Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Your testes need no introduction — otherwise known as testicles or balls, they are two oval-shaped organs located in your scrotum.
Testes perform very significant roles in your reproductive system: they are responsible for the production of testosterone and are instrumental in the formation of sperm.
Without testosterone, you wouldn’t be unable to achieve efficient erections. An erection is also often brought to an end with the discharge of sperm, making these two organs important for at least two roles in your sexual and reproductive health.
But what happens if you lose both balls? How will your sexual activities be affected? Very importantly, will this impact erectile function?
We'll be taking a closer look at the functions of your testes and the conditions which may require their removal. We'll also be examining the possibilities of achieving erections after losing one or both testicles. Then, we'll note treatment options where there are difficulties in realizing erections.
Through a process regulated by endocrine hormones, your testes are able to produce perhaps the most important elements of your reproductive system: testosterone and sperm.
By being important for the creation of both products, your testes help with the execution of many physiological functions via testosterone. They are also major determinants of male fertility through sperm.
While the exact mechanics explaining how testosterone affects erections are yet to be determined, experimental studies — many carried on animals — have suggested that testosterone may regulate the endothelial cell functions.
These endothelial cells regulate the supply of blood to surrounding tissues. They also organize the growth and development of connective tissue.
Testosterone is also believed to regulate the components necessary for the erectile process: smooth muscle cells, nerve fibers and tunica albuginea structure.
This hormone may also be useful for the release of nitric oxide which is necessary for the formation of an erection.
Likewise, sperm acts as the ultimate decider of male reproductive ability, making it a key element of the erectile process.
Without your testes, neither testosterone nor sperm will be produced effectively. This may disrupt reproductive health, as well as the formation and maintenance of erections.
The removal of one or both testes, also known as orchiectomy may occur for a number of reasons. It could be as a precautionary measure, in treatment of a condition, or as a result of trauma to the testes. These causes of an orchiectomy include:
The removal of testes may be necessary when a patient is suffering from aggressive prostate cancer. This is to prevent the production of testosterone which is known to worsen the growth of prostate cancer cells. This surgery is a precautionary measure against worsening prostate cancer.
Testicular cancer is the single-most common malignancy in men ages 15 to 45 years old, even though it accounts for just one percent of male tumors. It’s also highly curable when identified early and treated properly, with a five-year survival rate of 95 percent.
One of the ways to ensure the proper management of this condition is by removing both testes. This can prevent the multiplication of the malignant cancer cells. One testes may be removed if it is the only one affected.
This condition occurs when the testes rotate, causing a twist in the spermatic cord that supplies blood to them which can cut off blood supply.
While the testes are usually firmly secured to the scrotum, this condition may arise from trauma or exertion to the testes. In some instances it can be spontaneous.
Testicular torsion is rare and painful and is commonly observed in patients less than 25 years old.
This condition requires urgent surgery within six hours from when pain hits. An orchiectomy becomes necessary in about 20 percent to 40 percent of cases where a delay in seeking treatment has caused one or both testes to atrophy.
Blunt trauma to the testes is usually caused by sporting activities or motor vehicle/bicycle injuries. This trauma usually causes a rupture/fracture to the testes which can cause sudden pain, nausea and vomiting.
While most cases of ruptured testes may be salvaged within the first 72 hours of injury, where one or both testicles are unable to be restored, an orchiectomy becomes necessary.
There are different types of orchiectomies, depending on what condition is being treated, and the expected treatment outcomes. They include:
This requires the surgical removal of the testes through the scrotum. It is used for the removal of atrophic testicles, or testes that are no longer viable due to trauma, torsion or infection.
This type of surgery is performed where there is a benign growth in a patient with testicular cancer who is yet to hit puberty. It is intended to spare the testes.
This form of treatment is necessary to prevent over-treatment, ensure future hormonal and reproductive function, while helping to provide an effective cure.
It is also gaining popularity for use with smaller tumors. Adults may benefit from this organ-sparing approach where it is combined with radiation therapy to treat benign tumors.
This is the usual standard of treatment where a malignant growth is found in the testicles. It involves the removal of the spermatic cord and the testes.
It is adopted for adolescent or young adult patients.
And herein lies the question, fellas: can you still achieve and maintain your erection after losing your testes? Each type of orchiectomy plays a role in your erectile function, so, let’s break them all down.
When it comes to male fertility and erectile function, it's popularly believed that one testicle is enough to have erections and engage in sexual activity.
This is, of course, where the surviving testicle is in good health.
In a study to investigate how testicular torsion which occurs early in life may impact adult male fertility, 72 men who experienced the condition around the median age of 15.5 years were questioned.
Of this number, 49 had undergone orchiectomy, while 23 had surgical repositioning/orchiopexy.
Those in the orchiectomy group had 41 couples who experienced a successful first pregnancy.
It was however noticed that those who underwent orchiectomy in adolescence or adulthood took longer to get pregnant when compared to the orchiopexy group.
In another study to determine sperm production following unilateral orchiectomy to treat testicular cancer, 60 cases were examined intermittently.
At the start of the study, 36 patients were producing normal levels of sperm, seven were producing no sperm, while 17 produced only small amounts of sperm.
After a year, 45 patients were producing sperm normally, two patients that initially produced low amounts normalised, and 28 of the cases became fathers post-orchiectomy.
While these are great outcomes, living with one testicle isn't always without health complications.
In a study to determine hormone levels following orchidectomy, over 100 patients were reviewed a year following treatment.
A significant decrease in testosterone levels was recorded after orchiectomy. The concentration of other hormones like hcG and estradiol were also reduced. This didn't change after a year of treatment.
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The removal of both testes may be followed by decreased libido, lower semen levels, low testosterone and at least one sexual disorder. The ability to achieve and maintain an erection may not always be guaranteed where both testicles are removed.
Twenty-five percent reported low libido, 14 percent described their sexual capacities as poor, while 14 percent avoided sexual contact because of other therapies or diseases.
A minority of the patients found it difficult to achieve and maintain erections. Likewise, 24 percent of patients reported low semen volume after treatment. Fourteen percent dealt with premature ejaculation, while two percent dealt with late ejaculation, as well as the absence of ejaculate.
Undergoing an orchiectomy may also cause psychological stress and feelings of not being normal. This can affect body image, leading to a reduced libido.
The removal of your testes may have significant effects on libido, testosterone levels, and the ability to get and maintain an erection. However, there are multiple treatment options to help with the management and improvement of erectile function:
Phosphodiesterase-5 inhibitors, commonly known as PDE5 inhibitors, are drugs that allow blood vessels in the penis to relax, allowing for better blood flow, and thus, better quality erections.
Popular ED medications such as Viagra (sildenafil, generic Viagra), Cialis (tadalafil), Levitra (vardenafil) and Stendra (avanafil) all work by inhibiting the effects of PDE5 to improve blood flow to the penis.
These drugs essentially inhibit the phosphodiesterase-5 enzymes present in the smooth muscle of the penis, which causes the relaxation of the vascular smooth muscle in the penis, leading to the dilation of blood vessels in the penis, which allows for better blood flow.
These devices are made up of a hollow plastic tube, a hand or battery operated vacuum pump and a tension ring.
These parts help to increase the flow of blood to the penis, while also helping to maintain an erection when it is achieved.
They may be used in conjunction with a PDE5 inhibitor, but may not be a viable option, owed to adverse effects. These effects include infections, penile discomfort, bruising or numbness and mechanical failures of the device.
This requires the use of a needle to inject medication into the base or the side of the penis. It increases blood flow into the penis
Eventually, these injections can be self-administered at home for firmer erections. A P shot is one example of injections that can be used for erections.
Your testes are an important part of your reproductive and sexual health.
In the event that trauma or illness causes the loss of one or both testicles, there is a chance that erectile function may be affected.
Measures like PDE5 inhibitors, vacuum erection devices and injection therapy are, however, proven to help improve erections and erectile function.
To receive informed advice about the best option for your needs, speaking with a trusted healthcare professional is advisable.