Testicular Torsion

Testicular torsion is when your spermatic cord twists and cuts off blood flow to your testicle (testis), causing intense pain and swelling. Your spermatic cord supplies blood to your testicles.

Testicular torsion (pronounced “te-STIK-yuh-ler” “TAWR-shuhn”) isn’t common. It affects about 1 in 4,000 males under age 25. It usually happens without any apparent cause. You’re more likely to have it in your left testicle than your right. It can also affect both testicles. But this is rare. Less than 2% of all cases of testicular torsion affect both testicles (bilateral testicular torsion).

Testicular torsion is a serious medical emergency that requires surgery to fix. Your testicle can die without quick treatment. If you have sudden, intense pain in one or both testicles, call your healthcare provider or go to an emergency room (ER) right away.

Symptoms of testicular torsion

The main symptom is sudden, severe testicular pain. The pain may go away and come back.

Sometimes, the pain extends to your stomach. It may cause you to feel like you’re going to throw up. It also may be so painful that you have trouble walking or even standing.

Other testicular torsion symptoms may include:

• Swelling, especially on one side of your scrotum
• A visible lump on your testicle
• One testicle is higher in your scrotum than the other
• Scrotum discoloration (red, purple, brown or black)
• Peeing more than usual
• Fever

What is the main cause?

The main cause of testicular torsion is a “bell clapper” deformity. For most males, the testicles can’t twist because they attach to the inside of the scrotum. But if you have a bell clapper deformity, your testicles swing freely in your scrotum, like a clapper in a bell. This can lead to the spermatic cord twisting.

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

Many people think it occurs from physical activity, like jumping, lunging or twisting, but it can occur at any time. It may happen while you’re active. But physical activity isn’t the cause. It can also occur when you’re awake, asleep, standing or sitting.

Risk factors

Testicular torsion can affect anyone who has testicles. But you’re more likely to have it if:

• You’re between the ages of 12 and 18.
• You’ve had it before.
• Someone else in your biological family has had it.

Complications

The biggest testicular torsion complication is permanent damage to your testicle. Your testicle can only survive for about six hours without blood flow. If it dies, a surgeon must remove it from your scrotum.

It’s also possible to have a lower sperm count after a testicular torsion. A lower sperm count may cause male infertility, which affects your ability to have a biological child.

How do you tell if your testicle is twisted?

A healthcare provider will:

• Review your medical history
• Ask about your symptoms
• Examine your testicles

They’ll also order an ultrasound of your scrotum to see if blood is flowing within your testicular tissues.

How do I check myself?

Only a healthcare provider can diagnose testicular torsion. See a provider immediately if you have severe testicular pain.

How is testicular torsion treated?

It requires an orchiopexy. During this procedure, your surgeon will:

1. Make a small cut (incision) through your scrotum or groin.
2. Untwist your testicle to restore blood flow.
3. Secure your testicle to an inner wall in your scrotum with stitches to prevent a torsion from happening again.

Your surgeon will likely examine your unaffected testicle during surgery. If they notice it’s also hanging freely, they’ll stitch it to an inner scrotal wall.

Will it fix itself?

No. The only way to treat testicular torsion is surgery. If you don’t get surgery quickly, your surgeon may need to remove your testicle.

Don’t try to untwist your testicle yourself. You may make the torsion worse and cause permanent damage.

Recovery time

Your pain should decrease about a week after surgery. Around this time, you should be able to return to normal activities, including work or school. It’ll take up to two weeks to return to physical activity.

When should I see my healthcare provider?

Go to the nearest emergency room as soon as possible if you have testicular torsion symptoms.

After surgery, schedule a follow-up appointment with your provider. They’ll check your incision and see how well you’re healing.

You should also call your provider if you have any symptoms after surgery. These may include:

• Signs of infection, including fever, chills, discoloration or pus around your incision
• Heavy bleeding around your incision
• Increased pain
• Swelling

What can I expect if I have testicular torsion?

Your outlook is better the quicker you get treatment:

• Almost everyone keeps their testicle if they get treatment within four to six hours.
• Around half keep their testicle if they get treatment after 12 hours.
• Only around 1 out of every 10 keep their testicle if they get treatment after 24 hours.

Newborns with testicular torsion often lose their testicle. Your child’s surgeon will remove the testicle and secure the unaffected testicle to an inner scrotal wall. This prevents it from twisting in the future.

Can testicular torsion be prevented?

No. Most people don’t know they’re at risk of testicular torsion until they have it. Surgery will fix a torsion and prevent it from happening again.