Ascended Testicles

A young boy in my neighborhood recently had a surgery performed. His mom and I are good friends and she has been very open about telling many people and getting other parents informed of this particular condition. I certainly didn’t know about this, so figured I’d share this information here to continue educating parents on a topic that is common, but rarely talked about: ascended testicles.

When a male fetus is developing in the womb, their testicles originate inside of the body and slowly make their way down into the scrotum during the final months of pregnancy. Around 3-10% of full-term baby boys are born with undescended testicles. As you can imagine, premature babies have a much higher chance of this occurring, around 30%. Doctors don’t typically worry at this point, as they tend to find their way down in the first six months or so. If, after a year, they remain up in the groin area, then a surgery is needed to help move them down to where they’re supposed to be.

Once the testicles are descended, in theory, they should stay put. There is, however, natural contraction and relaxation of the cremaster muscle, which performs the task of lowering and raising the testicles frequently. The cremaster muscle is in charge of helping the testicles stay at a healthy temperature. When the body temperature is very warm, the cremaster muscle relaxes and the testicles hang lower. When the body temperature is cold, the muscles contract, causing the testicles to rise up closer to the body to stay warm.

Some boys have retractile testicles, or sliders, that move back and forth from the scrotum up into the groin. Most likely, nothing will need to be done with sliders as they tend to stop leaving the groin after puberty, because they get slightly larger and no longer fit up there as easily. However, these sliders have the potential to become ascended testicles. Meaning, they no longer come back down, but stay up in the body.

This is a common occurrence in boys between the ages of 5 and 9. And it is a condition that very well may need to be surgically fixed in a timely manner, especially as boys approach the age of puberty. There are a few reasons why puberty plays a big role in the need for surgery.

1. The testicles won’t be able to self-regulate their temperature, causing issues involving sperm count or sperm production in general.
2. Because space is limited in the groin area, the added organ (or two) up there can begin to cause a lot of pain.
3. Testicular torsion (twisting) can occur.
4. Overall, the blood supply to the testicle may not function properly, and the testicles will “die”.

The chance of obtaining testicular cancer after experiencing undescended or ascended testicles is much higher than the average male’s chances. So boys like my little neighbor, will have to do regular self-checks (similar to a female looking for breast cancer) beginning at puberty and throughout their whole lives.

The surgery previously mentioned is called orchiopexy. In some cases, like my neighbor, the cremaster muscle and other factors like anxiety or fear can cause the testicle to be so far ascended (out of the groin and into the abdomen) that two separate versions of the surgery need to be performed. One to lower the testicles down into the groin area (which my friend’s boy didn’t end up needing after all because the anesthesia relaxed him enough to allow them to drop naturally), and the second to settle them back down into the scrotum and safely “lock them in” so to speak. It is an outpatient surgery with a relatively easy recovery. My nine-year-old neighbor was instructed to not swim for 2 weeks or ride a bike for 4 weeks.

If it weren’t for this little boy’s older brother noticing something abnormal about him while in the shower, there’s a good chance this wouldn’t have been noticed and fixed in time to prevent some serious complications. Not all doctors check the growth and development of testicles after young ones are out of diapers, but it is certainly something you can request if you suspect something may be wrong.

My biggest takeaways from hearing about and studying this condition are 1. how surprisingly common it is, 2. how detrimental it can be if not known about, 3. how smooth the recovery is, and 4. how in the world had I never heard of this before? I knew about the original descent, but had no clue about retractile or ascending testicles being a possibility. My hope in writing this is that I was able to educate and bring to light something that may not have been previously known and should definitely be talked more about.