Cryptorchidism: Causes, Diagnosis and Treatment

Many parents first hear the word cryptorchidism at a newborn or infant checkup when a doctor says they cannot feel one or both testicles in the scrotum. This condition, commonly called undescended testicles, is very treatable, but understanding it can ease a lot of worry.

This guide explains what cryptorchidism is, why it happens, how doctors check for it, when treatment is needed, and what it means for your child’s future health.

What Are Undescended Testicles?

In male babies, the testicles form high in the abdomen during pregnancy and normally move down into the scrotum (the skin pouch under the penis) before birth or within the first few months of life.

Cryptorchidism is the medical term used when one or both testicles are not in the scrotum but are located somewhere along the usual path of descent or, less often, in an unusual (ectopic) location.

• Unilateral cryptorchidism: only one testicle is undescended.
• Bilateral cryptorchidism: both testicles are undescended.

Most cases involve just one testicle, and the right side is affected more often than the left.

How Common Is Cryptorchidism?

Undescended testicles are the most common genital abnormality in male infants.

• About 3% of full-term boys are born with at least one undescended testicle.
• Up to 30% of premature boys have cryptorchidism at birth because they have had less time for the testicles to move down before delivery.

Many of these testicles descend on their own in early infancy. By about 3 to 6 months of age, the true rate of undescended testicles falls to around 1% of boys.

How Testicles Normally Develop and Descend

Understanding normal testicular descent helps explain what goes wrong in cryptorchidism. Testicles usually move through two main phases during pregnancy:

1. Transabdominal phase (early pregnancy): The testicles form near the kidneys and then move down inside the abdomen toward the groin.
2. Inguinoscrotal phase (later pregnancy): Guided by a structure called the gubernaculum and influenced by hormones, the testicles pass through the groin (inguinal canal) into the scrotum.

This process is usually complete by around the seventh to eighth month of pregnancy. Anything that interferes with these steps may result in an undescended testicle.

Types and Locations of Undescended Testicles

Doctors classify undescended or abnormal testicular positions in several ways. Two key distinctions are:

• Palpable testis: The doctor can feel the testicle during an exam, usually somewhere in the groin.
• Non-palpable testis: The doctor cannot feel the testicle; it may be in the abdomen, very small, or absent.

Why Does Cryptorchidism Happen?

The exact cause is often not known, but experts believe it involves a mix of hormonal, genetic, and environmental factors that affect testicular development and descent.

Recognized Risk Factors

• Premature birth or very low birth weight
• Family history of undescended testicles or certain genital differences
• Pregnancy factors, such as maternal diabetes, obesity, or placental problems
• Maternal or paternal smoking and heavy alcohol use during pregnancy
• Some conditions present at birth, such as certain syndromes or hormone disorders

Often, no single cause is found, and parents should not blame themselves. In most cases, there is nothing that could have been done differently to prevent cryptorchidism.

How Parents Usually Notice the Problem

Most babies with cryptorchidism appear completely healthy and comfortable. The main sign is that one or both sides of the scrotum look or feel empty.

• The scrotum may look smaller or flatter on one side.
• When you gently feel the scrotum, you may notice only one testicle or no testicles at all.

There is usually no pain, redness, or swelling. Undescended testicles rarely cause discomfort in babies.

How Doctors Diagnose Undescended Testicles

Evaluation typically starts with a careful physical examination and medical history.

Physical Exam

• The doctor gently feels the scrotum, both groins, and lower abdomen.
• They check whether each testicle is present, its size, and whether it can be moved into the scrotum and stay there.
• They also look for signs of a hernia (a bulge in the groin) or other genital differences.

Distinguishing Retractile from Undescended

One of the most important steps is telling the difference between a retractile testicle and a truly undescended one:

• Retractile: Can be gently moved into the scrotum and will stay there for a while unless the cremaster muscle pulls it back up.
• Undescended: May be pulled down, but it does not stay in the scrotum when released or cannot be moved down fully.

Are Ultrasound or Other Tests Needed?

In many children, imaging such as ultrasound is not helpful and is not routinely recommended before seeing a pediatric urologist, because a skilled physical exam usually gives enough information.

In special situations, such as when both testicles are non-palpable or there are concerns about hormone or sex development conditions, doctors may order blood tests or imaging and sometimes use laparoscopy (a minimally invasive camera surgery) to locate a non-palpable testicle.

When to Worry and When to Wait

Many baby boys have a testicle that seems a bit high or hard to feel in the first weeks of life. Because descent can continue after birth, doctors typically observe at first.

• If a testicle is still undescended by around 3 to 6 months of age (corrected for prematurity), it is unlikely to come down on its own.
• At that point, referral to a pediatric urologist or pediatric surgeon is recommended to plan treatment.

Waiting beyond this age for spontaneous descent can increase the risk of long-term problems such as reduced fertility and testicular cancer.

Why Treatment Matters

The main reasons to treat an undescended testicle are to help protect your child’s fertility, lower cancer risk, and allow easier self-examination later in life.

Fertility and Future Fatherhood

Testicles are designed to work at a temperature slightly cooler than the rest of the body, which is why they sit in the scrotum. When a testicle remains in the abdomen or groin, the higher temperature can damage the cells that produce sperm.

• Men with a history of undescended testicles, especially if both sides were affected or treatment was delayed, have a higher risk of reduced fertility.
• Early surgery (usually in the first year of life) improves the chances of normal sperm production compared with later treatment.

Risk of Testicular Cancer

Cryptorchidism is associated with an increased risk of testicular cancer later in life.

• Moving the testicle into the scrotum with surgery does not completely remove this risk, but it makes it easier to examine and find any changes early.
• Boys treated at a young age still need to learn how to perform testicular self-exams as teenagers and young adults and should attend regular checkups.

Other Possible Complications

• Inguinal hernia: An open connection between the abdomen and groin is common with undescended testicles and is often repaired at the same time as surgery.
• Testicular torsion: An undescended testis is more prone to twisting on its blood supply (torsion), which can cause sudden, severe pain and permanent damage if not treated quickly.
• Psychological impact: As boys grow, an abnormal scrotal appearance may cause embarrassment or anxiety; correcting the position can help body image and confidence.

Treatment: Orchiopexy and Other Options

The standard treatment for a true undescended testicle is a surgery called orchiopexy.

What Is Orchiopexy?

Orchiopexy is an operation in which a surgeon:

• Locates the testicle (in the groin or abdomen).
• Frees it from tight tissues so it can be moved.
• Gently brings it down into the scrotum.
• Secures it in place to reduce the chance of moving back up.

The procedure is usually done under general anesthesia and often as same-day surgery, meaning your child can go home a few hours afterward.

Timing of Surgery

• Most guidelines advise doing orchiopexy between 6 and 18 months of age.
• Earlier correction is associated with better fertility outcomes than waiting until later childhood.

Hormone Treatment

In the past, hormone injections were sometimes used to try to bring the testicle down. Current evidence shows that hormone therapy is much less effective than surgery and may have side effects, so it is rarely recommended today.

What Parents Can Expect Around Surgery

Before the Operation

• Your child will have a preoperative visit, where the surgeon reviews medical history and explains the plan.
• You will receive instructions about when your child needs to stop eating and drinking before anesthesia.

Day of Surgery

• The operation is usually less than an hour, though it may take longer if the testicle is in the abdomen or both sides are treated.
• Small incisions are made in the groin and/or scrotum. In some cases, laparoscopy (a small camera through a tiny cut) is used for non-palpable testes.

Recovery at Home

Most children recover quickly.

• Mild discomfort and swelling in the groin or scrotum for a few days is common.
• Pain is usually managed with over-the-counter medications as directed by the surgeon.
• Babies can often resume normal feeding and gentle activity the same day.
• Older children may need to avoid rough play, straddling toys, or sports for a short period.

The surgeon will schedule follow-up visits to check healing and confirm that the testicle remains in the correct position and is growing appropriately.

Long-Term Outlook

For most children who receive timely and appropriate treatment, the long-term outlook is very good.

• Many boys will have normal hormone production and puberty.
• Fertility is often normal or near normal, especially for boys with a single undescended testicle corrected early.
• The risk of testicular cancer remains slightly higher than average, so awareness and regular exams are important.

How Parents Can Support Their Child

• Attend regular checkups: Newborn and well-child visits allow doctors to track testicular position over time.
• Ask questions: If you are unsure whether a testicle is retractile or undescended, ask the doctor to explain what they feel and what it means.
• Follow referral advice: If your pediatrician recommends seeing a pediatric urologist, schedule that visit promptly.
• Prepare your child: For toddlers and older children, simple, reassuring explanations about the hospital and surgery can reduce fear.
• Teach body awareness: As your son reaches adolescence, encourage him to learn testicular self-examination and to report any lumps, pains, or changes.

Frequently Asked Questions (FAQs)

Is it my fault that my baby has an undescended testicle?

No. In almost all cases, parents did nothing to cause cryptorchidism. The condition is usually related to complex developmental, hormonal, and genetic factors that are beyond anyone’s control.

Can an undescended testicle still come down on its own?

Yes, but mainly in the first few months of life. If the testicle has not descended by about 3 to 6 months of age (corrected for prematurity), it is unlikely to move down on its own and evaluation by a specialist is recommended.

Will my child be able to have children in the future?

Many men with a history of a single undescended testicle that was corrected early have normal fertility. The risk of reduced sperm count increases if both testicles are affected or if surgery is delayed beyond early childhood.

Does surgery eliminate the risk of testicular cancer?

No. Orchiopexy lowers, but does not remove, the increased risk of testicular cancer. Its main benefit is that it places the testicle in the scrotum, where self-exams and doctor exams can detect changes earlier.

Is a retractile testicle the same as an undescended testicle?

No. A retractile testicle can be gently brought into the scrotum and will stay there temporarily; it usually does not need surgery but should be monitored over time. A true undescended testicle cannot be kept in the scrotum and usually requires surgical correction.

What if one testicle is missing?

Some boys have an absent testicle because it did not develop properly or was damaged before birth. In most cases, a single healthy testicle can provide normal male hormone levels and fertility, though regular follow-up with a specialist is important.