Testes (testicles) are male sex glands. They produce sperm and hormones for sexual reproduction. The testes are usually situated in the scrotum, but sometimes one or both of the testes do not move down into the scrotum once they develop. This is called undescended testes, and is also known as cryptorchidism (kript-ork-id-izm). 

About five per cent of male babies are born with undescended testes.

Signs and symptoms of undescended testes

The main sign of undescended testes is one testis (a single testicle) or both testes missing from the scrotum. Undescended testes will not cause your child any problems with urination, and will not cause any pain, unless the cord attached to the testis (spermatic cord) becomes twisted.  

What causes undescended testes?

The testes in a male foetus are formed inside the abdomen. The testes move down a tube called the inguinal canal and into the scrotum. This usually happens in the eighth month of pregnancy. A baby or child with undescended testes will have one or more of their testes located in the groin or abdomen instead of the scrotum.

There are two types of undescended testes: congenital and acquired.

Congenital undescended testes

Babies born without testes in the scrotum have congenital undescended testes.

Usually doctors cannot find the cause; however, some hormone and genetic disorders can cause undescended testes.

In babies born early (premature babies), the testes may not have had time to move down into the scrotum by the time the baby is born.

Acquired undescended testes

Sometimes a child is born with the testes in the scrotum, but they develop undescended testes later. As the child grows, the spermatic cord fails to grow at the same rate. It ends up too short, and pulls the testis back up into the groin. This can happen between one and 10 years of age.

When to see a doctor

If your baby is born with undescended testes, this will be picked up by your Maternal and Child Health Nurse or your doctor shortly after birth. Your baby's condition will be monitored.

If your baby's testes were in the scrotum at birth, and one or both of them disappears from the scrotum, see your GP. You will be referred to a paediatrician or paediatric surgeon. It is very important that the testes be brought down to the scrotum. 

If the testes do not come down, there is a risk of ongoing health issues such as:

• Torsion – the spermatic cord can become twisted and this can cut off the blood supply to the testes.
  
• Hernia – when a loop of bowel comes into the scrotum. See our fact sheet Inguinal hernia.
  
• Reduced fertility – the body temperature in the abdomen is higher than in the scrotum, and this can affect sperm production in the testes.
  
• Risk of testicular cancer – this happens in a relatively low number of boys. The risk is usually less than 1 in 100.
  
• Poor self-esteem – due to having abnormal looking genitals.

Treatment for undescended testes

For babies born with undescended testes, the testes may come down by themselves in the first three months after birth, and no treatment is needed.

If the testes do not come down by themselves, your child will be monitored, and if they are not down after six months, an operation called an orchidopexy (ork-id-o-peck-see) is needed. An orchidopexy brings the testis down into its normal location in the scrotum. Orchidopexy is done under anaesthesia.

During surgery, a small cut is made in the groin and the cord is gently stretched to free up the testis. A second cut is made in the scrotum and the testis is secured inside the scrotum. The cuts are then stitched up. This operation is usually a day procedure and your child should be able to go home on the same day.

Complications from orchidopexy are rare, but may include:

• The testis does not reach the scrotum after the first operation, and the procedure needs to be done again.
  
• If the testis is very high in the abdomen or the blood supply to the testis is poor, it may shrink. This is very rare.

Care at home

After your child's surgery, you will be given some post-operative care instructions. Contact your child's surgeon or the hospital if:

• your child develops a fever of 38.5ºC or higher
  
• the wounds become infected (appear red, swollen, or leak fluid)
  
• you are worried for any other reason.

You may need to give your child pain relief – paracetamol is usually enough. See our fact sheet Pain relief for children.

Limit your child's activity for the first few days after surgery – the surgeon will advise you of when your child can return to their normal activities.

Follow-up

An appointment will be made for your child to see their surgeon after the operation.  Regular checks may be needed to make sure the testicle remains in the scrotum. Your child will need to learn how to do regular testicular self-examination when they become a teenager.

Key points to remember

• Undescended testes is when the testes are not in the scrotum. 
• There may be several reasons for undescended testes. Usually the cause is unknown.
• An operation is needed if the testes do not move down by themselves by six months of age. This is done to reduce ongoing health issues.
• The operation is a day procedure and your child will usually go home the same day.

For more information

• See your Maternal and Child Health Nurse, GP or paediatrician.
• Kids Health Info fact sheet: Pain relief for children
• Kids Health Info fact sheet: Spinal anaesthesia
• The Royal Children's Hospital Surgery Department fact sheet: Anaesthesia and Pain Management
• Better Health Channel: Undescended testicles
• American Urology Care Foundation: What are undescended testicles (Cryptorchidism)?

Developed by The Royal Children's Hospital Paediatric Urology and Surgery departments. We acknowledge the input of RCH consumers and carers.

Reviewed March 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.