In the male fetus, testicles form around the thirtieth week of gestation. In a female fetus, those same structures become ovaries. The testicles usually descend during the first year of life, but if one or both remain in the belly after the first birthday, a surgeon needs to rectify this rare disorder by bringing them down.
Water in the Testicles
In some instances, liquid from the intestine leaks into the scrotum, which fills with fluid and makes the testicles appear swollen. This condition is not painful, and it generally resolves after a few months. If it persists through the end of the first year, your doctor may recommend a simple surgery.
If you discover one day that Jimmy’s scrotum is very swollen, this most likely represents a testicular hernia, which means that a defect has opened a gap between the scrotum and the abdomen, allowing some of the intestine to slip downward and into the sac. Unlike fluid in the testicle, this swelling appears and disappears over the course of the day, primarily on one side, as the intestinal content moves back and forth through the opening. The swelling will be more prominent when Jimmy cries, because crying increases the pressure in the abdomen and pushes the intestine into the scrotum.
A testicular hernia can occur at any age. It’s not painful, but it carries the danger of intestinal twisting or obstruction. Although surgery is required to repair this condition, it’s not an emergency unless the intestine gets pinched, which would be accompanied by signs of blockage, sudden vomiting, and belly distention.
In some cases, as in cold weather or cold water, for example, descended testicles retract slightly into the scrotum. Once you know they have descended, don’t worry if you sometimes can’t feel them. They haven’t gone far, and they’ll be back.
At any age, a sudden onset of intense pain in a child’s testicles could be a sign that the vessel that feeds them has twisted, jeopardizing blood flow and risking the entire testicle. This is an emergency, and surgery must be performed within a few hours to save the organ. Fortunately, this torsion is very rare in children under five years, and it’s even rarer in infants, in whom you can’t precisely localize a sudden onset of pain.