An Overview of Testicular Torsion

Why Testicular Torsion Is Considered a Medical Emergency

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Testicular torsion is a serious condition that can cause sudden, severe pain. It occurs when the tissue surrounding the testicle is not attached completely, allowing the testicle to rotate. This, in turn, causes the spermatic cord—which extends from the abdomen to the scrotum—to twist, cutting off the sole blood supply to the testicles. Testicular torsion causes pain and swelling of the testicle and is considered a medical emergency. 

Testicular torsion symptoms
Illustration by JR Bee, Verywell

With no blood supply to the testicle, an infarct (death of the tissue) could likely occur, causing a very tender, red, and swollen testicle. Testicular torsion requires emergency surgery to save the testicle. But when the blood supply has been cut off for prolonged periods, it can result in damage to the testicle, or in the worst case scenario, loss of the testicle.

Testicular torsion is a relatively uncommon condition, occurring in 1 in 4,000 males under age 25. It can also occur in males of all ages, from newborn baby boys to senior men. Torsion usually happens on just one side, but in rare instances, it occurs in both testicles.

Symptoms

Symptoms of testicular torsion include sudden, severe pain, usually on one side of the scrotum. Swelling of the scrotum will cause one testicle to appear larger than the other, and may cause a testicle to be positioned higher than normal or at a strange angle. Redness or darkening of the scrotum is also common.

Other signs of testicular torsion include:

  • abdominal pain
  • nausea and vomiting
  • frequent urination
  • fever
  • waking up in the middle of the night or early morning with severe scrotal pain (common in young boys).

It’s possible for a newborn to be born with testicular torsion. The testicle is commonly dead if the condition occurs in utero. Unlike in adults adult, there is not usually any apparent pain or discomfort involved.

Causes

It’s not clear exactly what causes testicular torsion. Some experts say there is a genetic anomaly which allows the testicle to freely float inside of the scrotum. Normally, the testicle is not able to twist around inside the scrotum, because the tissue is attached properly. However, when a male is born with a condition that is sometimes called a “bell clapper” deformity, the testes are not attached, and they can freely move around inside the scrotum.

Other factors linked with the occurrence of testicular torsion include:

  • Minor surgery of the testicles
  • Rapid growth during puberty
  • Cold temperatures

Although physical activity may be the impetus that results in testicular torsion, it is not the underlying cause. The condition commonly occurs when standing, sitting down, or even during sleep.

Diagnosis

Whenever a male experiences severe pain in the scrotum or testes, it’s important to seek emergency medical care right away (even if swelling or discoloration are not present). Immediate treatment is required to prevent the loss of the testicle.

Another scenario that constitutes an immediate visit to the urologist or other healthcare provider is when a person has sudden testicle pain which subsides without treatment. In this scenario, called intermittent torsion and detorsion, surgery is required to prevent torsion from occurring again.

Testicular torsion is usually discovered via physical exam by the urologist, though x-rays may also be used for diagnosis. 

Treatment

Because testicular torsion involves the elimination of the only blood supply to the testicles, treatment must occur very promptly. This involves surgery to untwist the spermatic cord and restore the blood supply. Even if the emergency physician can untwist the testicle themselves, surgery is still required to stitch the testicle in place, preventing future occurrences.

Long-term damage can occur if treatment is not initiated within six hours of the start of torsion. One study discovered that three in four males diagnosed with testicular torsion required removal of the testicle (a procedure called orchiectomy) when emergency surgery did not occur beyond 12 hours after symptoms began.

After a person has been treated for testicular torsion, common expectations may include:

  • Taking pain medications
  • Returning to work or school in a few days to a week
  • Avoiding strenuous activity or exercise for several weeks
  • Noticing that the other testicle has slightly enlarged after surgical removal of the affected testicle (a condition called compensatory hypertrophy)

A Word From Verywell

Testicular torsion, although rare, is a very serious condition that requires immediate medical attention and treatment. It is important for a person to seek medical attention if experiencing any severe pain in the testes or scrotum. As with many medical conditions, symptoms are likely to grow worse with prolonged absence of medical treatment.

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