Undescended Testicles

Overview

Undescended testicles is a condition where one or both testicles haven't moved into the scrotum (the pouch of skin below the penis) before birth. In the womb, testicles form inside the belly and usually drop into the scrotum during the last few months. Sometimes this drop doesn't happen, and the testicle stays in the abdomen or the groin. It's most often found in baby boys, but it can also be noticed later in childhood or even in adults.

Yes. About 1 to 2 out of every 100 baby boys born at full term have an undescended testicle. The number is higher for babies born early (premature), affecting about 30 out of 100.

It most often affects baby boys, especially those born premature or with a low birth weight. It can also be found in older boys or adult men who were not treated in childhood.

Symptoms

Common symptoms

• An empty scrotum on one side or both sides
• A testicle that can be felt in the groin but not in the scrotum
• A soft bulge in the groin area
• No pain or discomfort in most cases

Symptoms in children

• Same signs as in babies: scrotum looks flat or uneven
• A testicle that may move down temporarily and then go back up
• If the child is older, they might mention a lump in the groin

Symptoms in older adults

• An adult who was not treated earlier may notice one scrotum is empty
• No pain typically, but it can be associated with fertility problems
• Slightly higher risk of testicular cancer, so it should be checked by a doctor

Causes

Main causes

• The exact cause is often unknown
• Hormones from the mother or the baby may affect the pathway that guides the testicle down
• A physical blockage or problem with the tissue that pulls the testicle down

Risk factors

• Premature birth (before 37 weeks)
• Low birth weight
• Family history of undescended testicles
• Certain genetic conditions, such as Down syndrome

When to see a doctor

See a doctor urgently if:

• If you notice sudden severe pain in the scrotum or groin
• If the scrotum becomes swollen, red, or tender
• If the child has nausea or vomiting with groin pain

Book a routine appointment if:

• If your baby boy's testicle has not moved down by 6 months of age
• If you ever notice a missing testicle in the scrotum during a check or while changing a nappy
• If you or your son have concerns about fertility later in life

Diagnosis

A doctor can usually diagnose an undescended testicle with a physical exam. They will look at and feel the scrotum, groin, and lower belly. The room may be warm to help the testicle relax and move down.

Tests that may be done

• Physical exam of the scrotum and groin
• Ultrasound (a painless scan using sound waves) if the testicle cannot be felt
• Sometimes a small camera test (laparoscopy) if the testicle is very deep in the abdomen

What to expect at your appointment

The doctor will ask about the baby's birth history and any family history. They may ask you to bring the baby back for a repeat exam because testicles can move down on their own. If treatment is needed, a referral may be made to a specialist (urologist or pediatric surgeon).

Treatment

The main goal is to bring the testicle into the scrotum, ideally in the first year of life. In some cases, waiting is all that's needed. If it hasn't descended by 6 months, treatment is usually recommended. Treatment is highly successful and can help protect fertility and lower cancer risk.

Self-care at home

• Keep routine checkups with your doctor
• Continue normal nappy changes and bathing
• Don't try to push the testicle down yourself
• Watch for any pain or swelling and report it to your doctor

Medical treatments

Hormone therapy is sometimes used. It involves giving a medicine – usually an injection – that might encourage the testicle to lower. This is not always effective and is used less often than surgery. Surgery (called orchidopexy) is the most common and reliable treatment. During this small operation, the surgeon brings the testicle down into the scrotum and fixes it in place. It is usually done between 6 and 18 months of age, and most children recover quickly.

When is surgery considered?

Surgery is recommended if the testicle hasn't descended by 6 months of age, or if it's found later in a child or adult. In adults, surgery may also be considered to reduce cancer risk, even if fertility is no longer a concern.

Living with this condition

After treatment, most boys are back to normal within a few days. The scrotum may be swollen for a week or two. You'll need to keep follow-up appointments to make sure the testicle stays in place. For adults who had untreated undescended testicles, regular self-exams of the scrotum are a good way to stay aware of any changes.

Lifestyle tips

• Let your child return to normal play once the doctor says it's safe
• Keep the surgical area clean and dry as directed
• For adults, do monthly testicular self-exams and see your doctor if you notice any lump or swelling

Diet and exercise

There are no special dietary needs. After surgery, avoid heavy lifting or rough play for the time your doctor recommends. A healthy mix of fruits, vegetables, and regular physical activity supports overall health for both children and adults.

Mental health and emotional wellbeing

For parents, it can be stressful to learn about a condition that involves your baby's health. Most babies do extremely well, so try to focus on the simple steps forward. For adults who were not treated, there may be feelings of embarrassment, anxiety about fertility, or body image concerns. It can help to talk openly with your doctor, a counsellor, or a trusted friend. If you ever feel hopeless or have thoughts of self-harm, please reach out for crisis support immediately.

Prevention

Undescended testicles cannot be prevented. It happens during development in the womb. Treatment, however, can prevent most long-term complications, so early detection and follow-up are the most important steps.

Complications

If left untreated

• Higher risk of testicular cancer
• Lower fertility or infertility
• Increased risk of a hernia (a bulge where tissue pushes through muscle)
• Higher chance of testicular torsion (twisting of the testicle), which is a medical emergency

Long-term outlook

The outlook is very good with treatment. When surgery is done in early childhood, the testicle almost always works normally, and fertility is usually preserved. There is still a slightly higher than average risk of testicular cancer, but regular self-exams help catch any issue early. With timely care, almost all boys and men can live full, healthy lives.

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