Private Parts II: More things parents of boys need to know

Testicular abnormalities in children.

While it can be uncomfortable for parents to talk about issues with their son’s private parts, abnormalities in the testicles and scrotum are common and treatable.

One of my favorite parts of my job is sitting down with anxious families and being able to make the uncomfortable comfortable for them. I hope I can do that for you here in this guide to the most common testicular abnormalities seen in young boys.

1.    Undescended testicles

A baby boy should have two testicles down in the scrotum. The best time to examine your son is while he soaks in a warm bath. If you’re unable to see or feel both testicles, make an appointment with a pediatric urologist.

If your son is diagnosed with an undescended testicle or cryptorchidism, we’ll observe him until he turns six months old. If at that point, the testicle hasn’t descended on its own, we’ll perform an orchiopexy to release the testicle from the attachments hindering its descent and tack it down in the scrotum so it can develop appropriately.

Orchiopexy is an uncomplicated hour-long day surgery, so you can take your son home the same day as the procedure. Your son will be pretty comfortable after surgery and will fully recover within a month. He’ll be prescribed pain medications for a few days and restricted from activities like bike-riding for a few weeks.

2.    Testicular pain

If your son complains of a swollen scrotum and sharp pain that may or may not be accompanied by nausea and vomiting, take him to the emergency department of a local hospital immediately. Testicular pain can begin any time of the day or night, and is either caused by torsion or epididymitis.

Torsion: Common in pre-pubertal boys (ages 12-16), testicular torsion is caused when a testicle is not attached well to the scrotum. If by a physical exam and ultrasound your son is diagnosed with testicular torsion, a pediatric urologist will perform a simple surgery to untwist the testicle and sew both testicles in place so they can’t turn in the future. Infrequently the testicle has to be removed if the blood supply is completely cut off for a long period of time.

Epididymitis: If your son complains of testicular pain but doesn’t have torsion, he will most likely have an inflammation called epididymitis, which is resolved simply with Advil or Tylenol, elevation, icing and a decrease in activity. Swelling and pain will typically improve within a few days. In sexually active teens, epididymitis is more likely infectious and therefore treated with antibiotics.

3.    Swollen scrotum

If your child has a bulge on one side of his groin and is uncomfortable, call your pediatrician. Try pushing gently on the bulge when your son is calm and lying down, and you will likely see the bulge get smaller or go back into the abdomen. A swollen scrotum can be indicative or either a hydrocele or an inguinal hernia, both diagnosed and treated by a pediatric urologist. Call your pediatrician first for a referral.

Hydrocele: A hydrocele is when fluid comes down from the abdomen into the scrotum and surrounds the testicle. This occurs when the inguinal canal (a passage from the abdomen to the genitalia) doesn’t close as it should at birth. We wait to repair a hydrocele with surgery until the child is a year old, in case the issue resolves on its own.

Hernia: When intestinal segments come down through an open inguinal canal, they can cause a bulge in the scrotum called a hernia. The risk of reoccurrence is high enough for hernias that we typically perform surgery within a few weeks of your son being diagnosed. Note: If the bulge is red or very hard, take your son immediately to the emergency department of a local hospital in case the blood flow has been cut off, which requires urgent attention.

For all of these conditions, remember that these benign abnormalities of the testicles and scrotum are common, treatable and not your fault. But anything can feel worrisome when it’s your child, so we encourage our patient families to use our secure nursing line to ask questions and send photos if anything changes between appointments.

Learn more about Boston Children’s Department of Urology.


About the blogger: Dr. Erin McNamara is a urologist at Boston Children’s Hospital and an instructor in surgery at Harvard Medical School.