What Is Testicular Torsion?

Testicular torsion requires surgery to prevent it from happening again.

If you have sudden and severe pain in your scrotum, then you might have testicular torsion. The condition is an emergency and you should seek care immediately.

Testicular torsion happens when a testicle rotates and twists the cord that moves blood to the scrotum. The blocked blood flow leads to sudden pain and swelling. This tends to happen most often to boys between ages 12 and 18. But it can occur at any age.

If this happens to you or your son, act quickly. You may need emergency surgery, but if you address it quickly, the testicle is usually fine.

Here’s more information to help you understand what testicular torsion is and what you need to do if it happens. It also explains how proper medical care can help prevent it from happening again.

Testicular torsion is not common. About 1 in 4,000 males under age 25 go through it. It can happen in newborns and men over 25, but that’s rare.

You may have symptoms in your scrotum area as well as all-over body symptoms. The main symptoms in the scrotum include:

• Sudden, severe scrotum pain
• Scrotum swelling
• Change in scrotum color, especially redness or darkening
• Unusual testicle position, typically high riding
• Visible lump in the testicle

You may also have:

• Fever
• Nausea
• Vomiting
• Abdominal pain
• Frequent urination
• Painful urination

Call your doctor if you’ve had sudden pain that goes away without treatment. Slow pain over several hours or days could also indicate torsion. Your testicle may be able to twist and untwist on its own. But you may still need surgery so it won’t happen again.

The spermatic cord carries blood from the abdomen to the scrotum. It also contains the vas deferens. This duct moves sperm from the testicles to the urethra. In testicular torsion, a testicle twists around the cord and cuts off or reduces blood flow to the testicle. The testicle may rotate more than once. This can fully block blood flow.

Doctors don’t know exactly why this occurs. Those who get testicular torsion often have a testicle that can rotate inside the scrotum. They inherit this condition -- called bell clapper deformity. About 12% of men have it. But not every man with the trait will have testicular torsion.

Other potential causes include:

• Hours of strenuous activity
• Minor injury to the scrotum
• Cold temperatures
• Rapid testicle growth during puberty

Torsion may also occur during sleep. Boys who have one usually wake up with pain in the middle of the night or early in the morning.

Testicular torsion usually happens on one side only -- most often the left.

Testicular torsion can happen to any male, but several factors increase risk. They include:

• Age: Teens between 12 and 18 experience it most often.
• Family history: It is heritable, which means even though it’s not genetic, it can be passed on.
• Personal medical history: If you’ve had one before, you may have one again.

In addition, if you’ve experienced pain that went away on its own, it can still repeat. Your testicle may be twisting and untwisting itself, which causes more damage.

First, the doctor will confirm your signs and symptoms. Next, he’ll do a physical exam of the testicles and groin. During this exam, he may test your testicle’s reflexes by tapping the inside of your thigh on the side where it hurts. The testicle usually contracts when this happens. If it doesn’t, you may have torsion.

Some medical tests can help as well. These include:

• Urine test to check for an infection, such as a urinary tract infection
• Ultrasound to check for blood flow around the scrotum
• Surgery to determine whether your symptoms stem from torsion or another problem

Testicular torsion requires surgery. The doctor might untwist the testicle manually or through a more invasive procedure. The surgery includes making a cut in the scrotum, untwisting the cord, and stitching one or both testicles to the scrotum. This type of surgery prevents torsion from happening again.

If you have surgery, you’ll receive general anesthesia and be unconscious. After the surgery, you’ll recover within an hour or two and won’t typically need to stay in the hospital.

Testicular torsion can damage the testicle permanently. This may require removal of the damaged testicle through surgery. The damage could cause infertility.

The chance of a damaged testicle increases after about 6 hours of blocked blood flow. Within 6 to 8 hours, surgery can save the injured testicle most of the time. After 12 hours without treatment, testicle removal is necessary in about 3 of 4 patients.

Scrotum surgery takes time to heal. You may take pain medicine for a few days. You should be able to return to work or school in a few days or a week. Your doctor may advise you not to exercise, masturbate, or have sex for a few weeks.

The stitches shouldn’t be noticeable and shouldn’t be bothersome. If you feel pain or swelling again, contact your doctor immediately.

If you know you have bell clapper deformity, your doctor may be able to prevent torsion by attaching the testicles to the scrotum through surgery.