Retractile Testicle

by Sam Malone


Testicles begin to form in the abdomen of the male fetus around the eleventh or thirteenth week of life. By the eighth or ninth month, the testicles then begin to gradually descend into the scrotum, which is the small sac of skin hanging behind the penis. After birth, the testicles continue to move towards the scrotum where they will settle down after puberty. The cremaster muscle is the pouch that surrounds the testicles and is responsible for moving the testicles from the scrotum to the groin and vice versa. The reflex action of this muscle (known as the cremaster reflex) that involuntarily pulls the testicles up into the groin is strongest in children and tends to lessen as one reaches adulthood. Adults also experience this reflex action whenever the body is aroused or startled. Cold weather, sexual arousal and orgasm all cause the cremaster muscle to contract and pull the testicles up into the groin.

A retractile testicle refers to a condition where the testicle (one or both) moves back and forth between the groin and the scrotum. In most cases, the testicles can be maneuvered back into place in the scrotum by the hands during a physical examination. In some cases, the testicle may move into the groin and cannot be moved. In such situations, it is no longer referred to as retractile testicle but rather an ascending testicle.

There have been no conclusive studies on the effects of retractile testicle in adults though theories suggest that having a retractile testicle may make you more susceptible to conditions such as testicular cancer, infertility, and testicular torsion (where the cord that connects the groin to the testicles gets twisted). However, most cases of retractile testicle are harmless and cause no pain. As long as the testicles descend back into the scrotum within a short period of time, there is usually no cause for worry.

Symptoms: Symptoms of a retractile testicle may include:

  • The testicle may move from the scrotum to the groin without any pain or pressure
  • A retractile testicle may be notice only when it is no longer visible in the scrotum as the movement is rarely felt
  • The testicle may involuntarily appear or disappear from the scrotum and groin
  • The testicle can be moved by hand back into the scrotum from the groin
  • One testicle may be normal and the other retractile

A retractile testicle should not be confused for an undescended testicle. In cases of an undescended testicle, the testicles have never entered the scrotum at all. Any attempt at manipulating the testicles in the groin and manually moving them downwards into the scrotum will cause pain and discomfort.

Testicles are usually checked during visits to the doctor during childhood. Your pediatrician will examine the testicles and assess whether they have developed and descended correctly into the scrotum. If you have any doubts about your son’s development or any worries regarding testicular health, it is important to bring these concerns to your doctor’s attention. Symptoms such as pain or persistent pressure in the groin would need medical attention as well.

Treatment: The cremaster muscle that controls the movement of the testicles is primarily responsible for controlling the temperature of the testicles. Warmer temperatures cause the muscle to relax while colder temperatures will contract the muscle and pull the testicles into the body for warmth. Children may have overactive cremaster muscles that cause involuntary movement of the testicles back and forth. This reflex action tends to settle down post puberty.

Diagnosing a retractile testicle in adults or children can be done with a simple physical examination. While the condition tends to disappear on its own, there are cases where the testicles remain in the groin and stay ascended. In such situations, the expertise of an urologist or specialist may be required.

If the testicle is not located in the scrotum, the doctor will physically guide the testicles down to the scrotum using his hands. This may be done while lying down or squatting to make it easier to find the testicles. The examination is always done in a warm location to prevent the contraction of the cremaster muscle. If it is a case of a retractile testicle, the testicles will move easily into the scrotum and not move back up again immediately. When the movement of the testicles causes pain or pressure or the testicle immediately moves back into the groin, it is not a case of a retractile testicle and further investigation is necessary.

If a diagnosis of ascended or undescended testicle is confirmed, treatment may include hormone therapy using human chorionic gonadotropin (HCG) injections or a surgical procedure known as orchiopexy that moves the testicles permanently into the scrotum.

If you or your child has a retractile testicle, it is important to monitor the position of the testicles regularly to ensure that it the condition does not worsen or develop into an ascending testicle.

References:

  1. Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.
  2. http://www.med.nyu.edu/content?ChunkIID=99744

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