What Are Undescended Testicles? Causes, Risks, and Treatment

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What Are Undescended Testicles?

Undescended testicles are testicles that develop in the abdomen during pregnancy but do not descend into the scrotum as expected. The condition affects roughly 3% of full-term male infants and up to 30% of premature ones. About half resolve on their own by three months, and surgery is the gold standard for persistent cases to protect hormones and fertility.

What the research says

• Surgically corrected undescended testicles still carry a higher lifetime risk of testicular cancer. A meta-analysis of 6 observational studies (3 case-control and 3 cohort; 371,681 patients and 1,786 testicular cancer cases) found a pooled odds ratio of 3.99 (95% CI 2.80–5.71) for testicular cancer in adults with a history of orchidopexy for congenital cryptorchidism. The authors conclude that orchidopexy in the first year of life decreases the overall cancer risk (Florou et al., Eur J Pediatr, 2023). [2]

• Later correction was linked to poorer testicular function in adulthood. In 357 middle-aged men with previously undescended testes compared with 709 controls, men with a history of undescended testes had lower testosterone (p = 0.003), lower sperm concentrations, and higher FSH and LH levels. Only 21% had normal sperm concentrations (27% with unilateral and 12% with bilateral undescended testes); 44% had oligozoospermia and 35% had azoospermia. Age at correction (median 6 years in this group) was inversely correlated with testicular volume and sperm concentration (Rohayem et al., Endocrine, 2017). [3]

Key Takeaways: Undescended Testicles at a Glance

Understanding Undescended Testicles

During fetal development, the testicles develop inside the abdominal cavity. In the final stages of pregnancy, they typically migrate down a small path called the inguinal canal and settle into the scrotum. Undescended testicles occur when this migration is interrupted, leaving the testicle in the abdomen or groin.

This condition is the most common birth defect involving the male reproductive system. While it can be alarming for new parents, it is not painful for the baby and does not interfere with their ability to urinate.

Symptoms and Complications

The primary sign of cryptorchidism is a scrotum that looks or feels empty on one or both sides. In most cases, there are no other physical symptoms. However, leaving the condition untreated can lead to significant long-term health issues. [1]

Potential Health Risks

• Infertility: Testicles require a cooler temperature than the rest of the body to produce healthy sperm. Remaining in the warm abdomen can damage sperm-producing cells.

• Testicular Cancer: Men who had undescended testicles have a higher risk of testicular cancer, several times the usual risk in studies, though the overall chance stays low and early surgery reduces it. [2]

• Testicular Torsion: This is a medical emergency where the spermatic cord twists, cutting off blood flow to the testicle. [1]

• Inguinal Hernia: A bulge of tissue or organ through a weak spot in the groin muscle, which often occurs alongside undescended testicles. [1]

Causes and Risk Factors

Medical researchers believe that a combination of genetics, maternal health, and environmental factors may influence the descent of the testicles. A primary theory suggests that a temporary deficiency in testosterone during fetal development may stall the migration process.

The single most significant risk factor is premature birth. Babies born before the 37th week of pregnancy often haven't had enough time for the testicles to complete their descent. Other factors, such as low birth weight or a family history of the condition, may also play a role.

Diagnosis and Professional Care

Diagnosis usually happens during a newborn's first physical examination. A healthcare provider will gently feel the scrotum to confirm the presence of both testicles. If one or both are missing, the child may be referred to a pediatric urologist, a specialist in children's reproductive and urinary health. [1]

While imaging tests like ultrasounds are sometimes mentioned, they are often unnecessary for a diagnosis, as a skilled physical exam is the most reliable method for locating the testicle. [1]

Treatment: The Orchiopexy Procedure

If a testicle has not descended by the time a baby is six months old, it is unlikely to do so on its own. At this stage, doctors typically recommend a surgical procedure called an orchiopexy.

What to Expect During Surgery

During an orchiopexy, a surgeon makes a small incision in the groin to locate the testicle and another in the scrotum to create a small pocket. The testicle is carefully moved into the scrotum and secured in place. The procedure is usually performed as an outpatient surgery, meaning the baby can go home the same day.

Current guidelines advise doing an orchiopexy after 6 months of age and ideally by 18 months; older advice was between 12 and 24 months of age. This timing helps maximize the chances of normal testicular development and minimize future health risks.

Conclusion

Undescended testicles are a common and treatable condition. With a surgery success rate of 98%, most children go on to have normal reproductive health and testosterone levels. The most important step for parents is to ensure regular pediatric checkups and follow through with specialist referrals if the condition persists past six months.

Frequently Asked Questions

Is an undescended testicle painful for my baby?

No, cryptorchidism does not cause any physical pain or discomfort for infants.

Can I push the testicle down into the scrotum myself?

No, you should never attempt to move the testicle manually. This requires surgical intervention to be done safely.

What is the difference between a retractile testicle and an undescended one?

A retractile testicle moves back and forth between the groin and scrotum due to a muscle reflex. An undescended testicle stays in the abdomen or groin.

Does having one undescended testicle cause infertility?

Men with one undescended testicle typically have fertility rates similar to the general population. The risk is higher if both testicles were undescended.

At what age is surgery usually performed?

Doctors generally recommend performing an orchiopexy after 6 months of age and ideally by 18 months.

Can undescended testicles be prevented?

There is no known way to prevent this condition, as it is linked to fetal development and genetics.

Does my baby need an ultrasound for a diagnosis?

In most cases, a physical exam is sufficient, and an ultrasound is not required to confirm the diagnosis.

What happens if we don't treat it?

Untreated undescended testicles can lead to infertility, low testosterone, and a higher risk of testicular cancer and torsion.

How common is the condition in full-term babies?

It affects about 3% of full-term male infants.

Why is it more common in premature babies?

Premature babies are born before the testicles have had enough time to complete their natural descent from the abdomen.

Can hormones be used instead of surgery?

Hormone therapy is occasionally used, but orchiopexy (surgery) is considered the gold-standard treatment.

Is testicular cancer a major risk?

While the risk is slightly higher, it remains relatively low overall, especially with early surgical correction.

Will the testicle grow normally after surgery?

Surgery keeps the testicle in the scrotum in about 98% of cases; growth and function tend to be best when surgery is done early.

Can a child with this condition still have kids later?

Yes, the vast majority of children treated for cryptorchidism go on to have normal fertility.

What are the signs of an inguinal hernia?

A hernia often appears as a visible bulge in the groin area, especially when the baby cries or strains.

How long is the recovery after surgery?

Most babies recover quickly, usually within a few days, though they should avoid strenuous activity for a few weeks.

Is the surgery performed under general anesthesia?

Yes, the procedure is performed while the baby is asleep to ensure they are comfortable and still.

Can both testicles be undescended?

Yes, bilateral cryptorchidism occurs when both testicles fail to descend.

Does it affect the baby's ability to pee?

No, the condition does not impact the urinary tract or the baby's ability to urinate.

What is a pediatric urologist?

A specialist who treats conditions affecting the urinary and reproductive systems in children.

Should my son do self-exams when he's older?

Yes, monthly testicular self-exams are recommended starting in the teenage years to monitor for any changes.

Can the condition recur after surgery?

It is very rare, but in some cases, the testicle may move back up, requiring a follow-up procedure.

Do undescended testicles affect testosterone levels?

If left untreated, it can lead to lower testosterone production (hypogonadism).

Is it a genetic condition?

There is a genetic component, as it can sometimes run in families.

What is testicular torsion?

A serious condition where the spermatic cord twists, which is more common in undescended testicles.

Is the scrotum smaller in babies with this condition?

The side of the scrotum without the testicle may appear smaller or less developed.

Can the testicle descend after one year?

It is highly unlikely for a testicle to descend naturally after the age of six months.

Are there any dietary restrictions for the mother?

No specific diet has been shown to prevent or cause undescended testicles.

What is an “impalpable” testicle?

A term used when a doctor cannot feel the testicle during a physical examination.

Does the surgery leave a large scar?

No, the incisions are very small and typically heal with minimal scarring.

Can a child with one testicle play sports?

Yes, but they may be advised to wear protective gear like a cup to protect the remaining testicle.

Is cryptorchidism related to other birth defects?

It is often an isolated issue, but it can be part of certain genetic syndromes.

How do I take care of the surgical site?

Your doctor will provide specific instructions, usually involving keeping the area clean and dry.

Can a primary care doctor perform the surgery?

No, the surgery must be performed by a specialist, typically a pediatric urologist or pediatric surgeon.

Does it affect the size of the penis?

No, cryptorchidism does not affect the development or size of the penis.

What if the surgeon finds the testicle is unhealthy?

In rare cases, if the testicle is severely damaged or non-functional, the surgeon may remove it.

Can a baby with undescended testicles take a bath?

Yes, there are no restrictions on bathing before surgery.

Does the condition affect puberty?

If treated early, puberty typically proceeds normally.

Can it be detected during pregnancy via ultrasound?

It is difficult to diagnose with certainty before birth, as the testicles often descend late in the third trimester.

What is the “inguinal canal”?

The passage through which the testicles move from the abdomen into the scrotum.

Is it more common on the left or right side?

It can occur on either side, though it is slightly more common on the right.

Does the baby need to stay in the hospital overnight?

Usually not; it is typically an outpatient “day surgery.”

Can a retractile testicle become an undescended one?

Rarely, a retractile testicle may become “trapped” in the groin, a condition called an acquired undescended testicle.

What are the signs of infection after surgery?

Redness, swelling, discharge from the incision, or a fever.

Is the condition related to maternal smoking?

Some studies suggest a link, but it is not a definitive cause.

Can a child have an undescended testicle and a hernia at the same time?

Yes, they often occur together because the path for the testicle (the processus vaginalis) fails to close.

Does the surgery affect future sexual function?

No, orchiopexy does not negatively impact sexual function later in life.

How soon can we see the urologist?

Most pediatricians recommend a referral as soon as the condition is confirmed at birth or the first checkup.

Is the surgery 100% guaranteed?

While it has a 98% success rate, no surgery is without some risk, which your doctor will discuss with you.

Related Reading

Prosthetic Testicle (Testicular Implant): Procedure and Recovery explains prosthetic testicles.

References

1. Cleveland Clinic. Undescended Testicles. Cleveland Clinic. Last updated May 2, 2024. https://my.clevelandclinic.org/health/diseases/17594-undescended-testicles

2. Florou M, Tsilidis KK, Siomou E, et al. Orchidopexy for congenital cryptorchidism in childhood and adolescence and testicular cancer in adults: an updated systematic review and meta-analysis of observational studies. Eur J Pediatr. 2023;182(6):2499-2507. PMID 36988678. https://doi.org/10.1007/s00431-023-04947-9

3. Rohayem J, Luberto A, Nieschlag E, et al. Delayed treatment of undescended testes may promote hypogonadism and infertility. Endocrine. 2017;55(3):914-924. PMID 28070708. https://doi.org/10.1007/s12020-016-1178-0

Disclaimer

This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment.