During a physical exam for
undescended testicles, a doctor examines a boy's lower
abdomen and groin and notes the size, shape, and appearance of the genitals,
particularly the
scrotum. An undescended testicle can make the scrotum
appear unbalanced or undeveloped.
The doctor will apply gentle pressure to the scrotum and
groin area, moving his or her fingers along the normal
path of descent from the
inguinal canal to the scrotum, to see whether the
testicle can be felt under the skin. The doctor may also feel other areas near
the groin to look for any abnormalities. To ensure that his or her fingers move
smoothly over the skin, the doctor may use a lubricant such as K-Y
jelly.
If a testicle is felt above the scrotum, the doctor will use gentle
pressure to try to draw the testicle down into the scrotum. A true undescended
testicle cannot be drawn down completely to the bottom of the scrotum and, when
it is released, it immediately moves back up to its undescended
position.
If the testicle can be drawn down completely to the base of the
scrotum during an exam and remains there, it is very likely a retractile
testicle rather than a true undescended testicle. A retractile testicle is one
that has fully descended but that can be lifted up out of the scrotum by the
contraction of a muscle that is attached to the testicle. In the retracted
position, the testicle may rise as far as the superficial inguinal pouch, which
is a small pocket under the skin of the groin just below the inguinal canal. A
retractile testicle may develop later in childhood, so it is important that the
position of the testicles at birth and in early infancy be recorded during
well-baby checkups during the first year. Retractile testicles do not require
any treatment. As boys reach early adolescence, the testicles enlarge and the
cremasteric muscle reflex weakens, so the testicles usually descend back into
the scrotum on their own.
The baby or child should be warm, relaxed, and comfortable during the
exam. Also, different body positions may affect the position of the testicles.
To make the exam easier, the doctor usually will have the baby or young boy lie
on his back but also may have him sit cross-legged or stand in a certain
position. This is especially important with boys who are between about 2 and 7
years old, when the reflex of the cremaster muscles may draw the testicles up
higher than their normal relaxed position. The doctor also may use a warm
compress to help relax the cremaster muscles.
During the exam, the doctor will note any signs of hypospadias.
Hypospadias is a common birth defect where the
urethra does not extend to the tip of the penis.
Instead, the opening of the urethra is located somewhere along the underside of
the penis, running along a soft groove. The scrotum may also be incompletely
formed or divided into separate sacs or lobes. In many cases of hypospadias,
particularly when the genitals are incompletely formed, the testicles do not
descend. The doctor also will look for features that can indicate other
congenital (genetic) disorders that are often associated with an undescended
testicle, such as
cystic fibrosis or
Klinefelter syndrome.
