It was close to midnight in late September 2020 when I found myself removing yet another unfortunate torsed and necrotic testicle. The boy did not tell his parents about his pain when it started. Standing in the operating room, I remember asking, “How could we have prevented this? Wouldn’t it be nice if there were a children’s book about this…?”

I am not alone when I try to sound hopeful, forcing myself not to shake my head, as I speak to a young man in the emergency room who had ignored his painful torsing testicle for hours. Or days. But let’s face it, few parents and even fewer children know that a testicle can actually twist and die. Expecting them to know information they have no access to is unreasonable.

Like other pediatric urologists, I also frequently see boys with delayed referrals for undescended testicles. Despite the 2014 AUA cryptorchidism guideline, 68% of boys continue to be referred for evaluation past the recommended upper age for surgery of 18 months.¹ Furthermore, a steady 21% of them keep presenting after an unnecessary ultrasound. If parents knew what the AUA guideline recommended, could we offer earlier surgery, have better long-term results, and avoid needless tests?

Perhaps our messaging had been off. Why not bypass the whole medical establishment and forgo guideline updates or expensive educational campaigns targeting primary care and emergency room providers? Why not go directly to the boys and their parents, who can benefit from critical health information? Even better, why not provide it in an entertaining package that kids will like? Indeed, why not just write a humorous book about what you should know about your boy parts? Perhaps the way to go would be 3 rhyming and illustrated stories for boys 5 to 12 years old with accompanying question-and-answer sections for parents. Boom.

Over the following months, I shared the idea with friends and colleagues. One friend told me, “As a mom, I had no idea what I was dealing with. A book like this would have been so helpful!” This made perfect sense. Parents come to see me armed with a laundry list of questions about their young sons’ genitals. I get bombarded all the time with questions outside the hospital after parents learn I am a pediatric urologist. I run into perfect strangers on family vacations, on dates with my wife, at church functions, the airport, birthday parties, and at the gym, asking me questions about their son’s testicles and penis.

Parents want and deserve their questions answered. But they have difficulty finding reliable resources. Questions about “boy parts” apply to half of the world’s population, yet few people in the general public know the answers, or even where to find them. I am not aware of any child- or family-friendly resources to help parents find these answers. I hope this book will help change that.

Having published almost a hundred peer-reviewed papers, writing “What You Should Know About Your Boy Parts” has been the most challenging and most rewarding piece I put my pen to. What started off as an offhand comment blossomed to occupy many an evening as the adventures of Bobby and his testicles, Twisty and Topsy, came to life.

The writing process evolved over 3 years. The key was a great team. My wife has been my most relentless (and, at times, most exasperated) supporter and brutally honest critic. I hired talent. I worked with a great editor and a fantastic illustrator. I take full responsibility for what the book lacks.

Figure. Topsy the testicle encourages Bobby (inset) to speak to his parents about torsing Twisty’s plight. Reprinted with permission from Szymanski KM, What You Should Know About Your Boy Parts: Silly Stories for Boys with Questions and Answers for Parents. Konrad M Szymanski LLC; 2023.

I would write and rewrite in my “spare time” after a day of surgery or clinic, having put the kids to bed. The easiest part was reviewing the peer-reviewed literature and guidelines. I have done that before. But I was a complete novice venturing into children’s book writing. I read up on the craft, copyright law, iambic pentameter, self-publishing, character arcs, illustration, and setting up your own business. I drew inspiration from Dr Seuss, a genius of revolutionary rhyme and unique storytelling. The struggles of the Lorax and the annoyingly entreating Sam-I-Am helped me get in the groove as I searched for the perfect rhymes (Figure). As Twisty tells his undescended testicle twin, “Topsy, where are you? You’re not in your spot./We testes are besties. I miss you a lot!”

Another step in the writing journey was adapting the story I envisioned to appeal to the needs of my audience. I solicited feedback from over a hundred mothers, fathers, their sons, physicians, advanced practice providers, and nurses on virtually every aspect of the book, starting with the title and finishing with the illustrations. Thanks to their comments, the characters grew, and their stories developed. I added sections on bladder and bowel dysfunction as well as skin care in an uncircumcised phallus. My goal was to create something that would appeal to children and adults alike, entertain, and teach at the same time. Perhaps I succeeded.

My kids ask for “the bestie book” frequently. My 3-year-old can recognize Twisty and Topsy just as well as he can any of his favorite cartoon heroes. But what has been most inspiring has been the overwhelmingly positive feedback I have received from parents. As one single mom told me, “Without this book, I wouldn’t know how to even begin talking to my son about these things.” A dad wrote, “My sons love the book. I learned a lot.” The book is available on Amazon. I hope “What You Should Know About Your Boy Parts” helps many sons, nephews, and grandsons out there. It may help save a testicle one day!