The Nitty-Gritty 411 On Balls

There’s a nearly universal — and always mind-boggling — reaction when we tell people we spend our life podcasting, writing, and educating about puberty: they automatically assume we talk exclusively about girls. As if men magically spring from the earth fully grown. This response stems from the fact that as a culture, we’re socialized only to talk about male body changes in general and specifically “balls” (AKA testicles) as the punchline of a joke, rather than something worth having a serious conversation about. And as anyone who has ever gotten hit in the balls knows, they are worth having a very serious conversation about.

But we should level the playing field and have open conversations about all body parts. And while penises get top billing in the puberty pantheon, testicles are actually just as important because it’s where male puberty begins. Plus, we’re moms and know that boys run around talking about “balls” ad nauseam.

And because all caregiving adults should educate themselves about testicles — even the people who don’t have them! — we had to educate ourselves on this topic, including what they do, how they change and so forth, so that we could have fruitful conversations about puberty with our own sons. So we’re breaking down the 411, if you will, on balls: the basics we should all understand so that we know what’s happening with our kids’ bodies.

First, let’s do a little 101, because this is a safe space in case you know literally nothing about the topic. The testicles come in pairs (though some people are born with just one — which is true of pretty much everything that comes in pairs inside of the body). They’re egg-shaped and are contained within a sac called the scrotum. Near the top of each testicle sits a small tube called the epididymis. Sperm are made in the testicle but they are stored in the epididymis, where they finish maturing. (Cara actually wrote a book called, Guy Stuff that walks through all this information in a non-cringey way.)

The first physical sign of puberty in male bodies is often missed: extremely slow growth of the penis and testicles. This process starts when the brain releases specific hormones that travel to the testicles telling them, in turn, to make and release the sex hormone testosterone. It takes time to get the testicular testosterone factories fully up and running — it will be a while, sometimes a couple of years, until they are producing consistently high hormone levels and making sperm.

During this time, the testicles and the penis grow very slowly, a process that is hard to spot casually in the moment. It’s also around this same time that boys tend to get more private when changing their clothes, showering on their own, and closing their bedroom door more than they used to. The average onset of puberty for boys is now between ages 9-10. If the only sign is snail-like penile and testicular growth, unless you’ve got a nudist running around your house, you won’t know it's happening.

Important note, much like breasts, testicles are not always symmetrical — in fact, one almost always hangs lower than the other.

Testicles also have lumps. Many boys spend A LOT of time feeling around down under their underwear and might panic that they have cancer. The epididymis — AKA sperm’s finishing school — sits towards the top of each testicle. This structure almost always feels lumpy and bumpy. Before calling your healthcare provider in a panic, take a peek at an anatomical drawing of the testicle to see where the epididymis sits and then have your kid check the other testicle to see if they feel a similar lump on the other side. If the location is right and there’s symmetry, that’s the epididymis, not a tumor.

It’s also important to cover balls when you’re doing your puberty hygiene talks. They should be using soap on their groin, everywhere except the tip of the penis, especially once they grow public hair... because their sweat gets thicker and oilier. Beyond good washing, air is key! Our own kids change into their OOMSHORTS every day when they get home from school to give things a chance to breathe.

Things to look out for and when to see a medical provider

There’s a short list of testicular issues that should send you straight to the doctor, or even sometimes the emergency room. Not sure which one you need? Call your doctor’s office and ask! Pediatricians are almost always the first stop.

• Pain: Any sharp or acute onset pain in the testicle warrants a visit. If the epididymis gets infected, or the testicle is twisted, the pain can be so intense it causes vomiting.
• One testicle isn’t dropping or there’s an extra bulge. Pediatricians check to make sure testicles have descended starting at birth — it should be a routine part of every exam. But if a testicle ascends up into the groin and doesn’t come back down or if a new bulge appears, get checked. The new bulge, by the way, may be a hernia… another thing doctors check for during every visit (hence the “turn your head and cough” request).
• Chafing and other rashes: Because the scrotum hangs low, it can get irritated. Chafing is the rash that appears when skin rubs on skin, or sometimes when fabric rubs on skin. Lots of other rashes — from eczema to fungal infections — can appear down there as well. When in doubt, have someone check it out.

Testicles get bigger but also become more hidden during puberty, partially obscured by hair and also covered up by clothing or towels in an effort to gain privacy. It’s all very appropriate, but this doesn’t mean conversations about balls need to be clandestine as well. Science-based, non-judgmental conversations about changing bodies, how to take care of them, and when to worry removes layers of stress and confusion, for them and the adults who love them.

Dr. Cara Natterson is a pediatrician and New York Times bestselling author of ten books including The Care and Keeping of You series. Vanessa Kroll Bennett is a puberty educator and bestselling co-author with Cara of This Is So Awkward. Together, they are two of the most trusted voices on puberty. They co-host This Is So Awkward Podcast and run Less Awkward, the first company aimed at making puberty more comfortable with a membership for parents, an innovative health and sex ed curriculum for schools, and game-changing products.