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Testes

testes; testicle; ball; balls; scrotum; cremasteric; reflex; orchidopexy; hydrocele; epididymus; torsion; inguinal; hernia; puberty; undescended; femoral; mumps; orchitis;

The testes are formed in the abdomen (belly) while the baby is in the womb and they normally descend (move down) into the scrotum towards the end of pregnancy. Sometimes one or both testes do not descend at birth or over the next few months.

Contents

The testes (testicles or balls) are male sex glands where sperm and hormones are made. They hang in a pouch (or bag) outside the body, called the scrotum. The testes are sensitive to pain and to temperature. For this reason they hang lower on hot days so they can keep cooler and up near the warmth of the body on cold days. Wearing very tight jeans is not ideal for the health of the testes.

Alert!

If the scrotum or testes become red, swollen and/or painful at any age it is important to see a doctor immediately.

Undescended testes

  • The testes are formed in the abdomen (belly) while the baby is in the womb and they normally descend (move down) into the scrotum towards the end of pregnancy.
    • There is a picture showing an undescended testis in the fact sheet 'Undescended testes' from the Royal Children's Hospital (Victoria).
  • Through early childhood, the testes easily move up out of the scrotum especially if it is cold, or the child is upset. (This is called "cremasteric reflex"). They usually come down again when they are warm and you can often see them both in the scrotum after a warm bath. As long as they were properly down earlier in life, this going up and down (retractile testes) is normal.
  • Sometimes one or both testes do not descend at birth or over the next few months. This is more common in boys who are born prematurely.
  • If both testes are undescended, this can cause problems because, if the testis is in the abdomen, it may be too warm for normal development of sperm. If only one testis is undescended, the other testis will usually be able to make enough sperm so that it is unlikely that there will be a problem with fertility.
    • If the undescended testis is not brought down in the first year or two of life, it may affect the boy's fertility (ability to make sperm and father babies later on).
    • An undescended testis also has a greater chance of getting cancer in adult life, but this is still rare.
  • Some babies have a pad of fat around the groin that tends to hide both the penis and testes. This is normal and it goes away as the baby grows into a child. Both the testes and the penis can be felt inside this pad of fat.
  • In some boys a testis gradually moves up out of the scrotum between 5 and 10 years of age, as the child grows taller. This is called an ascending testis and should be checked by a doctor as it may need treatment.

What you can do

  • Check that both testes are in the scrotum in the few weeks after birth. This is usually easy to see and the doctor will normally check it at birth and at the 6-8 week check.
  • If it is hard to find or see the testes in the second 6 months of life, but you are sure that they were in the scrotum earlier, this is usually not a problem, but check with a doctor.
  • As your boy grows, check every year or so to be sure the testes can be seen or felt in the scrotum. The best time to do this is in a warm bath. If you cannot find one or both testes, check with your doctor.

Treatment for undescended testes

  • If a testis does not come into the scrotum in the first few months, an operation called an orchidopexy is done to bring it down and fix it in place. This is usually done between 6 and 12 months of age.
  • If the testis moves up out of a boy's scrotum later a similar operation is done to fix it down.
  • Testes that move up and down (retractile testes) rarely need treatment.

Fertility of undescended testes

Biopsies of testes have shown that the germ cells, which form sperm, are normal in number until 6 months of age with an undescended testis, but start to reduce in number after that age.

  • By the second year of life over a third of undescended testes have lost all germ cells.
  • Germ cell numbers at the time of operation are related to later sperm counts, but one normal testis is sufficient for normal fertility.
  • After two years undescended testes are still operated on so that if the rare testicular cancer occurs, it can be identified early, and also for cosmetic reasons - so the boy's scrotum looks the same as that of other boys.
  • The fertility of retractile testes (ones that move in and out of the scrotum) is normal.

Hydrocele

  • Often baby boys are born with extra fluid in the scrotum. The scrotum can look bigger than usual and the swelling may feel quite firm. This can be on one or both sides and is called a hydrocele.
  • A hydrocele is quite harmless and almost always goes away over the first few months of life.
  • Sometimes a hydrocele can develop quite suddenly at some time after birth - this should always be checked by a doctor to make sure that it is only a hydrocele.

What you can do

  • Check with a doctor 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.
  • If the hydrocele does not go away after eighteen months to two years an operation may be needed, however this is rare.

Inguinal hernia and femoral hernia

  • A hernia happens when some of the content of the abdomen (belly) finds its way through a weak spot in the muscles that cover it.
  • These weak spots are likely to be in the groin (causing inguinal hernias and femoral hernias) or around the umbilicus (belly button) causing an umbilical hernia. They can also happen at the top of the stomach (a hiatus hernia).
  • Inguinal hernias occur more often in boys than girls, while femoral hernias occur more often in girls.
  • Inguinal hernias are fairly 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 (doing poo) and goes away when the baby calms down.
  • Sometimes the hernia gets stuck (obstructed) and doesn't go away. This is painful and can block the bowel.
  • Femoral hernias occur occasionally in early childhood, and may cause the same problems as inguinal hernias.
  • For information about umbilical hernia see the topic 'Umbilical care and umbilical hernia'.

What you can do

  • If you notice any lumps or swellings, especially in the groin of boys and girls, or in the scrotum of boys, get your baby checked by a doctor.
  • They need to be checked, especially if the lump comes and goes.

Treatment for inguinal and femoral hernias

  • Because 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 over about 6 weeks old.
  • 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 testis

  • Sometimes the tissue supporting a testis can become twisted, and this blocks the blood supply to the testis.
  • This is not common but it can happen during childhood, and especially around puberty.
  • 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 which went away.
  • The scrotum will be red, painful and swollen on the side where the torsion is.

What you can do

  • Get medical help immediately.
  • An operation is needed very quickly (within hours) to save the testis.
  • There is a milder form (torsion of a small part on the side of the testis called the hydatid of Morgagni), but it can be difficult to tell if this is the problem, so an operation is often needed.

Epididymitis

  • Epididymitis is an infection around the testis.
  • It is rare in children, but may be caused by a viral infection in babies or a urinary infection in children.
  • It is more likely to happen in older adolescents and adults.

Mumps

15-35% of males who get mumps after puberty get a very swollen and sore testis (orchitis) usually only on one side. It is not likely that this will stop them from making sperm and having children even if both testes are affected, but this can occasionally happen.

Orchitis usually starts 7 to 10 days after swelling of the glands in the face starts. The boy or man becomes unwell again, with a fever and painful swelling of usually one testis, which lasts for several days.

This is one of the reasons for immunising children against mumps.

References

Royal Children's Hospital, Melbourne. Fact Sheet 'Undescended testes'. http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=9052

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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