Undescended Testicles: What You Need to Know

What are undescended testicles?

An undescended testicle, also called cryptorchidism, is a surgical disorder in newborn boys. The condition occurs when a baby is born with one or both testicles not positioned properly inside of the scrotum (the sack of skin located below the penis that contains the testicles). While a mother is pregnant with a boy, his testicles form inside his abdomen (stomach areas) and then normally travel down into the scrotum during the third trimester. An undescended testicle occurs when this process is not completed, and the testicle remains somewhere between the abdomen and the groin (private parts area).

An undescended testicle is normally detected at birth by a doctor, who will wait to see if the affected testicle will descend (or “drop”) on its own within the first six months of the baby’s life. If the testicle does not descend after six months, it will likely need to be fixed with surgery.

Undescended testicles are painless and typically harmless as long as they’re treated early on. However, an untreated undescended testicle can cause complications such as:

• infertility in the affected testicle
• a hernia in the area of the undescended testicle, called an inguinal hernia. Read more about inguinal hernias in children here(hyperlink)
• testicular torsion
• low self-confidence and body image struggles in your son as he gets older

Performing surgery to bring an undescended testicle into the scrotum also places the testicle into a position where it can easily be felt and monitored for tumors later in his life. 

What causes undescended testicles?

Doctors aren’t sure yet what causes a baby to have undescended testicles. However, the condition is more likely to occur if

• A family member has had an undescended testicle
• The baby is born prematurely

What are the symptoms of undescended testicles?

Babies with undescended testicles may have

• A testicles that appear to be missing
• A testicle that cannot be felt inside the scrotum
• Painless swelling or a lump in the groin area

Depending on whether your baby has one or both testicles affected, there may also be changes to the appearance of the scrotum

• If your baby has one undescended testicle, the scrotum may look uneven or lopsided
• If both of your baby’s testicles are affected, the scrotum may look flat and abnormally small 

How are undescended testicles diagnosed?

A doctor will perform a physical exam on your baby right after birth to determine whether or not the testicles are present in the scrotum.

A physical examination is used to rule out the possibility that your baby has retractile testicles, rather than undescended testicles. Retractile testicles are present in the scrotum sometimes, but not all the time. This is due to overactivity in the muscle that draws the testicles up into the body in response to things like stress and cold weather. Retractile testicles usually go away on their own either before or during puberty.

A doctor may also use an ultrasound to create an image of your baby’s abdomen and determine the exact location of the testicles.

How are undescended testicles treated?

Undescended testicles are treated with a surgery called orchiopexy, which moves the testicles down from the abdomen down into the scrotum. During the orchiopexy procedure, your child will be put to sleep under general anesthesia and feel no pain. The surgeon will make a small incision in his groin and free the testicle from its incorrect location in either the abdomen or the groin and move it down into the scrotum. If your son has developed a hernia associated with the testicle, the surgeon will also repair this during the surgery. 

In some cases, the undescended testicle may be undeveloped or made of dead tissue, which the surgeon will remove. If this happens, you might be asked to consider saline testicular prostheses, also called a testicular implant, for the scrotum. The implant will fill the space where the testicle is missing and give the scrotum a normal appearance, which will help to raise your son’s body image in the future.

How long does it take to recover from orchiopexy surgery?

Some patients might feel some discomfort after the operation, but most feel better after about a day. In order to prevent injury to the testicle or further discomfort, doctors normally recommend that patients avoid intense physical activity or sitting on riding toys for about two weeks. After surgery, the doctor will schedule follow-up appointments to make sure that the testicle is developing, functioning properly, and staying in place. These follow-up exams might include:

• Physical exams
• Ultrasound exams of the scrotum
• Tests of hormone levels