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Normal Testes Development?
Q: I'm concerned because I noticed something odd looking on my 2-1/2-year-old son's testicles. When my husband and I examined them we found that his testes are not in their sacs -- they are raised up above his penis. Is this normal?
A: I am not sure you need to be concerned since what you describe sounds normal. I am assuming you know that both his testicles have been down in the sac (scrotum) in the past and they are also the same size on the right and left. Most importantly you should always be able to bring the testicles down in their sac. An undescended testis or one that can't be brought down into the sac can then be a problem and should be evaluated.
What sometimes does happen though is that the testicle(s) moves back up (retracts) into the inguinal canal in response to an exaggerated muscle reflex, fooling parents. More commonly, with "retractile" testicles, one is able to bring down each testicle with careful palpation when the child is relaxed in a warm room or by placing him in a tub of warm water, which helps the testicles make their way back down into the sac. This examination can be made easier if the child is in the squatting position. Often more than one examination by you and/or his doctor may be necessary to establish the correct diagnosis.
A "retractile" testicle usually finds a permanent position in the sac during puberty and has none of the complications commonly associated with a true undescended testis. If there really is any question, I would let his pediatrician see if he can palpate the testicles, documenting that they are normal size, position, etc.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.