Boys are born with their testicles outside the body in a skin sack called the scrotum. Testicles exist in pairs, one on each side of the body. The testicles are formed in the abdomen of the male foetus. As the child grows in the uterus, the testicles gradually descend into the scrotum by the seventh month (28 weeks). They are found outside, in the scrotum, at birth and can be seen and felt. Sometimes one or both testicles fail to reach the scrotal sac. This leaves the scrotal sac empty on one (usually the right) or both sides. It occurs in approximately 3 per cent of full-term and 30 per cent of preterm babies. The likelihood increases if the baby has a low birth weight or there are family members who have a similar condition.
By the third month, in 80 per cent of the cases, the situation resolves itself and the testicles descend into the scrotum spontaneously by the fourth month. If this does not occur, then treatment is warranted.
The average human body temperature is 98.4 degrees Fahrenheit. In the scrotum, it is 94 degrees Fahrenheit. This low temperature is essential for the proper development of spermatozoa. If the testes remain in the abdomen, the high temperature it is exposed to causes faulty development of sperms. The sperm count becomes low, the sperms may not be structurally normal, or a condition called azoospermia develops when the sperms are absent. This results in subfertility or even sterility.
If the testes continue to remain in the abdomen, the likelihood of developing cancer of the testes is increased 10-fold. This may be because of the high temperature the testes are exposed to, or the organ may not have descended to its proper position as it was always defective.
Some boys have retractile testes. The testes are sometimes in the scrotum and at other times ascend into the inguinal canal. This is because the muscles which control the movements of the testes contract especially strongly, either in response to physical touch or emotional stimuli like laughter
A retractile testis can become stuck in the inguinal canal through which it ascends and descends. If and when this occurs, it can undergo torsion; its blood supply can get compromised. There is severe pain. If it is not surgically corrected within six hours, the testicle can die.
Usually, by the age of around 13 years, a retractile testis remains permanently in the scrotum, and no further treatment is required. Sometimes, however, it ascends into the groin or abdomen and becomes an undescended testis requiring treatment. Many parents are unaware of the seriousness of an undescended testis. Quacks and well-wishers might advise a “wait and watch” policy. Parents hope that the issue will resolve itself. If the testis has not descended by the age of four months, it is better to opt for surgery. The latest that surgery can be delayed is 18 months, after which its functioning is compromised. If the testis is in the inguinal canal, laparoscopic surgery can be done. Anaesthesia time and hospital stay are short. If the testis is in the abdomen, open surgery must be done. An undescended testis in the groin may also be associated with a wide inguinal canal and a hernia. This needs correction at the same time.
Human chorionic gonadotrophin, or HCG, injections and testosterone therapy have been tried as an alternative to surgery. Not only does this usually not work, it can also have dangerous side effects.
All men with an undescended testicle are not necessarily sterile. Many do have children, but their fertility is reduced. They are also at risk for testicular cancer.
The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in
