Analysis of Abnormal Physical Signs in Boys' Development and the Causes of Testicular Atrophy

**Abnormal physical signs during male development**

**Dr. Cao:**

My son is 10 years old, but his scrotum is empty; he has no testicles. His penis is also very small, like a baby's. Is his development unhealthy? I would like to ask you for your advice.

Gold××

Mr. Jin:

Sexual organ development is an important part of normal growth and development in children. Regular checkups can help detect and treat various malformations and abnormalities of the reproductive organs early, which is of great significance to children's future health and life.

Abnormal signs of male genitalia are quite common, mainly including cryptorchidism, phimosis and redundant foreskin, and hydrocele. Your boy has cryptorchidism and should be taken to the hospital for treatment as soon as possible.

Approximately 1.8% of boys exhibit cryptorchidism in newborns, with premature infants accounting for about 40% of this. Cryptorchidism can be unilateral or bilateral. 80% of cryptorchidism cases result in spontaneous descent within the first year of life; if it persists past the age of two, surgery is necessary. Many children with cryptorchidism also have inguinal hernias or hypospadias. If cryptorchidism is detected during a child's preschool physical examination, parents should take their child for immediate treatment. Otherwise, the older the child gets, the greater the adverse effects of the high temperature within the abdominal cavity on the testes, leading to more pronounced atrophy of the seminiferous tubules and a reduction in spermatogenic cells. Bilateral cryptorchidism often results in infertility. Although the interstitial cells of the testes in children with cryptorchidism can still secrete androgens, and axillary hair, pubic hair, and facial hair grow normally, simply examining secondary sexual characteristics is insufficient and should be taken seriously.

**Cao Kaiyong**

Why do testicles shrink?

**Dr. Cao:**

My left testicle is noticeably smaller than my right testicle. What could be the reason for this? Will it affect my fertility?

Ji ××

Mr. Ji:

The causes of small testicles can be broadly divided into two categories: congenital and acquired. Congenital causes include testicular hypoplasia. When suffering from conditions such as infantile sexual organs or hypopituitarism, both testicles often fail to develop fully. If abnormalities occur during embryonic development, resulting in incomplete testicular descent or cryptorchidism, the temperature inside the abdominal cavity is higher than that inside the scrotum, thus causing incomplete development of the affected testicle. This condition often leads to infertility.

Acquired testicular atrophy is mostly caused by trauma, testicular diseases, and infection. Closed injuries to the testicles can cause testicular hemorrhage, and sharp objects such as nails and wires can also puncture the testicles. Trauma can not only cause spermatic cord torsion, obstructing blood supply, but also endanger testicular survival; therefore, testicular injuries should be treated as early as possible. Delayed treatment can also lead to infertility.

Certain diseases, such as varicocele, can sometimes cause testicular atrophy. Varicocele occurs when the veins in the spermatic cord become obstructed for various reasons, resulting in a vine-like, tortuous dilation. Varicocele accounts for approximately 15% to 20% of male infertility cases. Severe varicocele-related infertility often leads to testicular atrophy.

Infection is also a significant cause of testicular atrophy. The most common is viral orchitis caused by mumps. If it occurs after puberty, orchitis complicated by mumps can cause a severe local inflammatory reaction, with excessive fluid accumulation in the tunica vaginalis cavity, i.e., acute hydrocele. Smallpox, chickenpox, measles, influenza, and other similar infections can occasionally cause secondary orchitis.

Clinically, determining whether testicular atrophy has occurred involves not only measuring the size of the testicles but also assessing their texture. During palpation, a softer testicle indicates more severe damage to the testicular parenchyma. Semen analysis can be very helpful when determining testicular atrophy is difficult. The most accurate method for diagnosing testicular atrophy is testicular biopsy and pathological examination.

**Cao Kaiyong**