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The role of the testicles and scrotal sac is seen as a precursor to that of the phallus in the development of castration anxiety. The two to three-year-old toddler having a bowel movement sees his scrotal sac and testicles at the same time he watches the fecal mass come out and drop off. He may, therefore, associate the loss of his feces with the loss of his testicles, and since at this age he wishes to please his mother with his bowel movement, the threatened loss of his testicles may be associated with his positive feelings toward her. The fact that in most boys the cremaster muscles may draw the testicles up into the inguinal canal whenever the boy is frightened furthers these associations.
The scrotal sac and testicles also play an important role in the feminine identification that the little boy makes with his mother as they present a visual image of paired appendages like the breasts and labia majora. In so far as the testicles and scrotal sac connote femininity, and femininity connotes castration, any threat of eruption of these fantasies will be defended against, particularly during puberty when the testicles enlarge and become sensitive to pain. The defense mechanisms of choice seem to be denial, repression, and displacement to the penis.