What is Testicular Torsion? Symptoms, Causes, & Treatment

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.

What are the symptoms of testicular torsion?

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:

• Sudden, intense pain in one testicle that may radiate to the lower abdomen
• Swelling and tenderness in the scrotum
• Nausea and vomiting from the severe pain
• The affected testicle may appear higher than normal or positioned at an unusual angle
• Redness or darkening of the scrotal skin
• Frequent urination or burning during urination
• Fever in some cases

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.

What causes testicular 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:

• Rapid growth during puberty that affects testicular positioning
• Physical activity or trauma, though many cases happen during sleep
• Cold weather exposure that causes the cremaster muscle to contract strongly
• Previous episodes of testicular pain that resolved on their own
• Family history of testicular torsion

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.

When to see a doctor for testicular torsion?

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:

• Sudden onset of severe testicular pain
• Testicular pain accompanied by nausea and vomiting
• A testicle that appears swollen, red, or positioned abnormally
• Severe pain that doesn't improve with rest or pain medication

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.

What are the risk factors for testicular torsion?

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:

• Newborns (within the first few days or weeks of life)
• Adolescents (ages 12-18 years)
• Young adults (early 20s)

Other risk factors include:

• Bell clapper deformity (improper testicular attachment)
• Previous episodes of testicular pain that resolved spontaneously
• Family history of testicular torsion
• Undescended testicle or history of undescended testicle
• Large testicles or rapid testicular growth during puberty

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.

What are the possible complications of testicular torsion?

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:

• Within 6 hours: Very high chance (over 90%) of saving the testicle
• 6-12 hours: Good chance (around 70-80%) of testicular survival
• 12-24 hours: Lower chance (around 20-50%) of saving the testicle
• Over 24 hours: Very low chance of testicular survival

Other potential complications include:

• Infection of the testicle or surrounding tissue
• Reduced fertility if the testicle is lost or severely damaged
• Chronic pain in the scrotum
• Cosmetic changes to the scrotum
• Psychological impact from losing a testicle

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.

How is testicular torsion diagnosed?

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:

• Doppler ultrasound to check blood flow to the testicle
• Urine tests to rule out infection
• Blood tests to check for signs of infection or inflammation

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.

What is the treatment for testicular torsion?

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:

1. Emergency surgery under general anesthesia
2. Untwisting the spermatic cord to restore blood flow
3. Assessing whether the testicle is still viable
4. Securing both testicles to prevent future torsion (orchiopexy)
5. Removing the testicle if it's no longer viable (orchiectomy)

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.

How to take care of yourself after testicular torsion treatment?

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:

• Take prescribed pain medications as directed
• Apply ice packs to reduce swelling (20 minutes on, 20 minutes off)
• Wear supportive underwear or a scrotal support garment
• Keep the incision area clean and dry
• Avoid heavy lifting and strenuous activity for 2-4 weeks
• Take time off work or school as recommended by your doctor

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.

How should you prepare for your doctor appointment?

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:

• List of current medications and supplements
• Details about your symptoms and timeline
• Questions about recovery, activity restrictions, or long-term effects
• Information about any family history of testicular problems
• Insurance cards and identification

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.

What's the key takeaway about testicular torsion?

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.