Should testes be checked during a well-child visit?

Testicular Examination During Well-Child Visits

Primary care providers should palpate testes for quality and position at each recommended well-child visit to detect undescended testes (UDT) and other abnormalities that may impact morbidity and mortality. 1

Importance of Testicular Examination

• Testicular examination is essential for detecting undescended testes (UDT), which occurs in 1-3% of full-term male infants and 15-30% of premature male infants 1
• Regular examination allows for detection of both congenital and acquired UDT, which can lead to reduced fertility, increased risk of testicular cancer, and potential testicular torsion if left untreated 1
• Approximately 70% of UDTs are palpable, while the remaining 30% may be located in the inguinal-scrotal area (30%), intra-abdominal (55%), or absent/vanishing (15%) 1

Timing and Frequency of Examination

• Testicular position should be assessed at every scheduled well-child visit throughout childhood due to potential changes in testicular position 1
• Special attention should be given to examination at the following ages:
  • Birth to 6 months: to detect congenital UDT 1
  • School entry: to screen for acquired UDT that may develop later in childhood 2
  • Throughout childhood and adolescence: to monitor for testicular ascent, especially in children with cerebral palsy or neuromuscular disease 3

Clinical Implications and Referral Guidelines

• Infants with UDT detected at birth who do not have spontaneous testicular descent by six months (corrected for gestational age) should be referred to an appropriate surgical specialist 1
• Boys with newly diagnosed (acquired) cryptorchidism after six months should also be promptly referred to a surgical specialist 1
• Phenotypic male newborns with bilateral nonpalpable testes require immediate specialist consultation to evaluate for possible disorders of sex development 1
• Boys with retractile testes should have their testicular position assessed at least annually to monitor for secondary ascent 1

Examination Technique and Documentation

• A thorough genital examination should include palpation of both testes for:
  • Position (scrotal, inguinal, nonpalpable)
  • Quality (size, consistency)
  • Mobility (retractile versus fixed) 1
• Documentation of testicular examination findings is critical for detecting changes in testicular position over time 4

Common Pitfalls and Caveats

• Avoid unnecessary imaging studies (such as ultrasound) in the evaluation of UDT prior to specialist referral, as these rarely assist in decision-making 1
• Be aware that spontaneous descent of testes may occur in the first six months of life, but is unlikely after this period 1
• Remember that acquired UDT (testicular ascent) can occur later in childhood, with peak incidence around 8 years of age 1
• Children with cerebral palsy or neuromuscular disease are at higher risk for acquired UDT and associated testicular torsion, requiring vigilant examination throughout childhood 3

Regular testicular examination during well-child visits is a standard of care with Grade B evidence strength, supporting its importance in preventing morbidity and mortality associated with untreated testicular abnormalities 1.