Testicular torsion is a medical emergency when a testicle twists around the spermatic cord, cutting off the blood supply. While it can occur without pain, most people experience severe pain in the scrotum and one testicle.

The Society for Academic Emergency Medicine (SAEM) explains that testicular torsion can occur at any age but is most common in babies during their first year and when the child reaches puberty.

Although testicular torsion can be painless, it is still a medical emergency and needs immediate treatment.

This article explains the pain and symptoms of testicular torsion and how to tell if a baby is experiencing it.

A mother bathing a toddler in a sink filled with bubbles.Share on Pinterest
Crystal Sing/EyeEm/Getty Images

Most people with testicular torsion experience intense pain in their scrotum and one of their testicles. The pain usually comes on suddenly and sometimes spreads to the abdomen.

The Urology Care Foundation (UCF) acknowledges that some people find their pain starts slowly, building up over hours or days. However, the UCF stresses that this is unusual.

A 2021 case study notes that, while there is little research into pain-reduced or pain-free testicular torsion, it can happen.

The study writers advise doctors to use ultrasound to help them diagnose testicular torsion, as delaying surgery may mean the person loses that testicle.

According to the National Center for Biotechnology Information (NCBI), the classic symptoms of testicular torsion are:

  • sudden, intense, and persistent pain on one side of the scrotum and one testicle
  • nausea and vomiting
  • lower abdominal pain
  • swelling in the testicle, and it will feel larger than the other
  • tenderness
  • changes in the color of the scrotum, such as red or dark skin

People with testicular torsion are often distressed and in significant discomfort, and some people have difficulty walking.

The NCBI also notes that some people only feel pain intermittently and that sometimes the person only experiences lower abdomen and groin pain.

Babies can also get testicular torsion. According to the UCF, the symptoms are usually different.

Babies tend to have a hard mass in their scrotums, and the surrounding skin may be darker than usual.

Unlike older children and adults, infants with testicular torsion may not express any pain.

According to UCF, newborns can have testicular torsion, but it is very rare. UCF also notes that doctors are seldom able to save a newborn’s damaged testicle and usually have to amputate it.

Testicular torsion occurs when the spermatic cord that supplies blood to the testes twists, cutting off the blood supply.

The NCBI explains that this cord is usually firmly attached inside the scrotum, but sometimes the attachment is too high, and the cord and testes have too much movement.

Doctors call this a bell clapper deformity, and it usually affects both testicles.

The testicle shrinks and withers if it does not receive blood for 6 hours. Due to a lack of blood, the testicle could “infarct,” or die.

Testicular torsion is a medical emergency, so anyone experiencing symptoms needs immediate medical attention.

Doctors can usually save the person’s testicle if they perform surgery within 8 hours, but the likelihood drops dramatically the longer the delay.

Many doctors can diagnose a person’s testicular torsion during a physical exam. They may gently feel the person’s scrotum to check if one testicle is higher than the other and whether there is any swelling.

The NCBI adds that doctors may recommend an ultrasound and compare the shape and size of the testes. They may also suggest a Doppler ultrasound to examine how blood flows around the testicle.

All people with testicular torsion need surgery, according to the UCF. In addition, doctors need to act quickly to save the person’s testicle. If they can perform surgery within 6 hours of the person’s symptoms starting, there is a 97% chance of the testicle being healthy.

Sometimes, doctors can untwist the spermatic cord manually during the physical exam. However, people will still need surgery to prevent it from recurring.

During surgery, doctors unravel the twisted spermatic cord and sew it in place. They may also add stitches to the other testicle if the person has a bell clapper deformity.

Doctors will remove the testicle if it is too badly damaged and they cannot save it.

Most people recover fully from surgery and can resume their usual activities within a few weeks.

The NCBI says that the earlier a person seeks medical help, the better the outlook.

The UCF adds that even if doctors remove the damaged testicle, the person’s other one usually produces enough sperm for them to be fertile.

However, it may be more difficult to treat testicular torsion in newborns. The UCF states that there have been cases of a second testicular torsion in newborns once surgeons have removed one testicle.

In these cases, surgeons may have to remove both testes. However, testicular torsion in newborns is very rare.

This section answers some frequently asked questions about testicular torsion.

Can people have testicular torsion without pain or swelling?

A 2021 case study highlights that someone can have testicular torsion without severe pain.

Most people experience swelling in the scrotum and testes, but this may not be immediately obvious.

Some people only feel pain intermittently, while others find it excruciating.

Would it be obvious if a person had testicular torsion?

The classic symptoms are obvious, and SAEM says many doctors recognize them immediately without further tests.

According to the UCF, any signs of swelling in the scrotum need prompt medical interventions to preserve the person’s testicle.

What can be mistaken for testicular torsion?

Although the symptoms of testicular torsion are fairly recognizable, the NCBI explains that doctors may also look for:

  • tumors
  • hydrocele, a buildup of fluid in the tissues surrounding each testicle
  • epididymitis, where the tube that carries sperm — the epididymis — is inflamed and swollen
  • orchitis, which is inflammation of the testicles
  • traumatic hematoma, where broken blood vessels leak blood into the nearby tissue after an accident or injury

Testicular torsion is a medical emergency that happens when the cord supplying blood to a person’s testicles twists and cuts off the blood supply to the organ. People need surgery to correct this.

It is usually severely painful, and the person’s scrotum swells. However, some people can have it without feeling any pain, although they will still have swelling.

If doctors can perform surgery within 6 hours of the person’s symptoms starting, there is a 97% chance of the testicle being healthy.

After this brief window, the likelihood drops, and the chance of testicle recovery falls below 10% after 48 hours.