Cryptorchidism: A Comprehensive Guide
Medically reviewed by Andre Stone | MD, University of Pittsburgh School of Medicine on August 24th, 2026.
Published on April 2nd, 2026. Updated on August 28th, 2026.
Key Takeaways
Cryptorchidism occurs when one or both testicles fail to descend into the scrotum before birth
It affects about 3-5% of full-term baby boys and up to 30% of premature babies
Many testicles descend naturally during the first few months of life. Descent after about 6 months is uncommon, so babies whose testicles remain undescended should be evaluated promptly.
Surgery is usually recommended between 6-18 months if testicles don't descend naturally
Early treatment helps prevent fertility problems and reduces cancer risk later in life
Overview
Cryptorchidism is a condition where one or both testicles don't move down into the scrotum before a baby boy is born. The testicles normally develop inside the abdomen during pregnancy and then descend into the scrotum during the last few months before birth.
This condition is one of the most common birth defects affecting male babies. It happens more often in premature babies because testicles usually descend in the final weeks of pregnancy. About 3-5% of full-term boys have cryptorchidism at birth, but this number drops to about 1% by their first birthday as many testicles descend on their own.
Getting proper treatment is important because undescended testicles can lead to fertility problems and increase the risk of testicular cancer later in life. The good news is that with early detection and treatment, most boys go on to have normal, healthy lives. Doctors can find this condition during routine baby check-ups right after birth. Treatment is usually simple and very successful when caught early.
Symptoms & Signs
The main sign of cryptorchidism is not being able to feel one or both testicles in the scrotum. Parents or doctors may notice that the scrotum looks smaller or appears empty on one or both sides.
Primary Symptoms
Empty or partially empty scrotum that feels soft and underdeveloped
Testicle that can sometimes be felt in the groin area but not in the scrotum
Asymmetrical scrotum where one side appears smaller than the other
A retractile testicle may move between the groin and scrotum but can be gently brought into the scrotum. It is different from an undescended testicle and should be checked regularly because it can sometimes move upward permanently.
When to Seek Care
Most cases of cryptorchidism are found during routine newborn exams at the hospital. However, parents should contact their pediatrician if they notice changes in their child's scrotum or if they can't feel both testicles during diaper changes. Sometimes parents notice the difference when bathing or dressing their baby. It's okay to ask your doctor any questions about what feels normal or different.
When to Seek Immediate Care
Seek urgent medical care right away for sudden groin or scrotal pain, swelling, redness or color change, especially if your child is vomiting or very distressed. These symptoms can indicate testicular torsion or an incarcerated hernia, which require emergency assessment.
Causes & Risk Factors
The exact cause of cryptorchidism isn't always clear, but it likely involves a combination of genetic, hormonal, and environmental factors. During normal development, hormones signal the testicles to move from the abdomen down through the inguinal canal into the scrotum.
Sometimes this process doesn't work properly. The testicles may stop partway down or never begin their descent at all. Problems with hormone production or sensitivity can interfere with this natural process. Cryptorchidism can be more common in some families, suggesting that genetic factors may contribute to risk. Understanding allergies and other developmental conditions can sometimes provide insight into how various factors affect normal growth.
Environmental factors during pregnancy may also play a role. Some research suggests that exposure to certain chemicals or substances might increase the risk, though more studies are needed to confirm these connections. A mother's health during pregnancy, like having diabetes, can affect how her baby develops. Healthy choices before and during pregnancy help protect the baby's development.
Prematurity
Babies born before 37 weeks have higher risk since testicles descend late in pregnancy
Low Birth Weight
Smaller babies are more likely to have undescended testicles
Family History
Brothers or fathers with cryptorchidism increase the risk
Maternal Factors
Diabetes, alcohol use, or smoking during pregnancy may increase risk
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Diagnosis
Medical History & Physical Examination
Your pediatrician will ask about your pregnancy, delivery, and your baby's birth weight. They'll also want to know if there's any family history of cryptorchidism or other genital abnormalities. The physical exam is usually the most important part of diagnosis.
During the physical exam, the doctor will gently feel the scrotum and groin area to locate the testicles. They may examine your baby while he's relaxed, crying, or in different positions. Sometimes testicles can be felt but are positioned higher than normal. The doctor will also check for other abnormalities that sometimes occur with cryptorchidism.
Diagnostic Testing
Imaging is usually not recommended before referral because ultrasound often cannot reliably locate a testicle that cannot be felt. A pediatric urologist or surgeon will determine whether any further evaluation is needed.
Hormone tests (rarely needed) to check testosterone and other hormone levels
Laparoscopic examination to find testicles located high in the abdomen
MRI is rarely used because it often does not change treatment. A specialist will decide whether any imaging or surgical evaluation is appropriate.
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Treatment Options
The goal of treatment is to move the testicles into the scrotum and keep them there permanently. Treatment timing is important because waiting too long can affect fertility and increase cancer risk later in life. If the testicle has not descended by about 6 months of age, adjusted for prematurity, referral to a specialist is recommended. Surgery is generally performed during the following year and ideally by 18 months.
Conservative Treatments
Observation and regular monitoring for babies under 6 months old since testicles may still descend naturally
Hormone therapy (rarely used) with injections of human chorionic gonadotropin in select cases
Regular check-ups every few months to track any changes in testicle position
Advanced Treatments
Orchiopexy surgery to move the testicle into the scrotum and secure it in place, typically performed between 6-18 months
Staged surgical procedures for testicles located high in the abdomen that require multiple operations
Removal may be considered in selected cases when the testicle is severely damaged or nonviable. High abdominal testicles in young children can often be treated with a staged operation, so the specialist will recommend an individualized approach.
Most surgery is done as outpatient care, meaning your baby goes home the same day. The surgery usually takes less than an hour and has a high success rate. Your doctor will explain all options and help you decide what's best for your child.
Living with the Condition
Daily Management Strategies
Most boys with treated cryptorchidism live completely normal lives. After successful surgery, no special daily care is usually needed. Parents should teach their sons to perform regular self-exams starting in their teenage years to check for any lumps or changes. Regular follow-up visits with the pediatrician help ensure proper healing and development.
It's important to maintain open communication about the condition as your child grows. Some boys may have questions about their surgery or worry about being different from their peers. You can explain that many boys have had the same surgery and are doing great. Understanding rare types of anemia and other childhood conditions can help parents provide perspective on how common various medical treatments are.
Exercise & Movement
After surgery, your child will need to avoid strenuous activities for a few weeks while healing. Once fully healed, there are usually no exercise restrictions. Most boys can participate in all sports and physical activities without problems. Contact sports are generally safe once the doctor clears your child for full activity. Your doctor will tell you exactly when it's okay for your child to return to normal play and sports.
Prevention
Avoid smoking, alcohol, and illicit drugs during pregnancy as these may increase risk
Manage diabetes carefully during pregnancy with proper medical supervision
Take prenatal vitamins as recommended by your healthcare provider
Attend all prenatal appointments for proper monitoring of fetal development
Stay away from harmful chemicals and environmental toxins when possible during pregnancy
How quitting smoking improves your health provides valuable information for expectant mothers
Frequently Asked Questions
Many boys treated for cryptorchidism can later father children. Fertility is often near normal when only one testicle was undescended, but problems are more common when both testicles were affected. Early treatment may improve fertility potential but cannot guarantee normal fertility.
Re-ascent after successful orchiopexy is uncommon, but regular follow-up helps ensure the testicle remains in place as the child grows.
Sometimes cryptorchidism occurs with other conditions affecting the urinary tract or reproductive system. Your doctor will check for these during the initial examination. Most boys with cryptorchidism don't have any other birth defects.
Most doctors recommend surgery between 6-18 months of age if the testicles haven't descended naturally. Understanding ventricular tachycardia and other time-sensitive medical conditions helps illustrate why timing matters in treatment decisions.
After healing, the appearance often improves, but the scrotum or testicles may not be perfectly symmetrical, especially if the affected testicle is smaller. The surgical incision is usually small and often fades over time, although some scarring or asymmetry may remain.
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