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There are men who have three testes, the ball-like sac that makes sperm. In fact, there are men who have four, five, and six testes inside their two testicles (the testicles plus the scrotum, the pouch around it) or inside their testicles and their abdomen. This condition of polyorchidism or supernumerary testes is both more common than you might think but also a relatively rare condition. There are hundreds of cases in the medical literature, but it's something that many doctors won't encounter in their professional careers.

There are "symptoms" of supernumerary testes that appear in many cases:

  • The extra "ball," if there's just one, is more likely to appear on the left side than on the right. However, if it appears on the right side rather than the left, it is more likely to become malignant.
  • About 75 percent of multiple testicles are visible in the scrotum, but sometimes the additional testicle never descend. It remains in the abdomen.
  • Men who have this condition typically first notice when they are about 17 years old. One or in rare cases both testicles will be swollen and painful. Palpating (feeling) the testicle will reveal that there are two (or sometimes three) testes in the same sac.
  • The added pressure of the additional testes can twist the spermatic cord. When this happens, circulation to the testicle can be cut off. This is a medical emergency that always requires surgery. It's actually possible to die of a "twisted ball."
  • About 30 percent of guys who have more that two testicles will find out when they have an inguinal hernia
  • Multiple testes are more prone to testicular cancer.

Polyorchidism occurs before birth when the embryo is making the "genital ridge" that will become the testes, sperm ducts, and penis. For some reason, the ridge fails to form, and multiple testicles grow into the scrotum or the abdomen. 

Polyorchidism used to be treated with surgical removal of the excess testis or testes every time because of the risk of testicular cancer. Now doctors sometimes offer the option to retain the extra "ball" because of the possibility of increased fertility. If they allow this, however, they will also make sure that they schedule repeated MRIs on a regular basis to make sure it has not become cancerous. After about age 35, testicular cancer is very rare and it may not be necessary to have checkups quite as often. Testes that have not descended, that are still inside the abdomen, are more likely to become cancerous. If the additional testis is not attached to the vas deferens, the channel for sperm from the testicle to the urethra, then there is no possibility that it will contribute to fertility so there is no reason to keep it.

When men don't have surgical removal of their extra "balls," they are at lifetime risk for testicular torsion. Like testicular cancer, it is a condition that is relatively rare after the age of 35, but it something that has to be treated right away — in six hours or less. Testicular torsion isn't something a man won't notice. The symptoms usually include:

  • Severe pain
  • On just one side of the scrotum
  • That appears suddenly
  • With discoloration of the skin over the testis, especially in baby boys.

By the time pain begins to subside, tissue has begun to die. It is essential to get treatment by a urologist in a hospital to avoid permanent damage. Men who have multiple testes have to get prompt medical treatment for testicular pain. But men who don't have multiple testes likewise need immediate treatment when these symptoms arise.

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