health Library.
  3. "Testicular Cancer and Fertility." Testicular Cancer Awareness Foundation.
  4. "Male-to-Female Gender Confirmation Surgery." U of U Health.
  5. Washington, S., et al. “215 Bilateral Orchiectomy For Transgender Patients: An Efficient Surgical Technique That Anticipates Future Vaginoplasty and is Associated with Minimal Morbidity”. The Journal of Sexual Medicine, Volume 14, Issue 2, 2017, pp. e91-e92.
  6. "Partial Orchiectomy." Johns Hopkins Medicine Health Library.

 

Last Updated: 15 April 2019.

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