Left Testicular Descent: Causes and Treatment Options

Left testicle feels heavy and drooping?

I have been experiencing a heavy drooping of my left testicle for the past two to three years.
I had surgery for hydrocele when I was younger.
Last month, I visited a general surgeon regarding my testicles and underwent an ultrasound.
The doctor said there wasn't anything significantly wrong, but I mentioned that my left testicle is drooping and that its position in the scrotum is not aligned with the right side.
When standing, the testicles are usually oriented in an elongated oval shape, but my left testicle is nearly horizontal and hangs much lower than the right.
Recently, I noticed a lump-like structure in the left scrotum that resembles a blood vessel but is not quite the same.
However, there is no pain associated with the testicle.
Could this be caused by a varicocele? Would surgery improve the drooping of the testicle? If the above is considered normal, are there any methods to reduce the drooping of the testicle? The left testicle's drooping has been causing discomfort by rubbing against my inner thigh for quite some time.
Thank you.

Andrew, 20~29 year old female. Ask Date: 2012/03/08

Dr. Li Yilun reply Urology

Basically, the two testicles are usually not at the same height; some people have a higher left testicle (left-sided) while others have a higher right testicle (right-sided).
Typically, the testicles are supported by the cremaster muscle, which holds their weight.
As a result, factors such as aging, trauma, or surgery may weaken the cremaster muscle, causing the testicles to descend lower.
This condition is generally not considered a disease, so surgery is not typically performed.
If it does cause significant discomfort, a possible surgical option is to elevate the cremaster muscle, but such surgeries are rare, and there are no reports on the effectiveness of improvement.
However, if there are concerns, it is advisable to consult a urologist, as the physician often needs to perform a physical examination and take a medical history to determine the diagnosis and treatment options.

Reply Date: 2012/03/08

More Info

Understanding left testicular descent and its associated conditions can be quite complex, especially when it involves symptoms like a noticeable difference in position between the left and right testicles. Based on your description, it seems you have been experiencing left testicular descent for a few years, and you have undergone surgery for hydrocele in childhood. You also mentioned that a recent ultrasound did not reveal any significant issues, but you are concerned about the position of your left testicle and the presence of a lump in the left scrotum.

Possible Causes of Left Testicular Descent
1. Anatomical Variations: It is not uncommon for one testicle to hang lower than the other. This can be due to anatomical variations and is generally considered normal unless accompanied by pain or other symptoms.

2. Testicular Descent: The descent of the testicles occurs during fetal development, and any disruption in this process can lead to conditions like cryptorchidism (undescended testicle). However, since you mentioned that your left testicle has descended but is positioned lower than the right, this may simply be a variation rather than a pathological condition.

3. Varicocele: The lump you feel in your left scrotum could potentially be a varicocele, which is an enlargement of the veins within the scrotum. Varicoceles are more common on the left side due to the anatomical differences in venous drainage. They can sometimes cause a feeling of heaviness or discomfort in the affected testicle.

4. Hydrocele: Given your history of hydrocele surgery, it’s also possible that a new hydrocele could have developed, which may present as a lump in the scrotum. Hydroceles are fluid-filled sacs surrounding the testicle and can cause swelling.

5. Inguinal Hernia: If the lump is more pronounced when standing or straining, it could be an inguinal hernia, which occurs when tissue protrudes through a weak spot in the abdominal muscles.

Treatment Options
1. Observation: If the ultrasound did not show any significant abnormalities and you are not experiencing pain, your doctor may recommend a watchful waiting approach. Many anatomical variations do not require treatment unless they cause discomfort or complications.

2. Surgical Intervention: If the left testicle's position is causing significant discomfort or if a varicocele or hydrocele is diagnosed, surgical options may be considered. Surgery can help reposition the testicle or remove the fluid in the case of a hydrocele. For varicocele, a procedure called varicocelectomy can be performed to alleviate symptoms.

3. Supportive Measures: Wearing supportive underwear can help manage discomfort caused by the lower position of the left testicle. This can provide additional support and reduce any irritation caused by contact with the thigh.

4. Follow-Up: Regular follow-ups with a urologist are essential, especially if you notice any changes in the lump or if you start experiencing pain. Monitoring the condition can help in making timely decisions regarding treatment.

Conclusion
In summary, while the left testicle's lower position and the lump you feel may be concerning, they may not necessarily indicate a serious problem. Conditions like varicocele or hydrocele can often be managed effectively with medical intervention if they cause discomfort. It is crucial to maintain open communication with your healthcare provider, who can guide you through the appropriate diagnostic and treatment options based on your specific situation. If you have any further concerns or if symptoms worsen, do not hesitate to seek a second opinion or further evaluation from a urologist.

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