Why Is My Son’s Testis Missing? 14 Possible Causes!
Mrs xyz is a 45 years old woman. She has a complaint that one of her son’s testes is missing since birth. The son is 5 months old. According to the mother the right testis is not in the scrotum. And that is how it has been since birth. This has been a source of worry to her. On examination I found out that in deed the right testis is not in the scrotum. However the left testis was present and normal in size.
However, the right testis was not completely absent, because it was located somewhere in the lower part of the abdomen.
What is the cause of the missing testis?
The absence of the testis in the scrotum which is the normal location is called cryptochidism.
Cryptochidism means undescended testis.
Normally the testes are not produced in the scrotum. They are produced in the abdomen. It is from that site of production inside the abdomen that they descend and enter the scrotum.
The descent starts towards the end of intrauterine life to almost about 1 year of life.
In the process of the journey from the abdomen to the scrotum, anything can happen that could hinder it’s arrival to its promised land – the almighty scrotal bag!
There is no known particular trigger that causes inability of the testis to descend successfully, but some factors have been implicated as predisposing factors to this.
Possible Risk Factors of missing testis (undescended testis)
A child whose brother or father had missing testis is at risk of having it.
Studies in the US have found out that undescended testis is more likely in whites than in blacks.
It has been shown that missing testis (undescended testis) is increased in twins of boy-boy pair.
4. Low birth weight
Low birth weight increases the chances of developing undescended testis.
5. Breech Presentation during birth
A baby presenting with any other part of the body that is not the head while coming out from the mother is called breech. The factors that cause this breech presentation have been argued to also possibly cause inability of the testis to descend.
Smoked foods during pregnancy has been implicated. Caffeine remains controversial in causing undescended testis.
7. Calender Time of birth
A study shows undescended testes can occur between September and November, and from January to May. These have not been substantiated.
8. Exposure to environmental and industrial chemicals
These chemicals have been linked to disruption of hormones, hence inducing cryptochidism.
These include pregnancy related medications – taken to prevent pregnancy, promote pregnancy, against pain, against nausea and vomiting, etc.
Some recreational drugs like cocaine, marijuana have been implicated too.
10. Smoking by Mother and/or father
Use of tobacco and tobacco products could be a risk factor in developing undescended testis. This can be through maternal or paternal smoking.
As expected, alcohol could expose to cryptochidism. However, some say it’s only when you drink so heavily.
12. Maternal Age
Studies show being above 30 years or being below 20 years in your first pregnancy could lead to undescended testis. Another studies have shown that age can be protective too. So it is difficult to draw a conclusion here on the impact of age.
13. IVF BABIES
Children born through invitro fertilization have 30% risk of having missing testis than those born through normal means.
The descent of the testes is hormone driven. High maternal oestrogen ,and low maternal testosterone has been associated with maldescent of the testis.
Complications of undescended Testes
- It can turn to cancer
- It can be injured because it’s in an abnormal location
- Infertility /impotence
When to see a doctor?
As soon as you notice that your childs testis is missing ,report to your doctor as soon as possible. This is because salvaging that testis is time dependent. The more time you waste the more likely you spoil the testis.
You may also check your sons testis now, there’s no perfect time to do that.
What is the TREATMENT?
The treatment is surgery. The testis that did not descend will be offered some help by Paediatric surgeon who will bring it down to the scrotum and keep it fine.
Thank you so much for reading. Please comment.
3. Preikša RT, et al. Higher than expected prevalence of congenital cryptorchidism in Lithuania: A study of 1204 boys at birth and 1 year follow-up. Human Reproduction. 2005;20:1928–1932. doi: 10.1093/humrep/deh887.