7 Key Symptoms of Undescended Testicle: Warning Signs Parents Should Know

An undescended testicle, medically known as cryptorchidism, is a condition where one or both testicles fail to move down into the scrotum before birth. This is one of the most common congenital abnormalities affecting male infants, occurring in approximately 3% of full-term newborns and up to 30% of premature baby boys. While many cases resolve naturally within the first few months of life, recognizing the symptoms early is crucial for timely medical intervention and preventing potential complications such as infertility or testicular cancer later in life.

Understanding the signs and symptoms of undescended testicle helps parents and caregivers identify the condition promptly. This comprehensive guide outlines the seven most important symptoms and warning signs associated with cryptorchidism, providing detailed information to help you recognize when medical evaluation is necessary.

1. Empty Scrotum on One or Both Sides

The most obvious and primary symptom of an undescended testicle is an empty or underdeveloped scrotum on the affected side. When examining your baby boy, you may notice that one side of the scrotum appears smaller, flatter, or less full compared to the other side. In cases where both testicles are undescended, the entire scrotal sac may look unusually small and underdeveloped.

During a physical examination, you won’t be able to feel the testicle in its normal position within the scrotum. The scrotum should normally contain two firm, oval-shaped testicles that can be gently felt through the skin. If one or both are missing from their expected location, this is a clear indication of cryptorchidism.

What to look for:

• Asymmetrical appearance of the scrotum
• One side noticeably flatter or smaller than the other
• Unable to palpate (feel) one or both testicles in the scrotal sac
• The scrotum may feel soft and empty when gently examined

2. Testicle Located in the Groin Area

In many cases of undescended testicle, the testicle hasn’t completely failed to descend but has stopped somewhere along its normal path. Most commonly, the undescended testicle can be found in the inguinal canal, which is the passageway between the abdomen and the scrotum located in the groin area.

Parents or healthcare providers may be able to feel a small, firm lump or mass in the groin region, particularly in the crease where the thigh meets the lower abdomen. This testicle may be more noticeable when the baby is relaxed or warm, and less apparent when the baby is cold or crying, as the cremaster muscle reflex can cause the testicle to retract further upward.

Characteristics of a groin-located testicle:

• A small, movable lump can be felt in the inguinal region
• The lump may move slightly with gentle pressure
• More prominent during warm baths or when the baby is relaxed
• May cause slight bulging in the groin area

3. Retractile Testicle Movement

Some boys have what appears to be an undescended testicle but actually have a retractile testicle, which is a related condition that can sometimes be confused with true cryptorchidism. A retractile testicle is one that moves back and forth between the scrotum and the groin due to an overactive cremaster muscle reflex.

While this isn’t technically the same as an undescended testicle, it’s an important symptom to recognize. With a retractile testicle, you may observe that the testicle is sometimes present in the scrotum and sometimes disappears into the groin area. This movement is often triggered by cold temperatures, touch, or emotional stress that causes the cremaster muscle to contract.

Signs of retractile testicle:

• Testicle can be manually guided into the scrotum but retracts again
• Intermittent presence in the scrotum
• More likely to retract during physical examination or when cold
• Typically returns to the scrotum on its own when relaxed and warm

4. Abdominal Mass or Swelling

In less common cases, the undescended testicle may be located high in the abdomen rather than in the inguinal canal. When this occurs, the testicle may not be palpable during a physical examination at all. However, in some instances, particularly if there are associated complications, there may be subtle abdominal swelling or a mass that can be detected.

An intra-abdominal testicle is more difficult to identify through physical examination alone and often requires imaging studies such as ultrasound or MRI for proper diagnosis. This type of undescended testicle carries a higher risk of complications and typically requires surgical intervention.

Indicators of abdominal location:

• Complete absence of palpable testicle in both scrotum and groin
• Possible subtle lower abdominal fullness or asymmetry
• Requires imaging for definitive location
• May be associated with other congenital abnormalities

5. Associated Inguinal Hernia

Boys with undescended testicles have a significantly higher risk of developing an inguinal hernia on the same side. An inguinal hernia occurs when abdominal contents, such as intestine or abdominal fluid, push through the inguinal canal, creating a visible bulge in the groin area.

The presence of a hernia alongside an undescended testicle is an important symptom to recognize because it may require more urgent surgical attention. Parents should watch for signs of a hernia, including a bulge that becomes more prominent when the baby cries, coughs, or strains, and disappears when the baby is calm or lying down.

Signs of associated inguinal hernia:

• Visible bulge or swelling in the groin or scrotum
• Bulge increases in size with crying or straining
• May cause discomfort or irritability in the baby
• In severe cases, the bulge may become firm, tender, or discolored (indicating strangulation, which is a medical emergency)

6. Asymmetric Scrotal Development

Beyond simply appearing empty on one side, the scrotum itself may show abnormal development when a testicle is undescended. The side lacking a testicle often doesn’t develop the same skin rugae (wrinkles) and texture as the side with a normally descended testicle. This asymmetric development is particularly noticeable in older infants and children.

The affected side of the scrotum may appear smoother, less pigmented, and less developed than the normal side. Over time, this difference may become more pronounced if the condition is not addressed. In cases of bilateral undescended testicles, the entire scrotum may appear underdeveloped, smooth, and smaller than expected for the child’s age.

Developmental differences to observe:

• Smoother skin texture on the affected side
• Reduced or absent rugae (scrotal wrinkles)
• Lighter pigmentation compared to the normal side
• Overall smaller size and less robust appearance
• Lack of temperature-related contraction and relaxation on the affected side

7. No Pain or Discomfort (In Most Cases)

Interestingly, one of the key symptoms of uncomplicated undescended testicle is the absence of symptoms—specifically, the lack of pain or discomfort. Most infants and young children with cryptorchidism do not experience any pain, tenderness, or apparent distress from the condition itself. The undescended testicle typically doesn’t cause the child any noticeable discomfort.

This absence of pain is actually a distinguishing characteristic that helps differentiate uncomplicated undescended testicle from other conditions such as testicular torsion or trauma, which are painful emergencies. However, parents should be alert to any changes in this pattern. If a child with a known undescended testicle suddenly develops pain, swelling, or tenderness in the groin or abdominal area, this could indicate a complication such as testicular torsion or incarcerated hernia and requires immediate medical attention.

Important pain-related considerations:

• Undescended testicle itself is typically painless
• Baby shows no signs of distress or discomfort from the condition
• Normal feeding, sleeping, and activity patterns
• Sudden onset of pain or tenderness is abnormal and requires urgent evaluation
• Pain may indicate complications requiring immediate medical care

Main Causes of Undescended Testicle

Understanding the causes of cryptorchidism can help parents recognize risk factors and understand why the condition occurs. While the exact cause isn’t always identifiable, several factors are known to contribute to undescended testicles:

Premature Birth

Premature infants have a much higher incidence of undescended testicles because testicular descent typically occurs during the last trimester of pregnancy. Babies born before 37 weeks of gestation may not have had sufficient time for the testicles to complete their natural descent into the scrotum.

Hormonal Factors

The process of testicular descent is regulated by hormones, including testosterone and other substances produced by the fetal hypothalamus and pituitary gland. Abnormalities in hormone production or response can interfere with normal testicular descent. Conditions affecting the hypothalamic-pituitary-gonadal axis may result in cryptorchidism.

Genetic and Familial Factors

Boys with a family history of undescended testicles have an increased risk of developing the condition. Certain genetic syndromes and chromosomal abnormalities, such as Down syndrome, Prader-Willi syndrome, and conditions affecting androgen production or response, are associated with higher rates of cryptorchidism.

Anatomical Abnormalities

Physical abnormalities in the pathway from the abdomen to the scrotum can prevent normal testicular descent. These may include:

• Abnormal development of the gubernaculum (the tissue that guides testicular descent)
• Narrow or blocked inguinal canal
• Abnormal attachment of the testicle
• Insufficient or absent processus vaginalis

Maternal Factors

Certain maternal conditions and exposures during pregnancy have been associated with increased risk of undescended testicles:

• Maternal diabetes
• Obesity during pregnancy
• Exposure to certain environmental chemicals and endocrine disruptors
• Maternal smoking or alcohol consumption
• Use of certain medications during pregnancy

Low Birth Weight

Babies born with low birth weight (less than 2,500 grams or 5.5 pounds), regardless of gestational age, have an increased risk of cryptorchidism. This may be related to overall developmental delays or hormonal insufficiencies.

Other Congenital Abnormalities

Undescended testicles may occur alongside other congenital conditions affecting the genitourinary system, abdominal wall, or other organ systems. The presence of other birth defects may increase the likelihood of cryptorchidism.

Prevention of Undescended Testicle

Unlike many other health conditions, undescended testicle is generally not preventable because it’s a congenital condition that develops before birth. However, there are some measures that may help reduce risk and ensure the best possible outcomes:

Prenatal Care and Healthy Pregnancy

While not guaranteed to prevent cryptorchidism, maintaining optimal health during pregnancy may reduce risk:

• Avoid smoking, alcohol, and recreational drugs during pregnancy
• Maintain a healthy weight before and during pregnancy
• Control chronic conditions such as diabetes with proper medical supervision
• Avoid unnecessary exposure to environmental toxins and endocrine-disrupting chemicals
• Take prenatal vitamins as recommended by your healthcare provider
• Discuss all medications with your doctor before taking them during pregnancy

Regular Prenatal and Newborn Screening

While this doesn’t prevent the condition, early detection is crucial:

• Attend all scheduled prenatal appointments
• Ensure thorough physical examination of newborn boys, including genital examination
• Request specific evaluation if you have a family history of cryptorchidism
• For premature infants, ensure careful monitoring and follow-up examinations

Awareness of Risk Factors

Being aware of factors that increase risk can help parents and healthcare providers be more vigilant:

• Know your family history of cryptorchidism or other congenital conditions
• Inform your pediatrician about any risk factors
• Ensure more frequent monitoring if risk factors are present
• Be prepared for the possibility if your baby is born prematurely

Frequently Asked Questions About Undescended Testicle

At what age should undescended testicles be treated?

Most undescended testicles that will descend naturally do so within the first 3-6 months of life. If the testicle hasn’t descended by 6 months of age, it’s unlikely to descend on its own. Medical evaluation and treatment are typically recommended between 6 and 18 months of age to minimize the risk of complications and preserve fertility potential.

Can an undescended testicle descend on its own after birth?

Yes, many undescended testicles descend spontaneously during the first few months after birth, particularly in premature infants. Studies show that approximately 70-80% of undescended testicles present at birth will descend naturally by 3 months of age. However, spontaneous descent after 6 months is rare, and descent after 12 months is extremely unlikely.

How is an undescended testicle diagnosed?

Diagnosis primarily involves physical examination by a healthcare provider who will attempt to locate the testicle by palpation (feeling for it with their hands). The examination is typically performed with the child in different positions—standing, sitting, and lying down—and in a warm environment to relax the cremaster muscle. If the testicle cannot be felt, imaging studies such as ultrasound, CT scan, or MRI may be used to locate it, though these are not always conclusive. In some cases, laparoscopy (a minimally invasive surgical procedure) may be needed for definitive diagnosis and location.

Does having an undescended testicle affect fertility?

An undescended testicle can affect fertility, particularly if left untreated or if both testicles are affected. Testicles need to be in the scrotum where the temperature is slightly cooler than body temperature for optimal sperm production. The longer a testicle remains undescended, the greater the potential impact on fertility. Early treatment significantly improves the chances of normal fertility in adulthood. Boys with one undescended testicle who receive timely treatment usually have near-normal fertility rates.

Is an undescended testicle related to testicular cancer?

Yes, having an undescended testicle increases the risk of developing testicular cancer later in life, with the risk being 4-8 times higher than in men with normally descended testicles. The risk is higher for intra-abdominal testicles than for those in the inguinal canal. Importantly, early surgical correction doesn’t eliminate this increased cancer risk but makes the testicle easier to examine and monitor. Men who had undescended testicles should perform regular testicular self-examinations and have routine medical check-ups throughout their lives.

What’s the difference between retractile testicle and undescended testicle?

A retractile testicle is one that has fully descended into the scrotum but can move back up into the groin due to an overactive cremaster muscle reflex. It can be manually moved back down into the scrotum where it will stay temporarily before retracting again. An undescended testicle, on the other hand, has never completed its descent and cannot be manually brought down into the scrotum and positioned to stay there. Retractile testicles usually don’t require treatment and often resolve as the child grows, while true undescended testicles typically require medical intervention.

Should I be concerned if my baby has one undescended testicle?

While one undescended testicle (unilateral cryptorchidism) is relatively common and often resolves on its own in the first few months of life, it does warrant medical attention and monitoring. You should inform your pediatrician, who will examine your baby and monitor the situation. If the testicle hasn’t descended by 6 months of age, your doctor will likely recommend consultation with a pediatric urologist or surgeon. With appropriate medical care and timely intervention if needed, the long-term outlook is generally very good.

Can physical manipulation help bring down an undescended testicle?

No, parents should not attempt to manipulate or massage an undescended testicle to try to bring it down. This can cause harm and doesn’t address the underlying problem. Only healthcare professionals should perform physical examinations of undescended testicles. If the testicle is truly undescended (not retractile), it cannot be manipulated into a stable position in the scrotum and will require medical evaluation and possibly surgical intervention.

Are there any complications if undescended testicle is left untreated?

Yes, untreated undescended testicles can lead to several complications including: reduced fertility or infertility due to impaired sperm production caused by the higher temperature outside the scrotum; increased risk of testicular cancer; higher likelihood of testicular torsion (twisting of the testicle); associated inguinal hernias; psychological and cosmetic concerns as the child grows; and potential hormonal imbalances. These risks increase the longer the testicle remains undescended, which is why early detection and treatment are important.

References:

• Mayo Clinic – Undescended Testicle
• Johns Hopkins Medicine – Undescended Testes
• NHS – Undescended Testicles
• Children’s Hospital of Philadelphia – Undescended Testes
• Urology Care Foundation – Cryptorchidism
• Boston Children’s Hospital – Undescended Testes