As a 14-year-old suffering with a swollen testicle, Belfast's Michael Patrick tried his best to ignore the condition until he was finally forced to seek medical advice. He tells Meadhbh McGrath why his new play is all about challenging taboos.
For teenage boys, puberty is often a source of great embarrassment as Michael Patrick, from Belfast, can testify when he recalls his response when he had a worrying intimate medical condition.
"I had a swelling in my left testicle. I first noticed it when I was 14 or 15, and I didn't tell a soul about it," he recalls.
His father Michael had died from Motor Neurone Disease when Michael Jnr was just eight years old, and he didn't want to worry his mother Patricia, who had her hands full raising four children on her own. "I didn't have any sort of father figure to talk to, so I just ignored it and hoped it would go away on its own. It didn't, and it just got bigger and bigger and bigger," he explains. "I was terrified about it, but I just put it to the back of my brain and ignored it. I nearly told my mum so many times, then ended up telling myself it would go away or sort itself out."
Michael, now 26 and working as an actor, describes his teenage self as "a bit of a nerd, but a loud nerd". He loved science and went on to study physics at Cambridge University, but wasn't interested in sport and says he was a bit heavier in school.
Although he would share just about everything with his friends (still his close friends today), he felt this was one thing he could never raise and instead spent his nights silently panicking about what it might be.
The swelling, meanwhile, continued to grow, and began to interfere with his daily routine in rather awkward ways.
"Running was difficult, it would swing about quite a lot. Or trying to go the swimming pool was very embarrassing, or if I was on my feet for a long time I'd feel it getting heavy and there'd be an ache from the dragging nature of it."
What Michael wouldn't learn for three years was that it was a hydrocele testis, a harmless build-up of fluid around the testicle that causes the scrotum to swell. In a desperate attempt to treat it without alerting his mum, Michael resorted to a series of foolhardy home remedies.
"In my head, it was tied up with masturbation. Maybe it was Catholic guilt, but at that age you're exploring your body and learning about all these changes, so I thought it must be something to do with that. So I tried 'fasting' for a long time, then I tried doing it too much, I tried squeezing it, I tried every cream that was sitting in the medicine cupboard, I tried cold showers, hot baths, anything I thought would make it go away. It didn't, of course."
While hydroceles are quite common and benign, as the years passed he became convinced it was something far more sinister.
"My dad died from a sickness, so going through this potentially life-threatening illness really made me think of my dad again. It brought up memories I didn't want to think about - I thought, 'If this is testicular cancer, I'll have to go through all those things my dad went through'."
Just before his 18th birthday, Michael says his testicle had grown to the size and shape of a "giant avocado", and he decided he couldn't put it out of his mind any longer.
"It was getting sore, I was trying to hide it and I wasn't able to hide it. At that stage, I eventually did tell my mother and we went to the doctor," he explains.
"The doctors' reaction was 'Wow, look at the size of that thing. Why have you not come in sooner?'. They were shocked, and that worries you a bit - doctors shouldn't be shocked, they should know what's going on.
"I got fast-tracked through a lot of stuff because it was so big, and that made us all so worried. I had to go for an ultrasound on a Saturday, and you never get an ultrasound on a Saturday with the health service, you have to wait, so that made us think it was something really serious."
After a gruelling weekend, Michael's results came back and he was told it was a hydrocele. The doctors explained that the testis is generally surrounded by lubricating fluid, and excess fluid is absorbed by an outer membrane, but that the membrane had stopped working.
They would have to drain the fluid, either through needle aspiration or a surgical procedure, which reduced the chances of the hydrocele recurring. Michael opted for the surgery.
"They drained 400ml from it - less than a pint, more than a can of Coke. They stitch your testicle directly to the inside of your scrotum, so that's what I have now," he says.
"My left testicle is no longer floating around freely, it's stuck firmly to the wall of the scrotum and that performs the draining function. There were stitches to deal with, but then it was fine.
"If I'd left it any longer, there was a risk of it bursting - the skin was stretched pretty taut by the time I went in. I was very lucky, it could have been a lot worse.
"Now the skin is a bit loose, it's a bit dangly, but I can live with it."
Michael, working with his friend and co-founder of the Pan Narrans theatre company Oisin Kearney, has drawn on the experience for a one-man show, My Left Nut, premiering at the Dublin Fringe Festival next month.
"This is the first time I've ever written anything. It was petrifying; if it hadn't been accepted to the festival, there's no way I ever would have written it," he says.
"I've never had the same feeling I had when I was studying for exams until I had to write this play. But now I'm very happy with what's come out of it.
"I didn't have any hang-ups in terms of feeling too frightened to share stuff, I wanted to share the story with people. They say write what you know and I've written exactly what I know about this period of my life."
While he kept a tight lid on what was going on at the time, Michael now sees the humour in it and looks back on that time as "absolutely ridiculous. What was I so worried about?".
He explains that despite the show being largely comic in tone, it also tackles his family's grief and why he was so reluctant to seek help.
Before he started writing the play, Michael interviewed his mother about her memories of the time and about his father.
"She was embarrassed as well, she had to raise two boys without having a husband to talk to, and she was as awkward as I was," he says.
"She beat herself up a bit about it - I remember when the doctor asked me how long I had it for, I said three years and my mum just put her head in her hands. I felt so guilty."
The play has also prompted him to reassess his father's death and how it affected his childhood.
"My dad and I were very close, but I was so young when he died that I didn't really fully accept his death. Even when I'm writing this, I'm still processing his death more and more. I don't think it's something you ever fully come to terms with," he says.
Michael has since read the play to his family, and while his mother was a bit concerned about the "cruder elements" about teenage boys' antics behind closed doors, they are happy the story is being told.
He describes it as "my thank you letter to them: I went through this horrible period in my life, because I was an idiot, and you were there for me the whole way through".
As for the audience, Michael hopes it will prompt men to take their health issues seriously and not put things off in a misguided attempt to appear manly.
"When it comes to doctors, men tend to think 'Ah it'll be alright, I don't want to bother them, it'll be grand'. It's such a cliche, but I would hope this play would help people to open up and share their problems. I've written a play about it and I still don't talk to people enough.
"I was in a very loving, supportive family with a lot of close friends around me, and I still didn't open up. You can have all the support in the world, but it doesn't matter if you're not willing to make the first step.
"Don't bottle it up like a complete fool, because you think it's manly to sort it out yourself. You can't be manly if you're dead."
Hydrocele testis is "an accumulation of fluid within the layers around the testicle itself", explains consultant urologist Robert Flynn.
The cause of most hydroceles is unknown, but in some cases it can occur after infection, trauma or very rarely in association with testicular tumours.
Hydrocele testis is quite common, especially in men over 40, but can affect men of any age, including infants and children. "I would see one a week on average," says urologist Dr Dermot Lanigan.
Hydroceles are typically benign and not painful, although it can be uncomfortable and the dragging feeling can cause an ache.
"A painless swelling is the only symptom, and they can progress slowly in size," he adds. "But they are completely harmless in themselves. They don't have any effect on testicular function, sexual function or sperm count.
"The main reason someone would come to see a specialist is either worry or because they're awkward and they're unsightly."
Most hydroceles are quite small and do not need treatment, but if they continue to grow, the fluid can be removed with a surgical procedure. It is a day case procedure, and Dr Lanigan notes that it is not as painful as men may imagine.
"I tell patients they'll be walking funny for a day or two, and tender maybe for a week or 10 days after, but the wound is small, the sutures dissolve, they tend to heal up well."
The fluid makes it more difficult to feel the testicle, and in men under 40, there is a risk that there may be an underlying tumour.
"The big thing men worry about when they feel any swelling is of testicular cancer, but this is normally a smooth swelling of the whole sac rather than a hard little lump on the testis. We can normally distinguish the two, but occasionally a hydrocele might mask a tumour or an epididymal cyst at the back of the testis, rather than the hydrocele which is at the front," says Dr Flynn, adding if they are worried they should seek professional advice from the GP.