Dear Dr. G,

Thank you for answering my query.

I’m a 25-year-old man, who is rather bothered by issues of my hidden gems in my pants.

I was born with a condition called undescended testicle.

According to my parents, this was discovered on the day I was born.

The doctors assured my parents the testicle was just “lost” along the way out and will find its way back on track soon.

Disappointingly, the “lost” ball did not find its way back and I underwent the operation to redirect the ball to its rightful place.

Truthfully, the mystery of the missing ball did not really affect my life in anyway until recently.

When I started having sexual relationship, I began to feel a bit “compromised” as I do not feel like I can perform in my full potential.

My girlfriend even suggested I should do a sperm test, as she is worried about my fertility once we are committed.

I would like to put Dr. G on the spot for the issues of undescended testicle?

Why did this happen and how common is it?

After the operation, do sufferers encounter any “sexual compromise”?

How does the hidden gems affect my ability to father a child in the future?

Looking forward to your responses.

Hidden Henry

Undescended testicle is also medically known as cryptorchidism. The term actually derives from Greek word “Kryptos” meaning hidden, and “orchis” meaning testicle. The male foetus initially develops the gonads within posterior wall of the abdomen, next to both kidneys. Around seven months of the foetal development, the testicle will “descend” from the retroperitoneal abdomen to the inguinal canal, and eventually drop into the rightful place of the scrotal sac. Undescended testicle occur when a child is born with one or both missing “gems”, that is usually “lost” along the path.

Cryptorchidism is a relatively common congenital abnormality affecting either one or both sides of the testicles. The condition has high prevalence of up to 30% amongst premature infant boys. On the other hand, such developmental defect can also be observed in around 3% of full term babies. Eighty percent of cryptorchid testes will naturally descend by the first year of life. This is making the overall true incidence of cryptorchidism to be around 1%.

Recent epidemiological data revealed an increase in the prevalence of cryptorchidism over the last five decades. Apart from premature babies contributing to the rise in mal-descent of testicles, other recognised risk factors also include excessive alcohol consumption during pregnancy, maternal exposure to pesticide and even certain types of cosmetics have been implicated.

The primary treatment for undescended testicle is actually conservative management, as the vast majority of the “lost balls” will find their way back to the rightful place. Twenty percent of the testicles may remain undescended after six month; and corrective orchidopexy may then be the necessary intervention.

The temperature of the testes in the scrotum is intended to be cooler than the rest of the body. Such arrangement is crucial for the process of spermatogenesis. Many men born with undescended testicles may have reduced fertility, even after the corrective surgery. Men with one-sided undescended testicle have reported infertility rate of 10%, and this increases to 38% when both testicles are noted to be undescended.

Early orchidopexy is usually recommended as studies revealed irreversible functional impairment when the correction is beyond two years.

Apart from spermatogenesis, the second crucial function of the testicle is the production of testosterone. Research indicates that boys with undescended testicles do not lead to any issues of gender-disorder, psychological impairment or sexual dysfunction. In fact, many studies have indicated even in the event of persistent cryptorchidism without corrective surgery, the Leydig cells in the testicle seem to be resilient to higher bodily temperature, and continue to provide testosterone necessary for healthy masculinity and sexual function.

One of the strongest arguments for corrective surgery is not the preservation of fertility or masculinity, but cancer prevention. This is because one in 500 men born with one or both undescended testicle are noted to develop testicular cancer. This translates to a nearly 50-fold increase in risk. Such risk of malignancy is 10 times higher than the general male population; therefore the vigilant surveillance with regular self-examination is of paramount importance.

The crypto-mystery of the causes of undescended testicle can never be fully understood, however the impact of the “missing gems in the pants” are well researched and documented. Although fertility may be affected in boys who underwent corrective surgery late in life, but the overall sexual function are often well preserved.

Procreation and recreation functions of the testicles are often uncompromised despite the “lost jewels”. Instead, the “real gems to preserve” is to mitigate the risk of cancer.

Dr. G is often put on the spot by men puzzled by their “lost balls” and bothered by the prospected of diminished sexual performance and prospect of parenthood. However the importance of stringent self-examination preventing the cover up of what is concealed, will ensure the “jewels will forever be shining in splendor!”

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