• Dr Peter Chew

Single testicle and fertility

My friend is 25 years old. He has only one testicle. Why is it so? Will he be able to father children next time? Will it affect his manhood?

A. The testes are the primary male reproductive organs producing sperm and male hormone, testosterone. They are two oval-shaped organs, about the size of a large walnut each. They are located inside the scrotum, which is the loose pouch of skin hanging outside the body behind the penis.

From the 5th to 7th weeks of pregnancy, the testes start to form and grow in the tummy (abdomen). At around 7th month of gestation, they gradually move and descend to the scrotum which is outside the abdomen. The descent is important as the scrotal temperature is about 3-4 degree Centigrade below the core body temperature. This cooler environment is essential for the growth and production of healthy sperm.

Some men are born with a single testicle. This is usually due to cryptorchidism or "hidden testicle". In this condition, there is an arrest in the descent of one of the testes into the scrotum. It is usually, but not always, diagnosed at birth. Often the “hidden testicle” may finally move into the scrotum on its own during the first year of life. If the condition is diagnosed early, surgery is performed to bring the testicle down to its permanent position. Otherwise, the testicle will remain in the abdomen and gradually wither away in adult life.

The abdominal testicle has to be removed as the risk of cancer developing is much increased. Other causes that may result in a man having a single testis include:

· Direct injury resulting in total death of the testicular tissue e.g. hernia surgery where the blood supply to the testicle is accidentally cut off.

· Testicular tumour or cancer requiring surgical removal.

· Testicular regression syndrome, or “vanishing testes “. This uncommon condition is the result of insults to the testicle during its foetal development.

When one testicle is absent, the other testicle will take over the functions. The lone testicle may increase in size, and start producing more testosterone and sperm to maintain the level that is required for the development and maintenance of manhood and fertility.

Medically, as long as the person is healthy, the absence of one testicle will not have much impact on the sex life or the chances of impregnating the wife. Psychologically, however, some men may experience feelings of inadequacy, loss of masculinity, or self-consciousness. These negative feelings can result in sexual dysfunctions such as erection or ejaculation problems. In such case, a cosmetic implant in the scrotum and/or sexual counselling may be necessary.

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