A retractile testicle is a condition in which the testicle is not located in the scrotum and moves around into the groin area. It can occur due to involuntary contractions in the cremaster muscle, which is a smooth muscle that covers the testes and connects the scrotum to the perineum. Contraction of these muscles can occur throughout the day, causing the testicles to rise.
A retractile testicle is very common in childhood as genital muscles are developing. However, it can also be noted in adults and can be triggered by cold climates, dangerous situations, or short spermatic cord.
Generally, testicles will return to their normal spot after migrating up into the scrotum, however manual repositioning may be required in some men. If the testicle does not go down on its own, or if the migration is associated with pain or swelling, you should proceed to a hospital for assessment and treatment.
Common symptoms
The main symptoms of a retractile testicle are:
- Spontaneous movement of testicle into the groin area
- A testicle that does not return to its normal position, either spontaneously or after manual manipulation
- A testicle that remains out of its regular positioning for a prolonged time
If you notice these symptoms, you should see a urologist to evaluate the underlying cause and to start treatment as necessary.
What is the difference between a retractile testicle and cryptorchidism?
Cryptorchidism is a congenital condition in which the baby’s testicles do not descend to the scrotum by the time of birth. This can be noted in just one or both testicles.
During pregnancy, the embryo’s testicles develop within the abdominal cavity and descend to the scrotum in the final stages of pregnancy, up to the first 6 months of birth. Testicles that do not descend within this timeline may descend later on, although they can continue to move up. This is referred to as cryptorchordism.
A retractile testicle, on the other hand, can emerge in childhood or adulthood and is usually related to contraction of the cremaster muscle. It can also affect one or both testicles.
Confirming a diagnosis
A retractile testicle diagnosis is confirmed by a urologist in adults or pediatrician in children. It is diagnosed through a physical exam of the scrotum and testicles.
Further testing is generally not required to confirm a retractile testicle diagnosis.
Main causes
A retractile testicle is caused by involuntary movement of the cremaster muscle, which can be triggered by:
1. Sex (during or after)
Sex usually employs various muscles in the body, but particularly the genital muscles, which contract involuntarily as a response to a pleasure stimulus. The cremaster muscle can also contract, causing the testicles to rise up into the abdomen or groin, especially during orgasm.
In these cases, the testicle does not disappear completes, and can lodge, instead in the upper scrotum. However, men with a larger inguinal canal (which connects the scrotum to the abdomen) may note that the testicle rises and is no longer palpable.
2. Cold climates
For regular sperm and hormonal production, the testicles maintain a temperature that is 2 to 3 degrees colder than core body temperature. This is why the scrotum is anatomically placed outside of the body.
However, in very cold environments, a drop in scrotal temperature can affect the testicles. The cold temperature can cause involuntary contractions in the scrotum as a way to maintain a normal temperature, causing the testicles to rise up.
3. Dangerous situations
The testicles are located in a sac outside of the body which is not protected by bones or other tissues. This increased exposure can also increase the risk for direct trauma that can cause damage to their structure and functioning.
As a natural defense mechanism, the body may trigger the muscles in the scrotum to contract when danger is perceived. This can cause the testicles to rise up from their regular positioning.
4. Short spermatic cord
The spermatic cord is a structure that is made-up of muscle tissue and small blood vessels that are connected to the scrotum and testicles.
In some cases, particularly in young children and teens, the spermatic cord may not develop completely or it may grow at a slow pace. In these cases, the testicles may remain closer to the pelvis and, depending on the length of the cord, testicles may even rise up into the abdomen. This problem typically resolves on its own following adolescence.
Treatment options
Treatment for a retractile testicle should be monitored by a pediatrician or urologist. In most cases, specific treatment is not required, as testicles usually return to their regular position on their own or with manual manipulation of the cremaster muscles or groin.
Nonetheless, men with a retractile testicle should follow-up with a doctor at least once per year. Testicles that become lodged within the groin may require surgical interventions.
Possible complications
A retractile testicle rarely presents with complications. However, testicles that ascend into the abdomen are at a higher risk of not descending on their own.
Other complications that may occur are:
- A higher risk for testicular cancer
- Testicular torsion
- Infertility
- Inguinal hernia
To prevent these complications, it is important to see a urologist or pediatrician if you suspect you have this condition, and to maintain regular follow-ups if it has been diagnosed.
When to see a doctor
In almost all cases, the testicles can ascend and then descend to their regular position without any medical treatment. However, you should seek medical attention if:
- The testicle does not descend after 10 minutes
- You feel intense pain or swelling in the scrotal area
- You experienced direct trauma or a blow to the genital area
Cases in which the testicle ascends and does not return to its position are more common in babies or children.
