Undescended Testicle

Overview

An undescended testicle, also called cryptorchidism, is a condition in which one or both testicles have not moved down into the scrotum before birth. The scrotum is the pouch of skin below the penis where the testicles normally sit. This condition is most often noticed in newborn boys during a routine physical examination.

In many babies, the testicle moves into the scrotum on its own during the first months of life. If it remains outside the scrotum, medical evaluation is important. The position of the testicle can affect future fertility, hormone function, and the risk of other testicular problems. With timely assessment and appropriate treatment, most children can be managed safely.

Symptoms

The main sign of an undescended testicle is that one or both testicles cannot be felt or seen in the scrotum. Parents may notice that the scrotum looks smaller, flatter, or uneven on one side. In many cases, the baby has no pain or discomfort.

An undescended testicle may be located in the groin, inside the abdomen, or along the path where it would normally descend. Sometimes, a testicle can move back and forth between the groin and the scrotum. This is called a retractile testicle and is usually different from a true undescended testicle, but it still needs medical assessment to confirm the condition.

Older children may be evaluated if a testicle that was previously in the scrotum is no longer consistently there. This may happen if the testicle moves upward over time, a condition sometimes called an acquired undescended testicle.

Causes and Risk Factors

The exact cause of an undescended testicle is not always known. Normally, during pregnancy, the testicles develop inside the abdomen and gradually move down into the scrotum before birth. This process is influenced by growth, hormones, and physical development. If this movement is delayed or interrupted, the testicle may remain outside the scrotum.

Several factors may increase the chance of an undescended testicle:

• Premature birth, because the testicles may not have had enough time to descend before delivery
• Low birth weight
• Family history of undescended testicle or other genital development conditions
• Certain pregnancy-related factors that affect fetal growth
• Conditions that affect hormonal or physical development

Having an undescended testicle does not mean that parents did anything wrong. It is a developmental condition that can occur even in otherwise healthy babies.

Diagnosis

Diagnosis usually begins with a physical examination by a pediatrician, urologist, or pediatric urologist. The doctor gently checks whether the testicle can be felt in the scrotum or groin. The examination helps determine whether the testicle is undescended, retractile, or not easily felt.

If the testicle cannot be felt, further evaluation may be needed. Imaging tests are not always required, because they may not reliably locate a testicle in every case. The doctor will decide whether additional tests are useful based on the child’s age, examination findings, and overall health.

In some cases, especially when the testicle cannot be felt, a minimally invasive surgical evaluation may be recommended to locate it and decide on treatment. If both testicles are not felt, or if there are concerns about genital development, additional specialist evaluation may be necessary.

Treatment Options

Treatment depends on the child’s age, the position of the testicle, and whether one or both testicles are affected. In newborns, doctors may observe for a period of time because some testicles descend naturally in the first months of life. If the testicle remains undescended, treatment is usually recommended during early childhood.

The most common treatment is surgery, called orchiopexy. During this procedure, the surgeon moves the testicle into the scrotum and secures it in the correct position. If the testicle is located in the groin, surgery may be straightforward. If it is higher in the abdomen, a different surgical approach may be needed. The surgeon will explain the safest plan based on the individual situation.

If a testicle is very small, poorly developed, or not healthy, the doctor may discuss other options. In rare cases, the testicle may be absent or may need to be removed if it cannot function normally or poses a risk. These decisions are made carefully by specialists and discussed with the family.

After treatment, follow-up is important to monitor healing, testicular position, and development. As boys grow older, doctors may also recommend education about testicular awareness, especially because a history of undescended testicle can be associated with a higher risk of future testicular problems.

When to See a Doctor

Parents should seek medical advice if one or both testicles are not seen or felt in the scrotum, either at birth or later in childhood. It is also important to consult a doctor if the scrotum looks uneven, if a testicle seems to move upward and stay out of the scrotum, or if there is any concern about genital development.

Urgent medical attention is needed if a child has sudden groin or scrotal pain, swelling, redness, vomiting, or a testicle that appears to be in an abnormal position. These symptoms may be related to other conditions that require prompt evaluation.

Regular pediatric check-ups are important because an undescended testicle is often found during routine examination. Early referral to a urology specialist can help families understand the condition and choose appropriate care at the right time.