Retractile Testis

What is a retractile testis?

Before your son was born, his testicles formed within his abdomen during fetal development. During the final months of development, the testicles gradually descend into the scrotum. If this descent isn't completed at birth, the testicle usually descends within a few months. If your son has what is called a “retractile testicle”, it means that the testicle originally descended as it should, but doesn't totally remain in place in the scrotum.

A retractile testicle may move between the scrotum and the groin (where the upper thigh meets the lowest part of the abdomen). When the retractile testicle is located in the groin it can often be easily guided by hand into its expected position within the scrotum (the bag of skin that sits behind the penis) on physical exam. When released, the testicle may stay in this expected position for a short period before returning to the groin. Your provider will be able to tell the difference between a true undescended testicle and a retractile testicle during the physical exam. This diagram illustrates the possible positions of the testicle:

Typically, the problem of a retractile testicle goes away (resolves itself) before or during puberty. The testicle moves to its proper location in the scrotum and stays there permanently. Our surgical team will continue to monitor your child periodically as, on occasion, the testicle may move into the groin and remain in that location. This is a separate condition known as ascending testicle.

A retractile testicle is not the same as an undescended testicle (cryptorchidism). An undescended testicle is one that never positioned itself in the scrotum.

What are the symptoms of retractile testis?

If your son has a retractile testicle, the testicle originally descended from the abdomen as it should, but doesn't remain in place.

Common findings:

• The testicle may spontaneously appear in the scrotum and stay there for some time.
• The testicle may spontaneously disappear again for some time.
• The testicle may be moved with gentle manipulation from the groin into the scrotum and doesn’t immediately return to the groin.

What causes retracile testis?

An overactive muscle (cremaster muscle) causes a testicle to become retractile. The cremaster muscle is a thin muscle that surrounds each of the testicles and the spermatic cord. As this muscle contracts (cremasteric reflex), it draws the testicle up toward the body. This reflex is easily activated by a touch of the inner thigh, cold surroundings, or in times of emotion, such as fear and laughter. Your provider needs to examine the patient to be able to differentiate between an undescended testicle and a retractile testicle. 

How is retracile testis diagnosed?

When coming to visit the pediatric surgical team, we will use a physical exam to determine where the testicle is located in the groin. Once identified, we gently palpate and guide the testicle to its correct position within the scrotum. The testicle should easily make its way into the scrotum. The testicle will either then remain in position for a period (retractile) or immediately return from its starting groin location (undescended). 

How is retracile testis treated?

Fortunately, surgery is almost never necessary. A retractile testicle typically will assume its intended position in the scrotum by the time of puberty. There is no recommended surgery for this condition. Your doctor will continue to follow your son yearly and observe for any changes with the testicle. Only undescended testicles will require operative treatment. Your provider will be able to determine what the correct diagnosis is for your child.

What should I expect for my child with retracile testis?

A retractile testicle is a normal functioning testicle that will not inhibit or cause problems related to growth, sexual development, or fertility. The appearance of the scrotum may be different at times, possibly less full looking on one side.  

In time, the expectation is that the retractile testicle will ultimately remain within the scrotum. With routine evaluations, we can ensure that there are no concerning changes to the testicle or indications for surgery.