It’s a ritual as old as childbirth itself: The accounting for all your child’s body parts. Let’s see… two eyes, good. … Ten fingers, check… Ten toes, great …
Often overlooked on male spawn are balls. There should be two of them. But this might grab your attention: 3 percent of full-term boys (and 30 percent of premature boys) are born with an undescended testicle. (An even tinier percentage is born with two undescended testicles.) One such boy is my son, who’s three months old and counting, and still missing a ball. What follows is what I’ve learned about his condition, and what you should know if you find yourself in the same situation.
First, a quick refresh: Your testicles are formed in your abdomen while you’re still in the womb. Not long before you’re born, they make like a surprise-release Jay-Z album, and just … drop. Nature is magical that way.
But for boys with a “missing” testicle, the testicle gets stuck somewhere between formation and descent. The technical term is cryptorchidism, pronounced with an emphasis on the orch, so that it sounds both gothic (“crypt”) and floral (“orchid,” which it turns out comes from the Greek for testicle). There’s no known reason why, but rest assured, it’s not believed to be something you or your partner did or didn’t do.
Most often, the testicle is in the groin area somewhere, and the doctor can actually feel it through the skin, which is kind of crazy. (I can assure you that it’s not like the BB stuck between Ben Stiller’s knuckles in The Royal Tenenbaums, as amusing as that might sound.) For those boys — 70 percent, it turns out — the testicle often drops on its own after a few days, weeks, or months.
But for boys like my son, it takes longer. When I took him in for his first series of checkups, I casually asked what would happen if the ball doesn’t drop. Thinking the answer would be something like “Oh, it will eventually” or “Eh, don’t worry about it,” I instead heard the word no parent wants to hear: surgery.
Was that really necessary? I wondered. I mean, as much as I cherish having two full-grown balls of my own, I also understand that, medically speaking, you really only need one. (Think of it as God’s riff on the old heir and a spare mentality.) Also, no dad wants to put his infant kid through surgery, let alone one in such a delicate, sensitive area.
Yes, I was told. Why? Simply put, an undescended testicle would put my son at a greater risk of both testicular cancer and infertility. It’s also uncomfortable, having a ball in the wrong place. Even if he undergoes surgery, my son will have a very slightly elevated risk of testicular cancer. So if you find yourself in the same situation, you’ll want to make sure he understands how to do a self-exam down the line.
The moment of truth comes at six months. If his testicle has not yet entered stage right (or left, in my son’s case), we’ll begin the process of scheduling the surgery (called orchiopexy). Now, we could put it off a few months or even years. But Dr. Richard Yu, pediatric urology specialist at Boston Children’s Hospital, recommends doing it as soon as possible. “Little guys recover better,” he says. “They require very little pain medication. And chances are they won’t remember the procedure.” But, do I really want my son’s earliest memory to be ball surgery?
Orchiopexy takes about an hour and doesn’t require a hospital stay. The procedure involves making an incision in the groin (for finding and moving the testicle) and a counter-incision in the scrotum (for making sure the testicle stays in place once it’s there). It’s a low-risk surgery, aside from the concerns that come with any surgery (blood loss, infection) and, of course, the risk of having anything come in close contact with the ever-sensitive male testicle. My son likely won’t have noticeable scars, as the incisions will be made in skin folds in the groin and on the scrotum. As for recovery, you can always count on a boy’s exuberance. “Most kids, if you do it between 6 and 18 months of age, are a little fussy,” Yu says. “But by the next day, they want to get up and play.”
Now, for a small percentage of boys with an undescended testicle, the testicle is not in the groin, and is likely in the abdomen. If that applies to your son, your doctor will likely recommend laparoscopy, where the surgeon makes a keyhole incision in the belly button and inserts a camera to see what’s up. During that procedure, there are three possible outcomes:
- The doctor finds the testicle is in the abdomen, and your doctor will recommend a variation of the above surgery called Fowler-Stephens Orchiopexy. If the testicle is lower down, this is a one-step surgery. If it’s higher up, your son will have two surgeries. One to “prepare things,” as Yu put it. Another six months later to bring the testicle down.
- The doctor finds out the testicle didn’t form. “Now you know,” Yu says. “That’s good news! It’s sad that it didn’t form, but it’s one and done, you don’t have to worry about it.” Yu adds that most boys, when they get older, don’t feel obliged to get a prosthetic testicle, but that remains an option if desired.
- Roughly five percent of the time — a minuscule number of boys, given we’re already talking about a small percentage of the small percentage born with an undescended testicle—the doctor finds testicle tissue, but it looks abnormal. Your doctor will likely recommend removing that tissue. “That procedure varies in time based on what you see,” Yu says. Your son will grow up with one ball, but it won’t have a meaningful impact on his fertility, sexual function or cancer risk.
So while we seem to have dodged that scenario, I’m still feeling anxious as we close in on that six-month deadline. After all, I’m 36 years old, and I’ve never had surgery of any kind. But my son might not even make it a year without going under the knife.
So like an eager New Year’s Eve reveler, I’m desperate for the ball to drop. I check out my son’s junk at every diaper change — I think I see it, I think. Hmm, no, maybe not. The kid’s nuts are so tiny it’s hard to tell—like trying to guess how many cherry tomatoes are inside a plastic grocery bag. In the end, it’s a classic “trust, but verify” situation. Even if I become confident both balls are there, only our pediatrician’s say-so will put us at ease.
Some people have asked me if I feel shame about the situation —“balls” is a metonym for courage, for virility, so it would be easy to feel like I’ve somehow failed as a father. But the honest answer is no. Just concern. I mean, I’m not shouting about it from the rooftops, present article excluded. But it feels like one of those things that’ll be funny … someday. Especially if he avoids surgery. But operation or no, he’ll always have a fun fact about himself at dinner parties.
More than anything, I’m comforted by Yu’s reassuring words about boys like my son: “They tend to be just fine.” I sure hope so.