Undescended testis

Overview

Undescended testis, also called cryptorchidism, is a condition where one or both of a baby boy's testicles do not move down into the scrotum before birth. The testicles normally form inside the abdomen and drop into the scrotum during the last few months of pregnancy. In undescended testis, they stay in the abdomen or the groin area.

Yes, it is common. About 3 percent of full-term newborn boys and up to 30 percent of premature boys are born with at least one undescended testicle.

It affects newborn boys, especially those born prematurely or with a low birth weight.

Symptoms

Common symptoms

• The testicle cannot be felt in the scrotum.
• The scrotum may look smaller on one side.

Symptoms in children

• In older children, the testicle might be felt in the groin instead of the scrotum.
• Sometimes the testicle can be gently moved into the scrotum but goes back (retractile testicle).

Symptoms in older adults

• For adults, the scrotum may be empty on one side, and they may feel a lump in the groin.

Causes

Main causes

• The exact cause is unknown, but it is likely due to a combination of hormonal and physical factors that affect the testicle's movement.
• Sometimes the testicle is blocked from moving down by growths or other tissues.

Risk factors

• Premature birth or low birth weight
• Family history of undescended testis
• Certain medical conditions in the mother during pregnancy, such as diabetes or smoking

When to see a doctor

See a doctor urgently if:

• Your baby has sudden pain, swelling, or redness in the groin or scrotum.
• Your baby is vomiting or has a fever.

Book a routine appointment if:

• If you notice your baby’s testicle is not in the scrotum by 6 months of age.
• At any age, if you think one testicle is missing or feels different.

Diagnosis

The doctor will perform a physical exam. They will feel the scrotum and groin for the testicle. If the testicle is not felt, they may do an ultrasound to find it.

Tests that may be done

• Ultrasound (sound wave imaging) to locate the testicle and check its size.
• Laparoscopy (a tiny camera inserted through the belly button) if the testicle is not found by ultrasound.

What to expect at your appointment

The exam is quick and painless. The doctor will gently feel the scrotum and groin. If an ultrasound is needed, it does not hurt. You can stay with your baby the whole time.

Treatment

Treatment aims to bring the testicle down into the scrotum to help fertility and reduce the risk of testicular cancer. The main treatment is surgery, often done before age 2.

Self-care at home

• Keep the diaper area clean and dry to prevent irritation.
• No home treatments can move the testicle down.

Medical treatments

Sometimes hormone treatments (such as human chorionic gonadotropin injections) are used, but they are not common. The standard and most effective treatment is surgery called orchidopexy, where the doctor gently moves the testicle into the scrotum and secures it in place.

When is surgery considered?

Surgery is usually recommended if the testicle has not descended by 6 to 12 months of age. It is typically done as a day surgery (no overnight stay) and has a high success rate.

Living with this condition

After surgery, your child can usually return to normal activities within a week or two. For an untreated undescended testicle, regular check-ups are important to monitor for changes.

Lifestyle tips

• No special lifestyle changes are needed.
• If your child has had surgery, follow your doctor’s advice on activity restrictions (like no rough play for a short time).

Diet and exercise

Normal diet and exercise for your child’s age are fine. After surgery, your doctor may suggest a soft diet for a day if needed.

Mental health and emotional wellbeing

For older boys or adults, having an undescended testicle can affect body image or self-esteem. Surgery and open conversations with a healthcare provider can help. If needed, counseling can support emotional well-being.

Prevention

Undescended testis is not usually preventable because the cause is not fully understood. However, avoiding smoking and managing health conditions during pregnancy may reduce some risks.

Complications

If left untreated

• Higher risk of infertility because the testicle needs to be in the scrotum to produce healthy sperm.
• Increased risk of testicular cancer later in life.
• Higher chance of inguinal hernia or testicular torsion (twisting of the testicle, which is a medical emergency).

Long-term outlook

With timely treatment, the outlook is excellent. Most boys who have surgery before age 2 have normal fertility and a very low risk of testicular cancer. Even if treated later, outcomes are generally good. Your healthcare team will guide you through the best options for your child.

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