Key takeaways: An undescended testicle (cryptorchidism) hasn’t moved into the scrotum. Some descend on their own in the first months. If a testicle hasn’t descended by about 6 months (adjusted for prematurity), guidelines recommend referral to a pediatric urologist, with surgery usually by 18 months.
Before birth, the testicles form inside the abdomen and move down into the scrotum, usually in the last months of pregnancy. Sometimes one or both testicles haven’t completed this journey by birth.
How Common Is It?
Undescended testicles are among the most common conditions found in newborn boys, and they’re more common in premature babies. Many descend on their own in the first few months of life.
Retractile Testicles
Some testicles move up and down between the scrotum and the groin because of a strong muscle reflex, especially when a baby is cold or upset. These are called retractile testicles. They’re usually normal but should be checked at well visits.
Diagnosis
Your baby’s doctor will feel for the testicles during exams. Ultrasound isn’t usually recommended to find undescended testicles; a physical exam by an experienced clinician is more useful.
When to See a Specialist
The American Urological Association guideline recommends:
- Referral to a pediatric urologist if a testicle hasn’t descended by about 6 months of age (adjusted for prematurity), because testicles rarely descend on their own after that.
- Surgery (orchiopexy) usually within the following year, ideally by 18 months.
- Urgent evaluation at birth for babies with both testicles not felt, especially if the genitals look different than expected, to check for other conditions.
Why Treatment Matters
Untreated undescended testicles are associated with lower fertility and a higher risk of testicular cancer later in life. Early surgery may help protect fertility and makes the testicle easier to examine later. Surgery is usually an outpatient procedure.
After Surgery
Your child will need follow-up exams. As they grow, teach them about testicular self-exams when appropriate.
Call your baby’s doctor promptly if: your son has sudden swelling, pain, or redness in the scrotum or groin, or a bulge that doesn’t go away. These can be signs of a hernia or testicular torsion, which need urgent care.
The Bottom Line
Undescended testicles often drop on their own in the first months. If not by about 6 months, see a pediatric urologist. Surgery by 18 months is recommended.
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Sources
- Kolon TF, Herndon CD, Baker LA, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014;192(2):337-345.
- Urology Care Foundation. Undescended testicles (cryptorchidism). https://www.urologyhealth.org
- American Academy of Pediatrics. Undescended testicles. HealthyChildren.org. https://www.healthychildren.org
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
