Testicular Torsion: Causes, Symptoms and Treatments

Diagram of a normal testicle compared to one with testicular torsion

What is Testicular Torsion?

Testicular torsion is a condition that occurs when the spermatic cord that supplies blood to the testicle becomes twisted. This twisting cuts off blood flow to the testicle, causing intense pain and swelling.

Testicular torsion must be treated immediately, usually requiring emergency surgery. If this condition goes untreated for more than 4-6 hours it can cause permanent damage to the testicle. If there is too much damage to the testicle, it will need to be removed.

Most of the time, the testicle can be saved within 4-6 hours. After 12 hours, the odds drop to roughly 50%. Beyond 24 hours, the odds of saving the testicle are only 10%.

Testicular torsion occurs most often in teenaged males. However, it can happen at any age, including before birth.

What Causes Testicular Torsion?

Testicular torsion isn’t a common condition, and only occurs in around 1 in 4000 males under the age of 25. It can also occur in infants and older men.

Testicular torsion can occur on either side of the scrotum, but it is rare to happen on both sides.

Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum, known as a bell-clapper deformity.

Most mens’ testicles are attached to their scrotums, which makes it difficult for them to become twisted. The testicles of males with bell clapper deformity are unattached and can become twisted in the scrotum.

Although testicular torsion can occur in any age group, it is more common in boys aged 12-18 years. It can occur after strenuous exercise, from an injury to the scrotum, or even while sitting, standing, or sleeping.

Other potential contributing factors could be exposure to cold temperatures or rapid growth of the testicle during puberty. There is often no obvious cause for the condition.

What Are The Symptoms Of Testicular Torsion?

You will likely know if you have testicular torsion. You will suddenly experience intense pain in one of your testicles. It may increase or decrease in intensity, but it will not disappear completely.

You might also experience the following symptoms:

  • Swelling of the scrotum, especially on one side.
  • Stomach pain
  • Nausea and/or vomiting
  • One testicle is unusually situated (higher up or at an odd angle).
  • Fever
  • Frequent urination (less common)

Testicular torsion in young boys often causes them to awaken during the night or early morning with testicular pain.

If one side of the scrotum becomes larger than the other, it could be the sign of a problem. Additionally, there could be a problem if there are changes in the color of the scrotum, particularly if there is redness or it becomes darker.

There may not be any swelling at first, but the scrotum will soon begin to swell and redden. Nausea and vomiting are also possible.

If you feel any discomfort or pain in your testes, it is important to seek immediate medical attention. Even if there is no swelling or change of skin color, you should still call your doctor.

Less often, a slow-onset pain in the testicle that develops over several hours or days can occur as a result of torsion.

Torsion more often occurs on the left side rather than the right. Of men who have testicular torsion, only 2% experience it in both of their testicles.

In some cases, testicular damage or loss of a testicle can affect a man’s ability to father children.

Intermittent Torsion and Detorsion

Sometimes the spermatic chord can twist and then untwist by itself without treatment. This is called torsion and detorsion, and it can increase the likelihood of testicular torsion in the future.

You may be tempted to ignore the problem if your spermatic chord untwists and the pain subsides, but it is best to see your doctor. The doctor can examine you and take measures to help prevent the occurrence of torsion in the future. This problem is often prevented by a simple surgical procedure.

Who Is At Risk?

Those who are at risk for developing testicular torsion fall into the following groups:

  • Age – In most instances, testicular torsion occurs in boys ages 12-18 .
  • Previous torsion episodes – If you have experienced testicular pain in the past that resolved on its own without treatment (due to torsion and detorsion), it is likely to reoccur . The more often you experience these episodes of pain, the greater your risk for testicular damage.
  • Genetics – Testicular torsion can be inherited if there is a family history of it.

When To See A Doctor

You should seek immediate emergency treatment for severe or sudden pain of the testicle. If you suffer from testicular torsion, receiving treatment as soon as possible can help prevent serious damage to your testicle, or even its loss.

Trying to ignore the pain or hoping it will go away can lead to severe damage to your testicle that may require its removal.

You will be treated immediately for testicular torsion. Your family doctor or the emergency room will likely first see you. You will then likely be seen by a specialist in male genital disorders (urologist) and urinary tract problems.

Don’t eat or drink anything until a doctor has examined you and determined whether or not you’ll need surgery.

It’s important to notify a doctor even if the pain in your testicle goes away by itself. If your torsion goes away, you are more likely to develop another one. A simple surgery that secures your testicles to your scrotum can help minimize the risk of a recurrence.

How is Testicular Torsion Diagnosed?

The staff and doctors will assume that you have a testicular torsion when you show up to the hospital or doctor’s office until further examination confirms it or rules it out.

Testicular torsion is often diagnosed by doctors through a physical examination of the scrotum, testicles, groin and abdomen. They may also check your reflexes by pinching or rubbing your inner thigh. Normally, this will cause the testicle to contract, but is not likely to happen if there is testicular torsion.

A doctor might also perform tests to determine if the spermatic chord is twisted. These may include:

  • Testicular Ultrasound – A testicular ultrasound is performed for checking blood flow in the scrotum. However, ultrasounds don’t always detect restricted blood flow, so it’s possible that it may not be able to eliminate a diagnosis for testicular torsion.
  • Urine or blood test – Blood and urine tests can be used to determine if pain or symptoms are caused by infection of the urinary tract or the testicle.
  • Surgery – Surgery could be required to determine if your symptoms are due to testicular torsion or some other condition.

If you have been experiencing pain over a period of several hours and a physical examination indicates that you may have testicular torsion, you will likely be admitted to immediate surgery. Any delay in surgery could lead to the loss of your testicle.

What Is The Treatment For Testicular Torsion?

Almost all cases of testicular torsion will require surgery. In rare circumstances, a doctor might be able to untwist the spermatic cord by pressing on the scrotum, a procedure called manual detorsion. However, in order to prevent further episodes of torsion from re-occurring, you will still need to have surgery.

Testicular torsion surgery usually does not require a hospital stay. When undergoing surgery you will be taken to an operating room at the hospital, or it may be done at your doctor’s office. You will likely be given medication for pain as well as general anesthesia, which means that you will be unconscious during the procedure.

A surgeon or urologist will make small incision in your scrotum and untwist the spermatic cord. Then, the doctor will stitch either or both of your testicles to the inside of your scrotum to prevent future torsions.

The procedure takes approximately 45 minutes. After the procedure is complete, the doctor will close the incision and you’ll be taken to a recovery room for 1-2 hours.

Sometimes doctors will not be able save the testicle if the torsion continues for too long. It will then be removed by doctors through a procedure called an orchiectomy.

After 6 hours of torsion, the damage may be irreparable. After 12 hours without treatment, there is a 75% chance that the testicle will need to be removed.

Testicular Torsion In Babies

Although it is rare, testicular torsion may occur in infants and newborns. In these cases the infant’s testicle may appear hardened, swollen, or darkened. If the infant has restricted blood flow it might not be detected by an ultrasound, so surgery may be required to confirm the torsion.

‚ÄčThe testes of newborn babies with testicular torsion are rarely able to be saved. In these cases, the testicle is almost invariably infarcted (meaning death of the tissue). There are also instances where Infants experience torsion on the other side shortly after birth. The baby would then most likely lose both testes.

Many pediatric urologists can operate in the first few hours to days following birth to remove the damaged testicle and place stitches to prevent torsion in the second testicle.

There is some debate regarding how best to treat infants with testicular torsion. It may be past the window of opportunity to perform emergency surgery on a baby who is born with symptoms or signs of testicular torsion, and there are also risks involved with general anesthesia.

However, emergency surgery may be able to save a portion or all of the testicle. It can also prevent the other testicle from developing torsion. Surgery on infants with testicular torsion may also prevent future issues with fertility and the production of male hormones.

Recovery Following Surgery

For a few days following surgery for testicular torsion, you may be required to take pain medication. You should be able return to school or work within a few days.

Men who have had surgery to repair testicular torsion should avoid strenuous activities or having sex (including masturbating) for a few weeks afterwards. Talk to your doctor to find out when you can resume your normal activities.

Men who have had their testicle removed may later be able get a prosthetic testicle to replace it. While most men will be able to have children and live normal lives with only one functioning testicle, a prosthetic can make it easier for some men to feel confident about their appearance.

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