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Pediatric & Adolescent Medicine
An undescended testicle (cryptorchidism) is a testicle that hasn't moved into its proper position in the bag of skin hanging below the penis (scrotum) before birth. Usually just one testicle is affected, but about 10 percent of the time both testicles are undescended.
An undescended testicle is uncommon in general, but common among baby boys born prematurely.
The vast majority of the time, the undescended testicle moves into the proper position on its own, within the first few months of life. If your son has an undescended testicle that doesn't correct itself, surgery can relocate the testicle into the scrotum.
Not seeing or feeling a testicle where you would expect it to be in the scrotum is the main sign of an undescended testicle.
Testicles form in the abdomen during fetal development. During the last couple of months of normal fetal development, the testicles gradually descend from the abdomen through a tube-like passageway in the groin (inguinal canal) into the scrotum. With an undescended testicle, that process stops or is delayed.
When to see a doctor
An undescended testicle is typically detected when your baby is examined shortly after birth. If your son has an undescended testicle, ask the doctor how often your son will need to be examined. If the testicle hasn't moved into the scrotum by the time your son is 4 months old, the problem probably won't correct itself.
Treating an undescended testicle when your son is still a baby might lower the risk of complications later in life, such as infertility and testicular cancer.
Older boys — from infants to pre-adolescent boys — who have normally descended testicles at birth might appear to be "missing" a testicle later. This condition might indicate:
- A retractile testicle, which moves back and forth between the scrotum and the groin and might be easily guided by hand into the scrotum during a physical exam. This is not abnormal and is due to a muscle reflex in the scrotum.
- An ascending testicle, or acquired undescended testicle, that has "returned" to the groin and can't be easily guided by hand into the scrotum.
If you notice any changes in your son's genitals or are concerned about his development, talk to your son's doctor.
The exact cause of an undescended testicle isn't known. A combination of genetics, maternal health and other environmental factors might disrupt the hormones, physical changes and nerve activity that influence the development of the testicles.
Factors that might increase the risk of an undescended testicle in a newborn include:
- Low birth weight
- Premature birth
- Family history of undescended testicles or other problems of genital development
- Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect
- Alcohol use by the mother during pregnancy
- Cigarette smoking by the mother or exposure to secondhand smoke
- Parents' exposure to some pesticides
In order for testicles to develop and function normally, they need to be slightly cooler than normal body temperature. The scrotum provides this cooler environment. Complications of a testicle not being located where it is supposed to be include:
- Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who've had an undescended testicle have an increased risk of testicular cancer.
The risk is greater for undescended testicles located in the abdomen than in the groin, and when both testicles are affected. Surgically correcting an undescended testicle might decrease, but not eliminate, the risk of future testicular cancer.
- Fertility problems. Low sperm counts, poor sperm quality and decreased fertility are more likely to occur among men who've had an undescended testicle. This can be due to abnormal development of the testicle, and might get worse if the condition goes untreated for an extended period of time.
Other complications related to the abnormal location of the undescended testicle include:
- Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. This painful condition cuts off blood to the testicle.
If not treated promptly, this might result in the loss of the testicle. Testicular torsion occurs 10 times more often in undescended testicles than in normal testicles.
- Trauma. If a testicle is located in the groin, it might be damaged from pressure against the pubic bone.
- Inguinal hernia. If the opening between the abdomen and the inguinal canal is too loose, a portion of the intestines can push into the groin.