Testicular Torsion

What is testicular torsion?

Testicular torsion is a serious and painful condition that affects your testicle(s). If you experience testicular torsion, the spermatic cord twists and cuts off blood flow to your testicle. If you don’t get immediate treatment, your testicle could die.

The spermatic cord supplies blood to the testicles in men and people assigned male at birth (AMAB). The testicles are the reproductive organs in the pouch (scrotum) below your penis. They make hormones and sperm.

How serious is testicular torsion?

Testicular torsion is a very serious medical emergency. If you have sudden, intense pain in one of your testicles, call a healthcare provider or go to an emergency room (ER) right away.

The risk of losing your testicle increases the longer you wait to get treatment for testicular torsion:

• Almost everyone keeps their testicle if they get treatment within four to six hours.
• Around half of people keep their testicle if they get treatment after 12 hours.
• Only around 10% of people keep their testicle if they get treatment after 24 hours.

How common is testicular torsion?

Testicular torsion is rare. It affects about one in 4,000 men and people AMAB under age 25. It’s usually a spontaneous event, meaning it occurs without any apparent cause.

It almost always affects only one testicle. It more commonly affects the left testicle than the right.

Can I have testicular torsion in both testicles?

Yes, you can have testicular torsion in both testicles. But it’s rare. Only about 2% of testicular torsion cases affect both testicles.

What are the symptoms of testicular torsion?

The main symptom of testicular torsion is sudden, severe pain in one of your testicles. It can occur at any time — when you’re awake, sleeping, standing, sitting or active.

Other testicular torsion symptoms include:

• Painful swelling on one side of your scrotum.
• A visible lump on a testicle.
• One testicle is higher in your scrotum than the other.
• Discoloration (red, purple, brown, black) in your scrotum.
• Nausea and vomiting.
• Abdominal pain.
• Peeing more than usual.
• Fever.

If you have sudden pain or discomfort in one or both testicles, but no other symptoms, you should still contact a healthcare provider right away. This is still a sign of a medical emergency.

What does testicular torsion feel like?

In most people, testicular torsion feels like a sudden, intense pain in your testicle that sometimes extends to your stomach or makes you feel like you’re going to throw up. It may be so painful that you have trouble walking.

In others, testicular torsion is an intense pain in your testicle that goes away and comes back.

What triggers testicular torsion?

Most testicular torsion cases occur in people who have a “bell clapper” deformity. In most people with testicles, the testicles can’t twist because they attach to their scrotum. If you have a bell clapper deformity, your testicles hang in your scrotum and swing freely, like a clapper in a bell. The free-swinging can lead to twisting.

Testicular torsion can also occur after an injury to your testicle or scrotum.

Physical activities don’t cause testicular torsion. Jumping, lunging, twisting or any other actions won’t cause a torsion. It may happen while you’re exercising, but the physical activity isn’t the cause.

Who does testicular torsion affect?

Testicular torsion can affect anyone who has testicles. However, 65% of all cases of testicular torsion occur in men and people AMAB between the ages of 12 and 18.

You may be more likely to have testicular torsion if you’ve had one before or if someone in your biological family has had one.

What are the complications of testicular torsion?

Without prompt treatment, testicular torsion may cause:

• Permanent damage to your testicle. Your testicles can only survive about six hours without blood flow. If your testicle dies, a surgeon must remove it from your scrotum.
• Male infertility. Studies show that 1 in 3 people have a lower sperm count after testicular torsion. A lower sperm count may affect your ability to have a biological child.

How is testicular torsion diagnosed?

A healthcare provider can diagnose testicular torsion according to your symptoms, medical history, scrotal ultrasound and a physical examination of your testicles. They may quickly refer you to a urologist (a healthcare provider who specializes in conditions that affect urinary tracts and reproductive systems).

What tests will be done to diagnose testicular torsion?

Your healthcare provider may order a scrotal ultrasound to determine if blood is flowing within your testicular tissues. A scrotal ultrasound is a quick imaging test that helps them see the organs in your pelvic area (the space between your abdomen and legs).

How do I check myself for testicular torsion?

Only a healthcare provider can diagnose testicular torsion. If you have severe testicular pain, see a healthcare provider immediately.

How is testicular torsion treated?

Testicular torsion requires surgery (orchiopexy). During an orchiopexy, a surgeon will untwist your testicle, which restores blood flow to the area. They’ll then secure your testicle to an inner wall in your scrotum with stitches (sutures). This prevents testicular torsions from occurring again.

The surgeon will usually perform surgery through your scrotum, but sometimes, they need to make a small cut (incision) through your groin. If you have a bell clapper deformity, torsion usually affects both testicles. In this case, your surgeon will also stitch your unaffected testicle to the inner scrotal wall.

Can testicular torsion fix itself?

No, testicular torsion can’t fix itself. If you don’t get surgery within six hours, a surgeon will likely need to remove your affected testicle.

Newborns with testicular torsion often lose their testicle. A surgeon will remove the dead testicle and secure the unaffected testicle to the inner scrotal wall, so it doesn’t twist later.

How soon after testicular torsion surgery will I feel better?

The first few days after testicular torsion surgery are often the most painful. There may be swelling or bruising on your scrotum or groin for about a week.

After a week, your pain should decrease, and you should be able to return to normal activities, including work or school.

You should avoid heavy lifting and strenuous activities (including sports) for at least three to four weeks. Talk to your healthcare provider before resuming any activity.

It’s important to remember that your body is unique. Your recovery time may vary. Follow your healthcare provider’s instructions on how to manage any pain or discomfort as you recover from testicular torsion surgery.

Can testicular torsion be prevented?

The only way to prevent testicular torsion is through surgery. Most people don’t know they’re susceptible to testicular torsion until they have it. Surgery prevents a torsion from occurring in your other testicle.

What can I expect if I have testicular torsion?

The outlook for testicular torsion is good if you get treatment right away — within six hours.

However, if you don’t have blood flow to your testicle for more than six hours, your testicle may lose its ability to function. If this happens, a surgeon will need to remove it.

What happens if you ignore testicular torsion?

If you don’t get treatment right away — within six hours — testicular torsion can permanently damage (infarct) your testicle. A surgeon will remove the damaged testicle if a torsion doesn’t receive treatment in time.

Testicular torsion can also affect your ability to have a biological child (it will affect your fertility).

When should I see my healthcare provider?

After surgery to correct testicular torsion, schedule a follow-up appointment with your healthcare provider. They’ll want to check your incisions and see how well you’re healing.

Call your provider right away if you have any symptoms after surgery, including:

• Heavy bleeding around your incision sites.
• Fever.
• Increased pain.
• Swelling.

When should I go to the ER?

Testicular torsion is a medical emergency. If you have any symptoms, go to the emergency room immediately. If you go more than six hours without treatment, testicular torsion can permanently damage your testicle.

What questions should I ask my healthcare provider?

• How do you know that I have testicular torsion?
• Will you be able to save my testicle?
• Do I have a bell clapper deformity?
• Will I still be able to have biological children if I lose my testicle?
• Will I have testicular torsion in my other testicle?

A note from Cleveland Clinic

Testicular torsion needs immediate treatment to prevent permanent damage to your testicle. You may think your symptoms will go away if you lie down, rest or ice your groin. But any time you have severe pain in your testicles, that’s your body’s way of telling you that something is wrong. Getting medical attention as quickly as possible is essential to increasing your chances of having the best outcome.