Retractile Testicle

1 What is Retractile Testicle?

A testicle that may move back and forth between the scrotum, the bag of skin hanging behind the penis, and the groin is called a retractile testicle.

For most boys, the problem of retractile testicle goes away before or during puberty as the testicle moves to its correct location in the scrotum and stays there permanently.

In fewer than 5 percent of cases, the retractile testicle remains in the groin and is no longer movable, this condition is called an ascending testicle or an acquired undescended testicle.

When the retractile testicle is residing in the groin, during a physical exam, it might be easily guided by hand into its proper position in the scrotum by a medical professional.

2 Symptoms

Here are the signs and symptoms of retractile testicle which you should be aware of to determine if your son has one and would need medical attention:

  • First is the testicle may be moved by hand from the groin into the scrotum and won't immediately retreat to the groin.
  • Second, the testicle might spontaneously disappear again for a time and might reappear again. The movement and recurrence of a retractile testicle might go unnoticed since it almost always occurs without pain or discomfort. As a result, it's noticed only when the testicle is no longer seen or felt in the scrotum.

If your son has a retractile testicle, the testicle originally descended as it should, but does not remain in place. Normally, during the final months of fetal development, the testicles that form in the abdomen descend into the scrotum and should be completed at birth but if not done so then the testicles usually descends within a few months.

The position of one testicle is usually independent of the position of the other one. For example, a boy might have one normal testicle and one retractile testicle.

Another somewhat similar condition is called undescended testicle (cryptorchidism) which is one that never entered the scrotum, but retractile testicle is different from undescended testicle.

Make sure to bring your child to the doctor during their scheduled well-back check-ups and annual childhood check-ups as your son’s doctor will examine your son’s testicles if they have descended to the scrotum and have appropriately developed.

Also, upon caring for your child such as when you change his diapers, make observation of his testicles and if you believe or even has suspicion that your son has a retractile or ascending testicle then immediately make a doctor’s appointment.

Once the doctor has determined that there is a possible abnormal or have concerns about the development of your son’s testicles, then the doctor will set up a regular follow-up to monitor changes in the condition.

Since retractile testicle does not present with pain and discomfort, if your son experiences pain in the groin area or testicles it is important to right away bring your child to see the doctor.

3 Causes

The main cause for a testicle to become a retractile testicle is an overactive muscle.

In order for a testicle to develop and function properly, it needs to be slightly cooler than normal body temperature. When the environment is warm, the cremaster muscle is relaxed, when the environment is cold, the muscle contracts and draws the testicle toward the warmth of the body.

The main purpose of the cremaster muscle is to control the temperature of the testicle. The cremaster muscle is a thin pouch-like muscle in which a testicle rests.

When the cremaster muscle contracts, it pulls the testicle up toward the body. An overactive muscle causes a testicle to become a retractile testicle. If the cremaster reflex is strong enough, it can result in a retractile testicle, pulling the testicle out of the scrotum and up into the groin.

The cremaster reflex can also be stimulated by rubbing the genitofemoral nerve on the inner thigh and by extreme emotion, such as anxiety. Some retractile testicles can become ascending testicles, this means the once-movable testicle becomes stuck in the "up position."

There some contributing factors that leads to retractile testicle such as a short spermatic cord as each testicle is attached to the end of the spermatic cord, which extends down from the groin and into the scrotum.

If growth of the spermatic cord doesn't keep pace with other body growth, the relatively short cord might pull the testicle up.

The cord houses blood vessels, nerves and the tube that carries semen from the testicle to the penis. Also, abnormal remnants of fetal tissues that created the path for normal testicular descent might affect the growth or elasticity of the spermatic cord.

Scar tissue following surgery to repair the hernia, a small gap in the abdominal lining through which a portion of the intestines can protrude into the groin, might limit the growth or elasticity of the spermatic cord leading to retractile testicle.

4 Making a Diagnosis

Retractile testicle can easily be diagnosed by your son’s doctor initially from physical exam. However, if there is any question about the diagnosis or need for immediate treatment, you might be referred to a doctor who specializes in urinary disorders and problems with male genitals in children (pediatric urologist).

The doctor will most likely ask you several questions to further understand the signs and symptoms experienced by your child, hence here are some examples of those questions:

  • Were both testicles previously identified as descended in a well-baby or annual exam?
  • When did you notice the absence of the testicle in the scrotum?
  • Have you observed this before?
  • Has your child experienced any pain in his testicles or groin?
  • Has your son ever been treated for a hernia?
  • Has your son experienced any trauma to his genitals or groin?

Part of the physical exam that will be conducted by the doctor is to determine the location of the testicles if it is not found in the scrotum, most likely it will be in the groin area.

Once it's located, the doctor will attempt to guide it gently into its proper position in the scrotum. Your son may be lying down, sitting or standing during this examination.

If the testicle is a retractile testicle, it will move relatively easily and painlessly. The retractile testicle won't immediately move up again.

If your son is a toddler, the doctor might have him sit with the soles of his feet touching and knees to the sides. These positions make it easier to find and manipulate the testicle.

It is most likely not a retractile testicle, if the testicle in the groin moves only partway into the scrotum, if the movement causes pain or discomfort, or if the testicle immediately retreats to its original location.

The testicle would be considered undescended, or if the testicle had been in the scrotum at one time, it would be considered an ascending testicle.

5 Treatment

There is no immediate treatment provided for retractile testicle. Most likely, your son's doctor will monitor any changes in the testicle's position in annual evaluations to determine if it stays in the scrotum, remains retractile or becomes an ascending testicle. Since before or during puberty, a retractile testicle is likely to descend on its own.

A surgery maybe recommended to move the testicle permanently into the scrotum if the testicle has ascended, or no longer movable by hand.

Surgery is also suggested if the testicle is still retractile during puberty which normally happens in the early teen years to ensure proper maturation of the testicle.

The surgical procedure is called orchiopexy, the surgeon frees the testicle and cord from any attached tissues, positions the testicle in the scrotum and stitches it into place.

After surgery, there are certain activities that will be restricted for a couple of weeks such as bicycle riding and other sports activity.

It is important to come back for follow-up exams two weeks after the surgery and after six months, as the doctor will assess wound healing and the position of the testicle.

Regular testicular examination would have to be practiced by adolescent boys and men who have had treatments to correct an ascending or retractile testicle, they should regularly check the position of the testicle to ensure it doesn't ascend at a later time.

Previously, hormone treatments were recommended to treat ascending testicles but recent studies showed the lack of evidence for successful response or long-term effectiveness of this treatment, hence the American Urology Association's 2014 guidelines no longer include this intervention.

6 Prevention

Regular retractile testicular test is recommended to prevent progression to other conditions. Make sure to work closely with your doctor as there is no specific treatment instead regular monitoring is needed.

7 Alternative and Homeopathic Remedies

There are no homeopathic or alternative remedies for retractile testicle.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with retractile testicle.

For infants and younger children, check the position of the testicles regularly during diaper changing or at bath time. Keep a record of any changes.

Once your child is old enough to understand what he is going through, you can help your son by making him understand his condition and make him aware of the development of his body by talking to him about it and his feelings.

Give your son the vocabulary to talk about the scrotum and testicles. Explain that there are usually two testicles in the scrotum.

When he's about to reach puberty, usually around sixth grade, and you're talking about what physical changes to expect, explain how he can check his testicles.

He might have anxieties about looking different from friends or classmates and be sensitive about his appearance as he has retractile testicle.

To help your son cope:

  • Remind him that there's nothing wrong with him.
  • Explain that the position of the testicle is something you, your son and his doctor will pay attention to and fix, if necessary and use simple terms to explain what a retractile testicle is.
  • Help him practice a response if he's teased or asked about the condition.
  • Buy loose fitting boxer shorts and swim trunks that might make the condition less noticeable when changing clothes and playing sports at school.
  • Be aware of signs of anxiety, such as not participating in sports that he would normally enjoy as well as possibly being bullied.

9 Risks and Complications

There are several risks and complications associated with retractile testicle.

Boys with retractile testicles are at a greater risk of developing ascending testicle. An ascending testicle, if not treated, is vulnerable to the same risks associated with an retractile testicle.

Risks associated with an retractile testicle include:

Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. What causes these cells to develop into cancer is unknown. Men who have had an undescended testicle have a greater risk of testicular cancer.

Fertility problems. Low sperm counts, poor sperm quality and low fertility rates are more likely among men who have had an undescended testicle.

There are various risks for an untreated undescended testicle hence your doctor will recommend Surgical treatment during childhood.

Other risks associated with undescended testicles are: Testicular torsion is the twisting of the spermatic cord. This painful condition cuts off blood to the testicle.

If not treated promptly, it might result in the loss of the testicle. An undescended testicle increases the risk of testicular torsion. Trauma. A testicle located in the groin might be susceptible to trauma or injury from compression against the pubic bone.