Cremasteric+Reflex

** Cremasteric Reflex  ** By rubbing or stroking the ipsilateral scarpa triangle on a mans thigh you can produce a cremasteric reflex, which causes the scrotum, as well as the testicle on the side which is being rubbed to raise or retract towards the body. Ipsilateral scarpa triangle is the technical term for the upper inner area of a man’s thigh. This effect is due to the contraction of the cremasteric muscle (Cremasteric reflex, 2006). While all men are different, it is most likely to occur when the rubbing is done with a sharp object. This reflex is one that is specific to males however; the female version of this would be called the geigel reflex. Medilexicon dictionary says “in the female, a contraction of the muscular fibers at the upper edge of the Poupart ligament on gently stroking the inner side the thigh; analogue of the cremasteric reflex in males” (Geigel reflex, 2006). “Some boys have very active cremasteric reflexes so that the testicle may actually leave the scrotum and stay in the inguinal canal” (Testicular Disorders, 2011). Since everyone is different, the cremasteric reflex is not always the same either. Some are more easily stimulated while others will retract for longer periods of time. Furthermore, some people have an absent or reduced reflex, these people are categorized as having an abnormal reflex. A man’s reflex is particularly important at a young age because abnormal reflexes can be linked with different problems which are more serious. This is one way for the body to communicate that there could be something wrong. Beni-Israel, Goldman, Bar Chaim, and Kozer’s article (2010) found that “Pain duration of less than 24 hours, nausea or vomiting, high position of the testicle, and abnormal reflex are associates with higher likelihood of (testicular) torsion. However, it must be noted that the presence of a normal cremasteric reflex does not rule out the possibility of testicular torsion, because 5 of the 17 patients with it have a normal reflex (Beni-Israel, Goldman, Bar Chaim, and Kozer’s 2010).
 * Brian T. Doyle **

Cremasteric reflex is the most commonly mentioned reflex among pediatric doctors. Bingol-Kologlu, Tanyel, Anlar, and Buyukpamukcu’s (2001) article “Cremasteric Reflex and Retraction of a Testis” examined whether or not there was a correlation between hyperactive cremasteric reflex and retractile testis (a condition in which a testicle may raise up and stay in the groin as opposed to the scrotum). They initially point our that the lack of a formal definition for hyperactive reflex as well as normal reflex have not yet been given. The issues surrounding cremasteric reflex typically pertain to adolescence. Much of the research done involves infants, but Bingol-Kologlu (2001) points out the “findings of the several studies documenting CR (cremasteric reflex) at birth are controversial with positivity rates varying from 2% to 92%” (p. 865). On the contrary to what was said earlier, in their study, they used a blunt object to produce the reflex. For this reason, it must be restated that everyone is different, and there is no single way to generate the reflex. This study found that there was no scientific data that proved there was any relationship between retractile testis and hyperactive cremasteric reflex. However, they note that an official definition of the parameters of the reflex could shed some light on the situation and prove differently (Bingol-Kologlu, 2001). Shafik, Ahmed, El Sabai, & Shafik’s (2006) article stated that “Increased CM (cremasteric muscle) EMG (electromyographic) on straining postulates a reflex relationship which we call the 'straining-cremasteric reflex' (SCR). We suggest that this reflex, which results in CM contraction, supports the spermatic cord veins against the increase of the IAP (intra-abdominal pressure) induced by straining and against the tendency of venous reflux from the abdominal veins.” This essentially means that in times in which the abdomen is under high pressure that the cremasteric muscle begins to contract more to relieve some of this pressure. Throughout researching CR, this is the first instance in which I have found a situation in which the cremasteric reflex is helping the body as opposed to being related to other problems (Shafik, 2006). This topic is a very good example of the importance of being able to have an open conversation with your physician and of being comfortable around him or her. This may be something one finds ‘weird’ or ‘abnormal’ but not think it is necessary to talk to one’s doctor about; however, if a person has an abnormal reflex, it could mean that something else is wrong. On the other hand one may not even know about it, so it is a good thing it is one of the most common reflexes for pediatricians to talk about. The information available on cremasteric reflex is limited to a simple definition at this point, which is why much of the information described above discusses its relationship to other problems or topics. Throughout my research of this topic, I have not seen anything that explains the reason for this reflex. It could be due to arousal, nervousness, your body trying to convey a message to you, or even a tingling that causes your testicle to retract. However, I do not have any insight as to the actual reason; that is simply my speculation. While conducting my research I was very surprised that I did not come across the answer to this question because it seems to me that it would be an important part of cremasteric reflex. References Beni-Israel, T., Goldman, M., Bar Chaim, S., & Kozer’s, E. (February 25, 2010). Clinical predictors for testicular torsion as seen in the pediatric ed. // The american journal of emergency medicine, volume 28, pages 786-789. //doi:10.1016/j.ajem.2009.03.025 Bingol-Kologlu, M., Tanyel, C., Anlar, B., & Buyukpamukcu, N. (2001). Cremasteric reflex and retraction of a testis. // Journal of pediactric surgery, volume 36, p. 863-867. //doi: 10.1053/jpsu.2001.23956 Cremasteric reflex. (2006). In // MediLexicon dictionary online. //[] Geigel reflex. (2006). In // MediLexicon dictionary online. //[] Mass General Hospital for Children. (2011). // Testicular disorders. // Retrieved from [] Shafik, A., Ahmed, I., El Sabai, O., & Shafik, A. A. (April 28, 2006). Straining-cremasteric reflex: identification of a new reflex and its role during increased intra-abdominal pressure. // Surgical and Radiologic Anatomy. //