Diseases & Conditions

Retractile testicle

A retractile testicle is a testicle that may move back and forth between its proper position in the bag of skin hanging behind the penis (scrotum) and the groin. When the retractile testicle is residing in the groin, it may be easily guided by hand into the scrotum during a physical examination.

For most boys the problem of a retractile testicle goes away sometime before or during puberty. When this happens, the testicle permanently moves to its correct location down into the scrotum.

Sometimes, the retractile testicle is no longer movable and instead stays up into the groin. When this happens, the testicle is no longer considered a retractile testicle. This condition is called an ascending testicle.

Testicles form in the abdomen during fetal development. During the final months of development, the testicles gradually descend into the scrotum. If your son has a retractile testicle, the testicle originally descended as it should, but then it didn't remain in place.

Signs and symptoms of a retractile testicle include the following:

• The testicle may be moved by hand into the scrotum and won't immediately "retreat" to the groin.
• It may spontaneously "appear" in the scrotum and remain there for a time.
• It may spontaneously "disappear" again for a time.

The movement of the testicle almost always occurs without pain or discomfort. Therefore, a retractile testicle is only noticed when you no longer see or feel it in the scrotum.

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

Retractile testicle is different from undescended testicle (cryptorchidism). The undescended testicle is one that never entered the scrotum. If a doctor attempted to guide an undescended testicle, it wouldn't move or would move slightly, most likely with some discomfort or pain.

During regular well-baby checkups and annual childhood checkups, your son's doctor examines your son's testicles to determine if they're descended and appropriately developed. If you believe that your son has a retractile or ascending testicle — or have other concerns about the development of his testicles — see his doctor. He or she will advise you on how often to schedule assessments to monitor changes in the condition.

If your son experiences pain in the groin or testicles, see your son's doctor immediately.

If your son has a testicle not located in the scrotum, his doctor will determine its location in the groin. 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 your son is a toddler, the doctor may have him sit with the soles of his feet touching and knees to the side. Older boys may be asked to squat. These positions often make it easier to find and manipulate the testicle.

If the testicle is a retractile testicle, it will move relatively easily and painlessly. The retractile testicle won't immediately move up again. Your son's doctor can then stimulate the reflex of the cremaster muscle by gently rubbing the upper inside of the thigh. This stimulation will usually cause the retractile testicle to move up again.

If the testicle in the groin moves only part way into the scrotum, if the movement causes pain or discomfort, or if the testicle immediately retreats to its original location, it's most likely not a retractile testicle. In such cases the testicle would be considered undescended, or ascending if the testicle had been in the scrotum at one time.

If your son's doctor has any particular concerns about the diagnosis, he or she may refer your son to a pediatric urologist.

A retractile testicle is likely to descend on its own before or during puberty. If your son has a retractile testicle, 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 has become an ascending testicle.

If the testicle has ascended — no longer moveable by hand — or if it's still retractile by age 14, your son's doctor will recommend treatments. The goal of treatment is to have the testicle permanently descend, thereby lessening the risk of complications. Treatments include:

• Surgery. A surgical procedure called orchiopexy is the most common treatment. Through one incision in the groin and another in the scrotum, the surgeon guides the testicle to its proper position and stitches it into place. Annual follow-up exams are usually recommended.
• Hormone therapy. Because descent of the testicle is partially regulated by hormones, descent can sometimes be induced with hormone therapy using human chorionic gonadotropin (HCG). HCG is administered by injection, generally twice weekly for four weeks.

It is important to understand that even with successful treatment of an ascending or retractile testicle, the increased risk of cancer remains. But, if a testicle is permanently in the scrotum rather than in the groin, it's more easily monitored. Therefore, abnormal cancerous growths would be detected and treated sooner.

Adolescent boys and men who have had treatments to correct an ascending or retractile testicle should regularly monitor the position of the testicle to ensure it doesn't ascend at a later time.