Created at:1/16/2025
Testicular torsion is a serious medical emergency where the spermatic cord twists, cutting off blood flow to the testicle. This condition requires immediate medical attention to save the affected testicle and prevent permanent damage.
Think of it like a garden hose that gets twisted and kinked. When the spermatic cord twists, it blocks the blood supply that keeps the testicle healthy and functioning. Without quick treatment, the testicle can die from lack of oxygen and nutrients.
The main symptom is sudden, severe pain in one testicle that comes on quickly and doesn't go away. This pain is often described as the worst pain a person has ever felt, and it typically happens without any obvious injury or cause.
Here are the key symptoms to watch for:
The pain usually doesn't improve with rest or over-the-counter pain medications. Unlike other causes of testicular pain, lifting the testicle typically doesn't provide relief with torsion.
Testicular torsion happens when the spermatic cord spontaneously twists inside the scrotum. The exact reason why this twisting occurs isn't always clear, but several factors can make it more likely to happen.
Most cases occur due to a condition called "bell clapper deformity." In this case, the testicle isn't properly attached to the inside of the scrotum, allowing it to move freely and potentially twist. This anatomical variation is present from birth.
Other contributing factors include:
Interestingly, many cases of testicular torsion occur during sleep or rest, not during physical activity. This suggests that the twisting can happen spontaneously without any external trigger.
You should seek emergency medical care immediately if you experience sudden, severe testicular pain. Testicular torsion is a true medical emergency that requires surgery within hours to save the testicle.
Don't wait to see if the pain improves on its own. The sooner treatment begins, the better the chances of saving the testicle. Ideally, surgery should happen within 6 hours of symptom onset, though some testicles can be saved even after longer periods.
Go to the emergency room right away if you have:
Even if you're not completely sure it's torsion, it's better to be safe. Other serious conditions can cause similar symptoms, and all require prompt medical evaluation.
Testicular torsion can happen to anyone with testicles, but certain factors make it more likely to occur. Understanding these risk factors can help you stay alert to the possibility.
Age is the biggest risk factor, with two peak periods when torsion is most common:
Other risk factors include:
Having one or more risk factors doesn't mean you'll definitely develop torsion. Many people with risk factors never experience this condition, while others with no apparent risk factors do.
The most serious complication of testicular torsion is loss of the affected testicle if treatment is delayed. When blood flow is cut off for too long, the testicular tissue dies and cannot be saved.
Time is critical in preventing complications. Here's what can happen based on timing:
Other potential complications include:
The good news is that having one healthy testicle typically provides normal hormone production and fertility. Most men who lose one testicle to torsion can still father children naturally.
Doctors can often diagnose testicular torsion based on your symptoms and physical examination. The classic presentation of sudden, severe testicular pain in a young person strongly suggests torsion.
During the physical exam, your doctor will check for several key signs. The affected testicle may be positioned higher than normal, lie horizontally instead of vertically, and be extremely tender to touch. The cremasteric reflex (testicle pulling up when the inner thigh is stroked) is often absent on the affected side.
Sometimes additional tests are needed to confirm the diagnosis:
However, if torsion is strongly suspected based on symptoms and exam, doctors often proceed directly to surgery without waiting for test results. The urgency of saving the testicle takes priority over getting additional confirmation.
Emergency surgery is the primary treatment for testicular torsion. The procedure, called orchiopexy, involves untwisting the spermatic cord and securing both testicles to prevent future torsion.
During surgery, the urologist will make an incision in the scrotum and untwist the affected testicle. If the testicle appears healthy and viable, it will be stitched to the inside of the scrotum to prevent future twisting. The same procedure is usually done on the other testicle as a preventive measure.
The surgical process typically involves:
In rare cases, a doctor might attempt manual detorsion (untwisting by hand) in the emergency room, but this is not always successful. Surgery remains the definitive treatment to both fix the current problem and prevent recurrence.
Recovery from testicular torsion surgery is usually straightforward, but you'll need to follow your doctor's instructions carefully to heal properly and avoid complications.
For the first few days after surgery, rest is your top priority. You'll likely experience some pain, swelling, and bruising around the surgical site, which is completely normal and should gradually improve.
Here's what you can expect during recovery:
You should be able to return to light activities within a few days, but full recovery typically takes 2-4 weeks. Your doctor will schedule follow-up appointments to monitor your healing and ensure everything is progressing normally.
If you're experiencing testicular pain, this is likely an emergency situation that requires immediate medical attention rather than a scheduled appointment. Head straight to the emergency room or call 911.
However, if you're recovering from torsion or have concerns about testicular health, here's how to prepare for a follow-up visit. Write down your symptoms, including when they started, how severe they are, and what makes them better or worse.
Bring important information with you:
Don't be embarrassed to discuss testicular symptoms with your healthcare provider. They're medical professionals who deal with these issues regularly and want to help you get the best possible care.
Testicular torsion is a medical emergency that requires immediate surgery to save the affected testicle. The key is recognizing the symptoms early and seeking emergency care without delay.
Remember that sudden, severe testicular pain should never be ignored or treated with a "wait and see" approach. Even if you're not sure it's torsion, it's always better to seek medical evaluation promptly. Quick action can mean the difference between saving and losing a testicle.
The good news is that with prompt treatment, most cases of testicular torsion have excellent outcomes. The surgery prevents future episodes and allows you to return to normal activities. Even if one testicle is lost, the remaining testicle can provide normal hormone function and fertility for most men.
Q1:Can testicular torsion happen more than once?
Yes, testicular torsion can recur if the testicle isn't properly secured during the initial surgery. However, the standard surgical treatment (orchiopexy) involves stitching both testicles in place to prevent future torsion. When done properly, this procedure is highly effective at preventing recurrence.
Q2:Can you prevent testicular torsion from happening?
There's no guaranteed way to prevent testicular torsion since it often occurs spontaneously. However, if you have risk factors like bell clapper deformity or previous episodes of testicular pain, your doctor might recommend preventive surgery (elective orchiopexy) to secure the testicles and reduce your risk.
Q3:Will I still be able to have children after testicular torsion?
Most men can still father children normally after testicular torsion, even if one testicle is lost. A single healthy testicle produces enough sperm and hormones for normal fertility. If you're concerned about fertility, your doctor can discuss options like sperm banking before surgery in certain situations.
Q4:How long does testicular torsion surgery take?
Testicular torsion surgery typically takes 30-60 minutes, depending on the complexity of the case. The procedure is usually done under general anesthesia as an emergency surgery. You'll likely go home the same day or after an overnight observation period.
Q5:What's the difference between testicular torsion and epididymitis?
Both conditions cause testicular pain, but they have different causes and treatments. Testicular torsion involves twisting of the spermatic cord and requires emergency surgery. Epididymitis is inflammation of the epididymis (usually due to infection) and is treated with antibiotics. Torsion typically causes more severe, sudden pain, while epididymitis often develops more gradually and may improve when you lift the testicle.