Testicles
When a baby boy is born, the pediatrician will check to see if both of the testicles have descended into the scrotum during gestation. Sometimes one or both are not descended but can be palpated slightly higher up in the canal that the testicles travel from the abdomen down to the scrotum. We give those little guys up to 1 year for the testicles to make their trip down to the scrotum. If they have not completed the journey by the kiddo’s first birthday, we need to have the urologist surgically locate and sew them into place to avoid future functioning issues of the testicles and to prevent testicular cancer.
Another common finding at birth is water/fluid in the scrotum surrounding the testicles. It usually resolves on its own in a month or two but, again, if it persists for more than 12 months then a urologist will need to drain the fluid and close the area in which the fluid collection occurred to prevent problems with the testicle later in life.
A more concerning finding in the scrotal area of boys would be a testicular hernia. This is when there is a defect in the abdominal wall that allows a part of the intestine to travel down and hang out in the scrotum. This swelling will often appear and disappear with increased abdominal pressure such as straining to poop, crying, or sneezing. We do not wait to repair this as an injury to the scrotum with intestine, or the twisting or obstruction of the intestine is a medical emergency due to concern of a possible intestinal rupture. If there is concern for this type of hernia, your pediatrician will refer you to a general surgeon for prompt repair.
Retractile testes are a common and natural part of the musculature surrounding the testicles and scrotum. If the bathtub is too cold or a kiddo is scared/crying, the testicles will rise up out of the scrotum as a way to “protect themselves.” This happens numerous times throughout the day but should never be painful and they should always return down once things are warmer or calmer. If it is painful when this happens, then the retracting maybe too strong or may go too high, requiring a urologist to investigate if the testicles are going up too high or getting stuck on something on the way up/down needing surgical correction.
Now anytime a kiddo, at any age, has a sudden onset of testicular pain it needs to be evaluated emergently due to the rare occurrence of testicular torsion. Testicular torsion is when the testicle twists on itself and cuts off the blood supply to the testicle. As my urology friends say, “Time is Testicle.” So, if your kiddo says they are having groin pain, so much that they are vomiting or unable to walk properly, they need to be seen in the Emergency Room for prompt evaluation and imaging with even more prompt surgical intervention if needed.