When the Testicle Doesn't Find Its Place
Cryptorchidism (medically: Maldescensus testis) is a congenital developmental disorder in which one or both testicles are not fully located in the scrotum but "get stuck" in the inguinal canal or abdominal cavity.
This anomaly occurs in about 2-5% of all male newborns, and significantly more often in premature babies. If it is not recognized or treated, it can affect fertility, hormone production, and even cancer risk later in life.
Even though cryptorchidism is usually corrected in early childhood, it is an issue that also affects adult men – for example, if it was diagnosed late, incompletely treated surgically, or leaves behind long-term consequences.
How does cryptorchidism develop?
During embryonic development, the testicles migrate from the abdominal cavity through the inguinal canal into the scrotum. This process should be completed by birth.
If a testicle "gets stuck" on the way – in the abdominal cavity, inguinal canal, or an atypical location – it is called cryptorchidism. This is not just a positional anomaly, but a functionally relevant disorder, as the testicles outside the scrotum are exposed to a higher body temperature, which impairs sperm production.
What forms are there?
- Inguinal cryptorchidism: Most common form, testicle is located in the inguinal canal
- Abdominal cryptorchidism: Testicle remains in the abdomen
- Gliding testicle: Testicle reaches the scrotum but retracts again
- Ectopic testicle: Testicle is located outside the typical descent path (e.g., thigh region)
- Retractile testicle (physiological): Harmless in children, as the testicle temporarily retracts into the groin, no therapy needed
It is important to distinguish between true cryptorchidism and harmless retractile testicles, as the latter does not cause fertility problems.
Why is this relevant for men?
Untreated cryptorchidism can have serious long-term consequences, even if it spontaneously resolved in childhood or was not noticeable at the time:
- Fertility disorders: Testicles outside the scrotum produce fewer sperm
- Increased risk of testicular cancer: Especially with abdominal cryptorchidism or unilateral cryptorchidism
- Hormone deficiency in adulthood: Impaired testosterone production
- Psychosocial burden: e.g., asymmetry or insecurity during physical intimacy
- Poorer temperature regulation in the testicular area
Especially men with unfulfilled desire to have children or abnormal hormone levels should check their childhood anamnesis – was cryptorchidism detected or treated back then?
Symptoms in adulthood
Early cryptorchidism can lead to the following symptoms in adulthood:
- Low testicular volume on one side
- Asymmetrical scrotum
- Impaired fertility (e.g., poor sperm quality in a semen analysis)
- Reduced testosterone levels
- Loss of libido, drop in energy
- Gradual onset of hormonal exhaustion ("Late-Onset Hypogonadism")
- Possibly palpable testicle outside the scrotum
How is cryptorchidism diagnosed?
In children, the diagnosis is usually made directly after birth or in the first months of life through palpation.
In adults, a urological consultation is often necessary, in conjunction with:
- Ultrasound (sonography) for localization
- Hormone diagnostics: including testosterone, LH, FSH, SHBG
- Semen analysis if there is an unfulfilled desire to have children
- Self-examination for lumps or volume differences
- If necessary, MRI, if the testicle cannot be found
Such a check is particularly important in unilateral testicular atrophy, or if there is no clear childhood documentation.
Therapy and long-term consequences
The standard therapy in childhood is surgical repositioning of the testicle into the scrotum (orchidopexy), ideally before the first birthday. This significantly reduces the risk of later complications.
In adulthood, fewer therapeutic options are available; depending on the findings, it involves:
- Hormone replacement (e.g., for testosterone deficiency)
- Sperm preservation (for desire to have children)
- Removal (orchiectomy) for abnormal testicles or tumor risk
- Close long-term urological monitoring
Conclusion
Cryptorchidism is not an issue that "ends with childhood." Even in adulthood, it can manifest as hormone disorders, unfulfilled desire to have children, or an increased risk of testicular cancer, often unnoticed for years.
Men with noticeable symptoms, hormonal imbalances, or an asymmetrical scrotum should not hesitate to clarify the issue – ideally first with their GP, who can then refer them to a urologist or endocrinologist if necessary.
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