Concerns About Scrotal Tightness in 18-Month-Old Boys: What Parents Should Know

A 1.5-year-old child has a scrotum that is mostly in a contracted and hardened state?

Hello Doctor, my son is currently 18 months old.
During most times when his genitalia is visible (such as during diaper changes or when undressing for a bath), his testicles are not in the scrotum, and the scrotum appears to be very tight and hard, almost like leather.
However, this condition disappears after a warm bath; post-bath, the scrotum enlarges and the skin becomes thinner, allowing the testicles to descend into the scrotum.
I have noticed that children of similar age do not have this issue; their scrotums are consistently soft, and their testicles are always in the scrotum.
I would like to ask the doctor if having a scrotum that is consistently tight and hard is abnormal? I am very concerned that this might affect the development of the testicles.
Should we consider further examination or surgical intervention? Thank you.

kimnomi, 30~39 year old female. Ask Date: 2016/08/12

Dr. Lin Yishou reply Pediatrics

Dear Parent,
The function of the scrotum, besides protecting the testes, is to regulate their temperature.
When the temperature of the testes is too high (such as after a bath), the scrotum relaxes to allow the testes to cool down.
Conversely, when the temperature of the testes is too low (such as in cold weather), the scrotum contracts to help warm the testes.
Based on your description, it seems that the function of the scrotum is normal.
The testes also descend into the scrotum.
However, I recommend that you visit a trusted pediatric clinic for a personal examination by a physician to determine if there are any abnormalities.
Thank you for your message.

Reply Date: 2016/08/12

More Info

When it comes to concerns about scrotal tightness in an 18-month-old boy, it is essential for parents to understand the normal anatomy and physiology of the male reproductive system, as well as the potential implications of any abnormalities.
In infants and young children, the scrotum can exhibit a range of appearances and behaviors due to several factors, including temperature, muscle tone, and developmental stage. The scrotum is designed to regulate the temperature of the testicles, which is crucial for proper sperm development later in life. The cremaster muscle, which surrounds the testicles, contracts in response to cold temperatures or physical stimuli, pulling the testicles closer to the body to maintain warmth. Conversely, when the body is warm, the muscle relaxes, allowing the testicles to descend into the scrotum.

In your case, you mentioned that your son's testicles are not consistently in the scrotum and that the scrotum appears tight and hard at times, particularly when he is not in a warm environment. This phenomenon is not uncommon in young children, especially if they are experiencing cooler temperatures. However, if the scrotum remains tight and the testicles do not descend into the scrotum consistently, it could indicate a condition known as "cryptorchidism," where one or both testicles fail to descend into the scrotum.

Cryptorchidism is relatively common in infants and can resolve on its own as the child grows. However, if the testicles remain undescended beyond the age of one, it may require medical evaluation. The reason for concern is that undescended testicles can lead to complications such as infertility, testicular cancer, and torsion (twisting of the testicle), which can be a medical emergency.

Given that you have observed a significant difference in your child's scrotal appearance compared to peers, it would be prudent to consult a pediatrician or a pediatric urologist. They can perform a physical examination and, if necessary, imaging studies to assess the position of the testicles and the overall health of the scrotum.
In terms of treatment, if the testicles are found to be undescended, the physician may recommend a surgical procedure called orchidopexy, which involves moving the testicle into the scrotum and securing it in place. This procedure is typically performed between the ages of 1 and 2 years, as early intervention can help prevent potential complications.

In summary, while some variation in scrotal appearance is normal in young boys, persistent tightness and the absence of the testicles in the scrotum warrant further evaluation. It is essential to address these concerns with a healthcare professional to ensure your child's reproductive health and development are on track. Early diagnosis and intervention can lead to better outcomes and peace of mind for you as a parent.

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