The spermatic cord provides blood flow to the testicle. When a testicle rotates on this cord, doctors refer to it as testicular torsion.

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Testicular torsion is a medical emergency — it occurs when blood flow to the testicle stops, causing sudden and often severe pain and swelling.

Testicular torsion is most common during adolescence and the first year of life. The resulting loss of blood flow can lead to the death of the testicle and surrounding tissues.

Doctors can usually save the testicle if surgery can correct the torsion within 6 hours. If a person waits longer for treatment, the chances of salvaging the testicle reduce.

A person with testicular torsion may experience:

  • sudden or severe pain in one testicle
  • swelling of the scrotum, the loose bag of skin under the penis that contains the testicles
  • lumps in the scrotum
  • nausea
  • blood in the semen
  • vomiting
  • abdominal pain

A person may also notice that one testicle is positioned higher than usual or at an atypical angle. This testicle may be larger and become red or dark in color.

Symptoms usually appear suddenly, although in some cases, the torsion can develop over a few days.

It is vital to seek emergency care for sudden or severe testicle pain. The signs and symptoms may be due to another condition, but prompt treatment can prevent severe damage or loss of the testicle in cases of testicular torsion.

If a person experiences sudden testicle pain that goes away without treatment, the testicle could have twisted and then untwisted without intervention. This is known as intermittent torsion and detorsion.

Even if the testicle untwists on its own, it is important to seek prompt medical help because surgery is necessary to prevent the problem from recurring.

Testicular torsion normally requires emergency surgery, where the surgeon will attempt to untwist the spermatic cord to restore blood supply. Manual detorsion is sometimes possible, but surgery can prevent recurrence of testicular torsion.

The operation is simple and minimally invasive. A surgeon will usually conduct the procedure while a person is under general anesthesia, and it does not usually require a stay in the hospital.

During surgery, the doctor will:

  • make a cut in the scrotum
  • untwist the spermatic cord if necessary
  • stitch one or both testicles to the inside of the scrotum to prevent rotation

Suturing both testicles will prevent torsion from occurring on the other side.

Prognosis

Surgery within 6–8 hours of testicular torsion has a good likelihood of saving the testicle, although recent research states waiting longer can still result in a doctor being able to save the testicle. However, the longer a person delays treatment, the lower the likelihood of saving the affected testicle.

Prolonging treatment can cause permanent damage and affect a person’s fertility. It may also result in needing to remove the affected testicle in a procedure called an orchiectomy to prevent gangrenous infection. This procedure can also alter hormone production in infants.

For this reason, the sooner a doctor can untwist the testicle, the greater the chances of successful treatment.

After surgery, an individual will need to avoid strenuous or sexual activity for several weeks.

Each testicle attaches to the spermatic cord and the scrotum. Testicular torsion occurs if the testicle rotates on the cord that runs upward from the testicle into the abdomen.

The rotation twists the spermatic cord and reduces blood flow. If the testicle rotates several times, it can cause a blockage in the blood flow, quickly leading to more damage.

People who experience testicular torsion may have an inherited trait that allows one or both testicles to rotate freely inside the scrotum. This trait means that their testicle is only attached to the spermatic cord and not the scrotum. Many people refer to this as a “bell clapper scrotum” because the testicle “swings” like a bell clapper.

Testicular torsion can occur at any time, including standing, sleeping, exercising, or sitting, and with no apparent trigger in those who are susceptible. Sometimes, it may occur due to an injury or rapid growth during puberty.

Factors that increase the chances of testicular torsion include:

  • Age: Testicular torsion is most common in males below the age of 25 years and often affects adolescent males between aged 12–16 years.
  • Previous testicular torsion: If the torsion occurs once and resolves without treatment, it is likely to happen again in either testicle unless surgery can correct the underlying problem.
  • Climate: Many health experts call torsions “winter syndrome” because they commonly occur during cold weather. For example, a person’s scrotum is often in a state of relaxation while in a warm bed. When the individual leaves the bed, the scrotum becomes exposed to colder room air. If the spermatic cord becomes twisted while the scrotum is loose, the sudden contraction from the abrupt temperature change can trap the testicle in that position, causing testicular torsion.

Testicular torsion in newborns and infants

Sometimes, testicular torsion occurs before or shortly after birth. In this case, it is not usually possible to save the testicle.

However, the child will need surgery after birth to diagnose and correct testicular torsion in the other testicle and prevent future reproductive problems.

Testicular torsion is normally an emergency, and prompt diagnosis and treatment are necessary.

The doctor will examine the scrotum, testicles, abdomen, and groin and ask questions about a person’s symptoms to determine whether the problem could be testicular torsion or another condition.

A healthcare professional may also test the patient’s cremasteric reflex, which is highly effective in helping diagnose torsion. In this examination, the doctor lightly rubs or pinches the inside of the thigh on the affected side. This normally causes the testicle to contract, but the reflex usually does not occur with testicular torsion.

If the diagnosis is uncertain, a doctor may consult a urologist immediately to avoid compromising the health of the testicle.

Medical tests that can confirm a diagnosis or help identify alternative health issues include:

  • urine or blood tests to check for infection
  • testicular ultrasound to assess blood flow, as decreased blood flow can be a sign of testicular torsion
  • nuclear scan of the testicles, which involves injecting tiny amounts of radioactive material into the bloodstream to detect areas of reduced blood flow

Exploratory surgery may also be necessary to identify whether symptoms are due to testicular torsion or another condition. If surgery does not reveal torsion, the surgeon may still attach the testicle to the scrotum wall to prevent future problems.

If pain persists for several hours and the physical exam suggests testicular torsion, a doctor may perform surgery without additional testing to prevent loss of the testicle.

Having testicles that can rotate or move back and forth freely in the scrotum is an inherited trait. Only certain people have this attribute.

The only way to prevent testicular torsion with this trait is through surgery to attach both testicles to the inside of the scrotum so that they cannot rotate freely.

Rarely, torsion may occur on both sides, but only in around 2 out of 100 men. If doctors remove one testicle, the remaining testicle may still produce sufficient sperm to conceive a child. However, those who have had testicular torsion may have a lower sperm count than those who have not.

Sometimes, the remaining testicle will grow larger to compensate. Therefore, a person should consider wearing protective clothing when taking part in sports and other activities to help protect the second testicle.

Testicular torsion is a condition where an individual’s testicle rotates around the spermatic cord, blocking blood flow to the area. It occurs most often in babies during the first year of life or adolescence.

Testicular torsion is an emergency that requires immediate medical attention, ideally within 6 hours. If a person waits longer to get treatment, they risk losing the testicle.