15382 Testicular Torsion

Overview

Testicular torsion is a medical emergency where the spermatic cord — the tube that carries blood and sperm to the testicle — gets twisted. This cuts off blood flow, causing sudden pain and swelling. Without prompt treatment, the testicle can be damaged or lost.

Testicular torsion is not common, but it is the most common cause of sudden, severe scrotal pain in young males.

It mainly affects boys and young men around puberty, usually between 12 and 18 years old. It can also happen in babies and in older men, but that is rare.

Symptoms

Common symptoms

• Sudden, severe pain in one testicle
• Swelling or redness of the scrotum
• A testicle that feels higher or sits at an odd angle
• Nausea or vomiting
• Abdominal pain or a dull ache in the lower belly

Symptoms in children

• Unexplained fussiness or crying in a baby
• Refusing to eat or having trouble settling
• A swollen, red, or tender scrotum that you notice during a diaper change or bath
• Sometimes no obvious complaint, so trust your instincts if your child seems unwell

Symptoms in older adults

• Testicular torsion is much less common after age 40, but the symptoms are the same
• Pain may not be as severe, and swelling can be subtle, but any sudden testicular pain should be taken seriously

Causes

Main causes

• The spermatic cord twists, often for no clear reason — this can happen during sleep, rest, or activity
• Injury to the groin or scrotum can sometimes trigger a twist
• In some people, the testicle is not attached securely to the scrotum, allowing it to rotate

Risk factors

• Being a teenager (the most common age group)
• Having had testicular torsion before — it can happen again
• Having a family history of testicular torsion
• A condition called 'bell-clapper deformity', where the testicle moves more freely than normal

When to see a doctor

See a doctor urgently if:

• Any sudden, severe pain in the testicles or scrotum
• Rapid swelling or redness of the scrotum
• Any of the emergency symptoms listed above — go to an emergency department right away

Book a routine appointment if:

• If you have ongoing or occasional discomfort in the testicles, even if not severe
• If you notice a lump, a change in size, or an unusual feeling in a testicle
• If you have questions about testicular health or fertility

Diagnosis

A doctor will ask about your symptoms and examine your scrotum, abdomen, and groin. If torsion is suspected, they may send you for an ultrasound or take you to surgery quickly. In many cases, the fastest and most reliable way to confirm the diagnosis is for a surgeon to look directly at the testicle.

Tests that may be done

• Physical examination of the scrotum and surrounding areas
• Ultrasound with color Doppler to check blood flow to the testicle
• Urine test to rule out an infection
• Sometimes immediate surgery for diagnosis and treatment at the same time

What to expect at your appointment

If a doctor thinks you have testicular torsion, they will act with urgency. You may be given an emergency referral to a hospital. The surgeon will explain the procedure and get your consent. You will likely be given anesthesia, and the whole process is usually done within hours of arrival.

Treatment

Testicular torsion is treated with surgery. The goal is to untwist the spermatic cord to restore blood flow to the testicle, and then fix the testicle in place so it cannot twist again. Time is critical — the sooner surgery happens, the better the chance of saving the testicle.

Self-care at home

• There is no home remedy for testicular torsion — it is a surgical emergency
• Do not massage or apply heat to the scrotum — that does not help and may delay care
• While waiting for medical help, lie down and keep still to avoid extra movement
• Do not eat or drink anything, in case you need surgery soon

Medical treatments

The main treatment is emergency surgery called detorsion. During surgery, the testicle is untwisted and checked for blood flow. If it is healthy, it is stitched securely to the scrotum with a procedure called orchidopexy. The other testicle is usually also fixed at the same time to prevent future torsion. If the testicle is beyond saving, it may be removed — this is done to protect the remaining testicle and your overall health.

When is surgery considered?

Surgery is nearly always needed for testicular torsion. Sometimes the cord can be temporarily untwisted by hand before surgery, but surgical fixation is still required to stop it from happening again.

Living with this condition

After surgery, you will need a few days of rest. There may be some pain, swelling, or bruising, but this usually settles quickly. Most people can return to work or school within a week, and to sports or heavy lifting after two to four weeks depending on your surgeon's advice.

Lifestyle tips

• Take pain relief exactly as your doctor recommends — do not exceed the stated dose
• Wear supportive underwear or a jockstrap if it feels comfortable
• Avoid strenuous exercise, lifting, or cycling until your doctor says it is safe
• Keep the area clean and dry; follow your surgeon's wound care instructions

Diet and exercise

You can eat a normal diet once you feel well enough after surgery. Drink plenty of water and eat gentle, nutritious foods if you are constipated from painkillers. Light walking is encouraged, but avoid contact sports or heavy exertion for at least two weeks, or as long as your doctor advises.

Mental health and emotional wellbeing

It is completely normal to feel anxious, embarrassed, or upset after a testicular emergency. You may worry about fertility or how your body looks. Talking to a mental health professional, a counsellor, or a trusted friend can help. Most people with one healthy testicle have normal hormone levels and can father children.

Prevention

You cannot always prevent testicular torsion from happening in the first place. But you can reduce the risk of harm by knowing the symptoms and acting quickly. If you have had torsion before, surgery to fix both testicles greatly lowers the chance of it happening again.

Complications

If left untreated

• Permanent damage to the testicle due to lack of blood flow
• Loss of the testicle — it may need to be removed if it dies
• Possible effects on fertility, although this is less common with one healthy testicle
• Infection or scarring in the scrotum

Long-term outlook

With prompt treatment, most people recover fully and keep both testicles. Even if a testicle is lost, the other one usually takes over normal functions, and you can live an active, healthy, and fulfilling life. Early action makes all the difference.

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