What are testicles?
The testicles (also called testes or balls) are the male sex glands where sperm are made. They hang in a pouch outside the body called the scrotum.
Testicles are formed in the abdomen (belly) while the baby is developing in the uterus (womb). They normally move down into the scrotum in the last month or 2 before birth.
Testicles are sensitive to pain and to temperature. Sperm need the right conditions and a cool temperature to form properly. This is why testicles remain up near the warmth of the body on cold days and hang lower on hot days so they can keep cooler. Wearing very tight jeans is not ideal for the health of the testicles.
Through early childhood, the testicles easily move up out of the scrotum, especially if the child is cold, wet, or upset. This is called cremasteric reflex. They usually come down again when the child is warm and you can often see them both in the scrotum after a warm bath.
An undescended testicle is one which is missing from the scrotum and is lodged in the groin or in the lower abdomen. This doesn’t cause any pain and doesn’t affect the way a boy passes urine (wee).
Undescended testicles can cause problems because if the testicle is in the abdomen, it may be too warm for normal development of sperm.
If the undescended testicle is not brought down in the first year or 2 of life, it may affect a boy’s ability to make sperm and father children later in life.
A person with an undescended testicle also has a greater chance of getting testicular cancer in adult life.
Types of undescended testicles
There are 2 types of undescended testicles:
- Congenital – where 1 or both testicles do not descend at birth or over the following few months. This is more common in boys who are born prematurely, or are very small when they are born.
- Acquired – in some boys a testicle gradually moves up out of the scrotum between the ages of 1 and 10. This is called an acquired or ascending testicle and should be checked as it may need treatment.
Checking for undescended testicles
Check that both testicles are in the scrotum in the few months after birth. Your doctor and child health nurse will routinely check during this time.
If it is hard to find or see the testicles in the second 6 months of life, check with a doctor or your child health nurse.
As boys grow, it is important to check every year or so to be sure the testicles can be seen or felt in the scrotum. If you cannot find one or both, check with your doctor or child health nurse.
The child health nurse will check your child’s testes at each scheduled meeting from birth to 3 years.
If the scrotum or testes become red, swollen or painful at any age it is important to see a doctor immediately.
Treatment for an undescended testicle
If a testicle does not come into the scrotum in the first 6 months, an operation called an orchidopexy is done to bring it down and fix it in place. This is usually done around 12 months of age.
If the testicle moves up out of a boy’s scrotum, a similar operation is done to fix it down.
Undescended testicles are still operated on if they occur after the age of 2 to reduce the chances of testicular cancer.
Testicles that move up and down (retractile testicles) do not need treatment, but should be monitored as they are more likely to become undescended.
Fertility of undescended testicles
Biopsies of undescended testicles (where a small sample of testicular tissue is examined) have shown that the number of sperm-forming germ cells are normal until the age of 6 months. Germ cell numbers start to reduce in number after that age.
In the second year of life over one third of undescended testicles will lose all germ cells. This means they will be unable to form sperm.
The number of germ cells present at the time of an orchidopexy is related to sperm counts later in life.
The fertility of retractile testicles (testicles that move in and out of the scrotum) is normal.
One normal testicle is sufficient for normal fertility (the ability to have children).
A hydrocele is a sac filled with fluid around a testicle. It causes the scrotum to be swollen. This is common for baby boys.
Signs and symptoms of a hydrocele
The scrotum can look bigger than usual and the swelling may feel quite firm. This can be on 1 or both sides.
Check with your doctor or child health nurse to be sure what the problem is.
The doctor may shine a light through the scrotum to see that the swelling is caused by fluid.
Treatment for a hydrocele
A hydrocele is quite harmless and almost always goes away over the first few months of life.
If the hydrocele does not go away after 18 months to 2 years an operation may be needed, however this is uncommon.
Sometimes a hydrocele can happen at some time after birth quite suddenly – this should always be checked by a doctor to make sure that it is only a hydrocele.
A hernia happens when some of the content of the abdomen finds its way through a weak spot in the muscles that cover it.
Weak spots can occur in the groin in muscles where the testicles moved down into the scrotum before or after birth. These are called inguinal hernias.
Inguinal hernias can be common in the first weeks of life. They usually look like a lump in the groin or the scrotum that appears when the baby is crying or straining (for example, when doing a poo) and goes away when the baby calms down.
Sometimes the hernia gets stuck (obstructed) and doesn’t go away. This is painful and the area may get red and sore, and can block the bowel.
Signs and symptoms of an inguinal hernia
If you notice any lumps or swellings in your child’s groin or scrotum, see your doctor, especially if the lump comes and goes.
If there is any sign of pain or redness, you should seek immediate medical help.
Treatment for an inguinal hernia
As inguinal hernias can easily become ‘stuck’ in young babies an operation is always needed. This is usually done within a day after the hernia is found in very young babies, and within a few days if the baby is older than 6 weeks.
Although the hernia may only be seen on one side, the operation is usually done on both sides as there is often another weakness on the other side.
The operation is fairly simple and you can usually take your baby home the same day.
Torsion of the testicle
Sometimes the tissue supporting a testicle can become twisted, and this blocks its blood supply.
Who is most at risk?
This is not common but it can happen during childhood, and especially around puberty.
It is more common where there is a history of an undescended testicle.
Signs and symptoms of testicular torsion
It usually starts suddenly with severe pain in the scrotum or lower abdomen, sometimes with vomiting. The boy may have had similar pains before that were not as bad and that went away.
The scrotum will be red, painful and swollen on the side where the torsion is.
Get medical help immediately.
An operation is needed very quickly (within hours) to save the testicle.
The epididymis is a small series of tubes inside the testicle made to store sperm. Epididymitis is an infection in this part of the testicle.
Who is most at risk?
It is very uncommon in children, and more likely to happen in teens and adults.
Signs and symptoms of epididymitis
In children, it usually starts as a bladder or kidney infection, which then spreads to the testicle.
This is often associated with a birth-related abnormality that makes infection more likely.
Symptoms of the original infection may include:
- abdominal pain
- frequent urination (weeing), a burning feeling when passing urine, or blood in urine
Symptoms in the testicle may include:
- swelling or firmness
- tenderness – pain usually starts at the back of the testicle, but can spread quickly to the whole testicle
- pain may start suddenly.
Treatment for epididymitis
If you notice any swelling or pain in your child’s testicle or scrotum, get them checked by a doctor straight away.
Where to get help
- See your doctor
- Visit a GP after hours
- Ring healthdirect on 1800 022 222
- Checking your child for undescended testicles should be routinely done by your doctor or child health nurse
- Treatment for undescended testicles is best done by 1 year of age.
- Untreated undescended testicles can cause problems with fertility or testicular cancer later in life.
- There is an increased risk of torsion in a testicle that has been previously undescended.
- If the scrotum or testes become red, swollen or painful at any age it is important to see a doctor immediately.
© Women’s and Children’s Health Network, reproduced with permission. The South Australian Government does not accept responsibility for the accuracy of this reproduction
Child and Adolescent Community Health
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