While bathing their baby, many parents gently feel the scrotum and notice that one side seems empty. This is how many families first discover cryptorchidism, while others are told by a doctor during an infant check-up. Do not panic—this is a very common condition in baby boys, and in many cases the testicle descends on its own during the first few months after birth. What really matters is this: if it still has not come down once the window for natural descent has passed, do not keep waiting.
What is cryptorchidism (undescended testicle)?
During fetal development, the testicles form inside the abdomen near the kidneys and gradually move downward, usually settling into the scrotum around the time of birth. If a testicle stops partway along this path or goes to the wrong place instead of staying in the scrotum, the condition is called cryptorchidism, also known as an undescended testis or undescended testicle.
Why the testicles move downward is currently thought to involve several factors working together, including traction from the tissues that anchor the testicle, abdominal pressure, and the influence of hormones—with hormones playing a major role. If anything goes wrong at any step, the testicle may stop along the way. It is more common in premature babies than in full-term babies, and it affects one side more often than both sides.
Where might the testicle stop?
When a doctor cannot feel the testicle inside the scrotum, it is broadly grouped by its location:
- Intra-abdominal testis: the testicle remains inside the abdomen and cannot be felt from the outside
- Inside the inguinal canal: it stops within the passage in the groin, where a small firm lump can sometimes be felt
- Ectopic testis: it strays off the normal path and ends up near the perineum, above the pubic bone, or near the opposite side of the scrotum
- Retractile testis: the testicle has actually descended, but a strong cremasteric reflex pulls it back up into the groin whenever the child is cold, nervous, or touched
This last type is the most common cause of a false alarm for parents. A retractile testis is very common in children around school age. The testicle returns to the scrotum during a warm bath or when the child is relaxed, and it usually settles permanently by puberty. Treatment is generally not needed, though it is still best to have a doctor confirm the diagnosis and follow up regularly.
What are the symptoms?
Cryptorchidism itself typically causes no pain or itching, and a child will not complain of discomfort. Most often, someone notices during a bath, diaper change, or check-up that one side of the scrotum looks flatter or smaller, or that nothing can be felt inside. The doctor will also check for any other associated genital development issues, such as hypospadias.
Why should it not be left untreated?
There is a good reason the testicles belong in the scrotum. The temperature inside the scrotum is slightly lower than inside the abdomen, and testicles need this cooler environment to produce sperm properly. Leaving a testicle inside the body for too long can lead to several issues:
- Reduced fertility: testicular tissue gradually changes over time, affecting sperm production. The farther the testicle is from the scrotum and the longer treatment is delayed, the greater the impact generally is. However, the secretion of male hormones usually remains normal, so secondary sex characteristics later in life—such as facial hair and voice deepening—are typically unaffected
- Higher risk of testicular tumors: an undescended testis has a higher chance of developing a malignant tumor later in life, most often appearing after puberty. While surgery to bring the testicle into the scrotum does not eliminate the risk completely, it allows for self-examination and much easier early detection
- Testicular torsion: a testicle sitting in an abnormal position is more prone to twisting
- Easier injury: a testicle trapped in the groin has less protection against bumps and impacts
- Often accompanied by an inguinal hernia: many children with cryptorchidism also have an open hernia passage, which is repaired at the same time during surgery
- Appearance and emotional well-being: an uneven scrotum is something a child may become self-conscious about as he grows older
What examinations are needed?
The single most important step is a physical examination by a doctor. An experienced physician will examine the child in a warm, relaxed setting to distinguish true cryptorchidism from a retractile testis.
- Ultrasound: helps locate a testicle in the groin, though deeper ones may not be visible—so not seeing a testicle on ultrasound does not mean it is absent
- CT or MRI: used in special situations to locate the testicle, after carefully weighing the necessity for a child
- Laparoscopy: When neither testicle can be felt or the location is unclear, the doctor may use laparoscopy directly to locate the testicle and treat it at the same time
If neither testicle can be felt on both sides, congenital absence of the testicles or other developmental issues must be considered, and the doctor will arrange blood tests and further evaluation.
Treatment: When Is Surgery Needed?
The general rule is: you can observe during the first few months after birth, but if the testicle still has not descended around the first birthday, it is unlikely to come down on its own. Surgery is recommended at this point rather than putting it off until school age.
- Orchiopexy: The main treatment method, which brings the testicle down into the scrotum and secures it in place. Depending on the location of the testicle, surgery may be performed through the groin or by laparoscopy
- Hormone therapy: Used in the past to help the testicle descend, but its effectiveness is limited and it is rarely the first choice today. Discuss with your doctor whether it is suitable
- Orchiectomy: If the testicle is already significantly shrunken and non-functional, or if the condition is only discovered at an older age, the doctor may recommend removal to prevent future tumour risk
- Testicular prosthesis: If appearance is a concern after removal, implanting a testicular prosthesis can be considered when grown up
- Retractile testis: Surgery is usually not needed and regular follow-up is sufficient; in the few cases where the testicle later stays pulled up and does not come back down, further evaluation is required
Some parents worry about their child having surgery at such a young age. This type of operation is very common in paediatric urology, usually done as a day procedure or with a short hospital stay, and recovery is quick. Waiting too long is actually a greater concern than the surgery itself.
What If Cryptorchidism Is Only Discovered in Adulthood?
Occasionally, a man only discovers during an adult check-up that one testicle is not in the scrotum. By this stage, sperm production in that testicle has usually been affected, so management focuses on tumour risk: the doctor will evaluate whether to move it into the scrotum for easier monitoring or remove it directly. If you plan to have children, a semen analysis is also recommended.
What Should You Watch For After Surgery?
- Attend follow-up appointments as instructed by your doctor to confirm that the testicle remains secured in the scrotum and is a normal size
- As your child grows up, teach him to feel his own testicles and perform occasional self-examinations from puberty onwards, seeking medical attention if any hard lump or swelling is felt
- Men with a history of cryptorchidism may consider an earlier fertility evaluation after marriage if pregnancy takes longer than expected
Advice from the Urologist
Cryptorchidism is not an emergency, but timing matters. A baby can be observed during the first few months after birth, but if the testicle still has not descended around the first birthday, you should consult paediatric urology to discuss surgery rather than continuing to wait. If you cannot tell whether it is a retractile testis, having a doctor examine it once is the most reliable way.
Cryptorchidism Frequently Asked Questions (FAQ)
Not necessarily. Many cases are a retractile testis, which pulls back into the groin when cold or nervous and comes back down once relaxed. Try feeling for it during a warm bath, though having a doctor examine your child remains the most accurate approach.
It can, most often within the first few months after birth. If it still has not descended around the first birthday, the chance of it coming down on its own is very low, and surgical evaluation is recommended.
Waiting is not recommended. The longer a testicle stays inside the body, the more its sperm-producing ability is affected, and the harder it is to monitor for tumours later on. Early surgery protects fertility and places the testicle where it can be easily felt.
Not necessarily. Many people with unilateral cryptorchidism who receive early treatment have normal fertility; the impact is greater when both sides are affected or when treatment happens later. If you plan to have children in adulthood, you can start with a semen analysis.
Usually not. The testicle has already descended on its own and simply pulls back up easily, and in most cases it settles into place by puberty. However, regular follow-up is needed because a small number may eventually stay pulled up and not come back down, which requires further evaluation.
Regular follow-up visits are still recommended for the testicle after orchiopexy. From puberty onward, learn to perform testicular self-exams and see a doctor if you notice a hard lump, swelling, or unexplained pain.
Further Reading
- What Is Testicular Torsion?
- What Is a Hydrocele?
- What Causes Scrotal Swelling?
- What Causes a Low Sperm Count?
- What Causes Testicular Pain?
- Testicular Prosthesis Implantation Surgery
Medical References
- EAU Guidelines on Paediatric Urology (European Association of Urology, section on Undescended testes)
- AUA Guideline: Evaluation and Treatment of Cryptorchidism (American Urological Association)
- Taiwan Urological Association
This article provides general health education information and does not replace a doctor’s diagnosis. Please seek medical evaluation if you have any symptoms or concerns.
