Undescended Testicle — Explained by Medical Evidence, Not Myths

An undescended testicle means one or both testicles have not moved down into the scrotum as expected. It is a common condition in newborn boys, and early medical follow-up helps guide treatment, protect future fertility, and reduce later complications.

Overview

An undescended testicle is a testicle that has not moved into its usual position in the scrotum by birth or in the months soon after. Doctors call this condition cryptorchidism. It may affect one testicle or, less often, both. In many babies, especially those born early, the testicle may descend on its own during the first few months of life.

Medical evidence shows that the main concern is not appearance alone. The scrotum helps keep the testicles at a slightly cooler temperature than the rest of the body, which supports normal development and future sperm production. When a testicle remains outside the scrotum, the risks of reduced fertility, testicular torsion, inguinal hernia, and later testicular cancer are higher than usual.

This topic is often surrounded by myths, such as the idea that all boys will simply “grow out of it” or that massage or exercises can bring the testicle down. In reality, a persistent undescended testicle should be assessed by a qualified doctor. Evidence-based care focuses on careful examination, follow-up during infancy, and treatment at the right time if descent does not occur naturally.

Symptoms and how it may appear

The most noticeable sign of an undescended testicle is that one side of the scrotum looks emptier, smaller, or less full than the other. In babies and children, the condition usually does not cause pain. Many cases are found during a newborn examination or routine child health visit rather than because the child seems unwell.

The testicle may be located in the groin, just outside the normal path of descent, or higher in the abdomen where it cannot be felt. A doctor may describe the testicle as palpable if it can be felt on examination, or nonpalpable if it cannot. This distinction helps guide treatment planning.

It is also important to distinguish an undescended testicle from a retractile testicle. A retractile testicle can move up out of the scrotum because of a normal muscle reflex, then return to the scrotum, especially when the child is relaxed or warm. A true undescended testicle does not stay in the scrotum normally. In some children, a previously descended testicle may move back up and become an ascending testicle, which also needs medical review.

• One or both testicles seem absent from the scrotum
• The scrotum looks uneven or underdeveloped on one side
• A testicle may sometimes be felt in the groin
• Usually no pain, fever, or urinary symptoms are present

Causes and risk factors

Before birth, the testicles form in the abdomen and usually move down into the scrotum during late pregnancy. An undescended testicle happens when this process is delayed, incomplete, or altered. In many cases, there is no single clear cause. Instead, doctors understand it as a condition influenced by a mix of hormonal, developmental, anatomical, and genetic factors.

Certain babies have a higher chance of being affected. Premature birth is one of the strongest risk factors because the final part of testicular descent often occurs later in pregnancy. Low birth weight, being small for gestational age, and a family history of genital development differences may also increase risk. Some babies with specific hormonal or genetic conditions can have undescended testicles as part of a broader pattern of development.

The position of the testicle matters too. In some children, the testicle is simply delayed along the usual path of descent. In others, it may be ectopic, meaning it has moved to an unusual location outside the normal path. Less commonly, the testicle may be absent or have shrunk because of a problem before birth. When both testicles are nonpalpable, doctors consider whether there may be a hormonal or developmental issue and assess the child more carefully.

Diagnosis and evaluation

Diagnosis usually begins with a careful physical examination. An experienced pediatrician, family doctor, or pediatric urologist examines the child in a warm, calm setting and gently checks the scrotum and groin. This often provides the most useful information. The clinician looks for whether the testicle can be felt, whether it can be moved into the scrotum, and whether it stays there.

Parents are sometimes surprised to learn that routine ultrasound is not always helpful. Medical guidelines generally emphasize that imaging often does not change initial management, especially when the diagnosis is clear on examination. If the testicle cannot be felt, referral to a specialist is usually more useful than repeated scans. In selected cases, further evaluation may include hormone tests or a laparoscopic procedure to locate a nonpalpable testicle.

The doctor also considers related conditions, especially an inguinal hernia, because the two can occur together. If there is uncertainty between an undescended testicle and a retractile one, the child may need follow-up over time. Some children may also be assessed for associated urologic concerns such as hypospadias if the genital examination suggests another developmental difference.

Treatment options

If the testicle has not descended by about 6 months of age, spontaneous descent becomes less likely. At that point, doctors usually recommend specialist assessment and planning for treatment. The standard treatment for a persistent undescended testicle is surgery called orchiopexy, which moves the testicle into the scrotum and secures it there. When performed at the recommended age, this approach supports normal development and may reduce later complications.

Orchiopexy is typically done under general anesthesia by a pediatric urologist or pediatric surgeon. The exact technique depends on where the testicle is located. A palpable testicle in the groin is often treated through a small groin or scrotal incision. A nonpalpable testicle may require keyhole surgery to locate it and bring it down safely. This is often discussed in relation to orchiopexy surgery.

Hormone therapy has been used in some settings, but surgery remains the main evidence-based treatment for most persistent cases. If a testicle is severely underdeveloped or absent, the surgeon may explain why repositioning is not possible. In older children or adults with a long-standing undescended testicle, treatment decisions may differ depending on fertility goals, the condition of the testicle, and cancer risk. When a hidden testicle must be located first, minimally invasive laparoscopy may be part of care.

Follow-up after treatment is important. The aim is to confirm that the testicle remains in the scrotum and is growing appropriately. Families may also receive guidance on long-term monitoring, especially in adolescence and adulthood, because a history of undescended testicle still carries some increased testicular cancer risk even after successful repair.

Possible complications if untreated

The most widely discussed long-term concern is fertility. A testicle that remains outside the scrotum may be exposed to higher temperatures that can affect its development. The risk is greater when both testicles are undescended or when treatment is delayed. Early surgery does not guarantee normal fertility later on, but it can improve the outlook compared with leaving the testicle undescended.

There is also an increased risk of testicular cancer compared with the general population. The risk remains higher even after repair, but bringing the testicle into the scrotum makes examination and future detection easier. This is one reason doctors recommend ongoing awareness during adolescence and adulthood rather than assuming the issue is permanently forgotten after childhood treatment.

Other complications include inguinal hernia, trauma, and testicular torsion, which is a twisting of the spermatic cord that can cut off blood supply. Torsion causes sudden pain and swelling and needs urgent medical care. Psychological concerns may also arise later because of differences in scrotal appearance or worries about sexual and reproductive health. For related emergencies or symptoms such as sudden testicular pain, prompt assessment is important.

Prevention, self-care, and long-term outlook

There is no reliable way for families to prevent an undescended testicle during pregnancy or after birth. What helps most is early recognition and regular child health checks. Parents should know that home remedies, manipulation, or massage do not safely correct the problem. A qualified doctor should guide observation and treatment decisions.

After surgery, most children recover well and return to normal activities according to their surgeon’s advice. Parents may be asked to watch for swelling, redness, fever, or signs that the testicle has moved position again. Attending follow-up visits matters because the doctor will assess healing and confirm that the testicle remains in the scrotum.

As boys grow older, they may be advised on normal testicular awareness and how to notice changes such as a new lump, persistent discomfort, or asymmetry. This advice is not meant to cause worry but to encourage confidence and familiarity with their own body. In international centers such as Acibadem International, multidisciplinary specialists in pediatric urology and surgery at JCI-accredited hospitals diagnose and treat undescended testicle, including cases that may need pediatric urology care.

When to seek medical care

Medical care should be sought if a newborn or infant appears to have one or both testicles missing from the scrotum. Parents do not need to panic, because some testicles descend naturally in the first months of life, but the finding should be mentioned at routine visits and followed up appropriately. If the testicle is still not in place by around 6 months of age, specialist referral is usually recommended.

Older children should be assessed if a testicle that was once in the scrotum seems to have moved higher, if the scrotum looks uneven, or if there is any uncertainty about whether the testicle is retractile or truly undescended. Adults who notice that a testicle has never been in the scrotum, or who were never treated in childhood, should also seek urologic evaluation.

Urgent medical care is needed for sudden groin or scrotal pain, swelling, redness, nausea, or vomiting, because these can be signs of torsion or another emergency. Prompt assessment is also important if an undescended testicle is associated with other genital differences, a groin bulge suggesting hernia, or concerns about puberty, fertility, or hormonal development.

Frequently asked questions

Can an undescended testicle come down on its own?

Yes, some undescended testicles descend naturally during the first few months after birth. If the testicle is still not in the scrotum by about 6 months of age, spontaneous descent becomes less likely and specialist assessment is usually advised.

Is an undescended testicle painful?

Usually, no. Most babies and children with an undescended testicle do not seem to have pain, and the condition is often found during a routine examination. Sudden pain or swelling is different and needs urgent medical evaluation.

What is the difference between an undescended testicle and a retractile testicle?

A retractile testicle can move up and down because of a normal muscle reflex and can often be guided into the scrotum, where it may stay for a time. An undescended testicle does not normally stay in the scrotum and may remain in the groin or abdomen.

Does an undescended testicle always need surgery?

Not always right away, because doctors may observe infants during early months to see whether natural descent occurs. However, if the testicle remains undescended after that period, surgery is usually the recommended treatment because it offers the best chance to reduce future risks.

Can an undescended testicle affect fertility later in life?

It can, especially if both testicles are affected or if treatment is delayed. Early treatment can improve the outlook, but the degree of future fertility depends on several factors, including how long the testicle remained undescended and whether one or both sides were involved.

Does treatment remove the risk of testicular cancer completely?

No. Repair lowers some risks and makes future examination easier, but a person with a history of undescended testicle still has a higher-than-average risk compared with someone who never had the condition. That is why long-term awareness and appropriate medical follow-up remain important.

References

• American Urological Association
• European Association of Urology
• American Academy of Pediatrics
• National Institute of Diabetes and Digestive and Kidney Diseases
• National Health Service

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.