A retractile testicle is a condition where a testicle pulls upward into the inguinal canal, sometimes hiding in the groin area. In other cases, the testicle may not be found in the scrotum temporarily but can be gently moved back into place with the hands.
This usually happens because of an involuntary contraction of the cremaster muscle, which connects the testicle to the abdominal area. When this muscle tightens, it can cause the testicles to rise in certain situations and, occasionally, move outside the scrotal sac.
If a retractile testicle is suspected, it is recommended to see a urologist or a pediatrician for children. Regular monitoring is often advised, especially if the testicle stops returning to the scrotum on its own, in which case surgery may be considered.
Main symptoms
The main symptoms of a retractile testicle include:
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The testicle rising toward the groin on its own
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A testicle that only comes down with manual support
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The testicle being absent from its usual position for a period of time
A retractile testicle may first be noticed during a testicular self-exam. If these symptoms occur, it is important to consult a urologist to determine the cause and discuss appropriate treatment if needed.
Difference between a retractile testicle and cryptorchidism
Cryptorchidism occurs when one or both testicles fail to descend into the scrotum, usually during the final months of pregnancy. Although it is commonly present from birth, the testicles can also rise over time in some cases.
A retractile testicle, however, is one that moves up easily and may temporarily leave the scrotal sac or be difficult to feel, but it can be manually returned to its normal position. This condition is typically linked to contraction of the cremaster muscle.
Confirming a diagnosis
A retractile testicle is usually diagnosed by a urologist for adults or a pediatrician for children through a physical exam of the scrotum and groin. The doctor checks the position of the testicles and how easily they move.
In most cases, no additional tests are needed to confirm the diagnosis.
Common causes
A retractile testicle occurs due to involuntary movement of the cremaster muscle. Several situations can trigger this muscle to tighten, such as:
1. During or after sexual activity
Sexual activity triggers involuntary contractions of several muscles, especially those in the genital area. The cremaster muscle is one of them, and this can cause the testicles to rise, particularly during orgasm. In many men, the testicle does not fully disappear but stays close to the upper scrotum. However, some men have a slightly wider passage between the scrotum and abdomen, which can allow the testicles to move farther upward without indicating a medical problem.
2. Cold temperatures
Exposure to cold can cause the cremaster muscle to contract as part of the body’s natural response to preserve heat. When the contraction is strong, the testicles may rise toward the body.
3. Situations of danger or being startled
The cremaster muscle may also contract when a person feels threatened or startled due to activation of the sympathetic nervous system. This appears to be a protective response that helps shield the testicles from injury.
4. Short spermatic cord
The spermatic cord contains muscles and small vessels that support the testicle inside the scrotum. In children and adolescents, the cord may occasionally develop slowly. When this happens, the testicle may sit higher in the scrotum or, at times, move upward and out of the scrotal sac.
Treatment options
Treatment for a retractile testicle should be guided by a pediatrician or urologist. In most cases, no specific treatment is needed because the testicles usually return to their normal position on their own or with gentle manual guidance.
Even so, yearly medical checkups are generally recommended, since some testicles may eventually stop returning to the scrotum. If that happens, surgery may be needed.
Possible complications
A retractile testicle rarely causes complications. However, when the testicle rises frequently, there is a risk that it may not descend again. According to the American Urological Association (AUA), undescended or persistently elevated testicles may increase the risk of fertility problems if not properly monitored. In some cases, especially when both testicles are affected, retractile testicles may contribute to infertility.
For this reason, it is important to maintain regular follow-up with a urologist or pediatrician to help prevent long-term complications.
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A retractile testicle moves up into the groin but can be gently brought back into place, often due to contraction of the cremaster muscle.
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Diagnosis is typically made through a simple physical exam, and most cases do not require treatment.
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Regular monitoring is important because, in some cases, the testicle may stop returning to the scrotum and surgery may be needed.