Ovarian Torsion

Ovarian Torsion is a condition in which an ovary, and sometimes the fallopian tube, twists around the tissues that support it, which can reduce blood flow and cause sudden pelvic pain. It is a time-sensitive gynecological condition that needs prompt medical assessment, usually by a gynecologist.

Overview

Ovarian Torsion is the twisting of an ovary around the ligaments and blood vessels that support it. In some cases, the fallopian tube twists as well; this is called adnexal torsion. The twist can reduce or block blood flow to the ovary, causing pain and making prompt medical care important.

This condition can happen at any age, including in children, adolescents, reproductive-age adults, and during pregnancy. It is more likely when the ovary is enlarged, often because of an ovarian cyst or benign mass. However, torsion can also occur in an ovary that appears otherwise normal, especially in younger patients.

Ovarian Torsion is considered a time-sensitive gynecological emergency. This does not mean that every case leads to permanent damage, but it does mean that sudden pelvic pain should be assessed quickly. With timely diagnosis and appropriate surgical care, many ovaries can be untwisted and preserved.

Symptoms

The most typical symptom of Ovarian Torsion is sudden pain on one side of the lower abdomen or pelvis. The pain may be sharp, cramping, or severe, and it may come and go if the ovary twists and partially untwists. Some people describe pain that starts suddenly during normal activity, exercise, or even at rest.

Nausea and vomiting are common because the twisting can strongly irritate pelvic nerves and the abdominal lining. Pain may spread to the back, side, groin, or thigh. Some patients also notice bloating, tenderness when pressing the lower abdomen, or pain that worsens with movement.

Symptoms can sometimes be less typical, especially in children, pregnancy, or when the torsion is intermittent. Fever is not a classic early sign, but it may occur if tissue irritation or another condition is present. Vaginal bleeding is not the main feature of torsion, so its presence may prompt doctors to consider other causes of pelvic pain as well.

• Sudden one-sided pelvic or lower abdominal pain
• Pain that may be constant or intermittent
• Nausea or vomiting
• Lower abdominal tenderness
• Pain radiating to the back, groin, or thigh
• Dizziness or feeling unwell in some cases

Causes & Risk Factors

Ovarian Torsion occurs when the ovary rotates on its supporting tissues. The most common reason is an enlarged ovary, because extra size and weight can make the ovary more mobile. Functional ovarian cysts, benign ovarian tumors, and enlarged follicles related to fertility treatment can all increase this risk.

Pregnancy can also be associated with torsion, particularly in early pregnancy when the corpus luteum cyst may enlarge the ovary. People with polycystic ovaries may have enlarged ovaries, which can contribute to mobility. A long ovarian ligament or increased ovarian movement may also play a role, especially in adolescents and children.

Most ovarian masses linked with torsion are benign, particularly in younger patients, but doctors still evaluate any cyst or mass carefully. A history of previous torsion can increase the risk of recurrence. Torsion is not caused by poor hygiene, sexual activity, or stress; it is a mechanical twisting event related to anatomy and ovarian size or movement.

• Ovarian cysts or benign ovarian masses
• Enlarged ovaries after ovulation induction or fertility treatment
• Pregnancy, especially early pregnancy
• Polycystic ovaries or ovarian enlargement
• Previous Ovarian Torsion
• Greater ovarian mobility, sometimes seen in younger patients

Diagnosis

Diagnosis begins with a careful medical history and pelvic or abdominal examination. The doctor asks about the timing, location, and pattern of pain, as well as nausea, vomiting, menstrual history, pregnancy possibility, fertility treatment, previous ovarian cysts, and prior pelvic surgery. Because several conditions can mimic Ovarian Torsion, the assessment is designed to identify the most likely and most urgent cause.

Pelvic ultrasound is the most commonly used imaging test. It can show ovarian size, cysts or masses, swelling, and fluid in the pelvis. Doppler ultrasound may assess blood flow, but normal blood flow does not always exclude torsion because the ovary has more than one blood supply and the twisting may be intermittent.

Blood and urine tests may be performed to check for pregnancy, infection, anemia, inflammation, or urinary conditions. In some cases, additional imaging such as CT or MRI may be used when the diagnosis is uncertain or when other abdominal conditions need consideration. However, the only definitive way to confirm torsion is usually surgery, most often laparoscopy.

Doctors consider Ovarian Torsion alongside other causes of sudden pelvic pain, such as ectopic pregnancy, appendicitis, ruptured ovarian cyst, pelvic inflammatory disease, kidney stone, endometriosis flare, or bowel conditions. Because imaging is not perfect, a gynecologist may recommend surgical evaluation when symptoms and examination strongly suggest torsion.

Treatment Options

Treatment for Ovarian Torsion is chosen by a specialist after assessment of symptoms, examination findings, imaging, age, pregnancy status, fertility goals, and the appearance of the ovary. Because torsion involves reduced blood flow, surgery is commonly needed. The goal is to untwist the ovary, restore circulation when possible, and address the cause of the twisting.

Minimally invasive laparoscopy is often used. Through small abdominal incisions, the surgeon can look directly at the ovary and fallopian tube, gently untwist them, and evaluate tissue health. If a cyst is present, the surgeon may remove the cyst while preserving healthy ovarian tissue when appropriate. In selected patients with recurrent torsion, a procedure to help secure the ovary, called oophoropexy, may be considered.

In many cases, an ovary that looks dark or swollen during surgery may recover after detorsion, so specialists often try to preserve it when safe. Removal of the ovary or fallopian tube may be necessary if tissue is clearly nonviable, if there is severe damage, uncontrolled bleeding, or if there is concern about a suspicious mass. The final approach depends on intraoperative findings and the patient’s overall situation.

Supportive care may include pain relief, fluids, treatment of nausea, and monitoring before and after surgery. If pregnancy is present, care is coordinated to consider both maternal health and pregnancy safety. Patients should not try to manage suspected torsion at home, because delay can reduce the chance of ovarian preservation.

Living With / Prognosis

Many patients recover well after prompt treatment for Ovarian Torsion, especially when the ovary can be untwisted and preserved. Recovery time depends on the type of surgery, whether a cyst was removed, the patient’s general health, and whether complications were present. The care team usually gives guidance on wound care, activity, pain control, and follow-up appointments.

Fertility is an understandable concern. If one ovary is preserved and functions normally, fertility may not be affected. Even if one ovary must be removed, many people can still ovulate and become pregnant with the remaining ovary, depending on age and other reproductive factors. A gynecologist or fertility specialist can provide individualized counseling.

Follow-up is important when an ovarian cyst or mass was found, when the patient is undergoing fertility treatment, or when symptoms recur. Doctors may recommend repeat imaging to monitor healing or to check that a cyst has resolved. Patients should report any return of sudden one-sided pelvic pain promptly, because recurrent torsion is possible, although not inevitable.

Acibadem International’s multidisciplinary gynecology, reproductive medicine, radiology, and surgical teams in JCI-accredited hospitals diagnose and treat Ovarian Torsion for international patients, with care plans based on specialist assessment and individual needs.

When to See a Doctor

Anyone with sudden, severe, or one-sided pelvic pain should seek urgent medical care, especially if the pain is accompanied by nausea, vomiting, dizziness, faintness, fever, or pregnancy. Ovarian Torsion can resemble other urgent abdominal and gynecological conditions, so assessment by a qualified doctor is the safest approach.

Medical attention is also important for pelvic pain in children and adolescents, because they may have difficulty describing symptoms and torsion can occur even without a known cyst. Patients who are pregnant, using fertility medications, or known to have ovarian cysts should be particularly cautious about new sudden pelvic pain.

Emergency evaluation does not always mean surgery will be required, but it allows doctors to perform the right tests quickly and decide the safest next step. If pain improves after a short time, medical advice is still recommended, because intermittent torsion can temporarily untwist and then recur.

Frequently asked questions

What is Ovarian Torsion?

Ovarian Torsion is the twisting of an ovary around the tissues and blood vessels that support it. This can reduce blood flow and cause sudden pelvic pain, often with nausea or vomiting. It is a time-sensitive condition that should be assessed urgently by a doctor.

What does Ovarian Torsion pain feel like?

The pain is usually sudden and felt on one side of the lower abdomen or pelvis. It may be sharp, severe, cramp-like, or intermittent if the ovary twists and untwists. Nausea and vomiting are common accompanying symptoms.

Can ultrasound rule out Ovarian Torsion?

Ultrasound is very helpful because it can show an enlarged ovary, cysts, swelling, or abnormal blood-flow patterns. However, normal Doppler blood flow does not always rule out torsion. If symptoms strongly suggest torsion, a gynecologist may still recommend surgical evaluation.

Is Ovarian Torsion always treated with surgery?

Surgery is commonly needed because the ovary must often be untwisted directly and blood flow restored. Laparoscopy is frequently used, and surgeons try to preserve the ovary when it is safe to do so. The exact approach is decided by a specialist after clinical assessment.

Can Ovarian Torsion affect fertility?

Fertility depends on whether the ovary is preserved, the health of the other ovary, age, and any underlying reproductive conditions. Many patients retain normal ovarian function after timely treatment. Even when one ovary is removed, pregnancy may still be possible with the remaining ovary.

Who is at higher risk of Ovarian Torsion?

Risk is higher when the ovary is enlarged, often due to an ovarian cyst, benign mass, polycystic ovaries, pregnancy, or fertility treatment. A previous torsion can also increase recurrence risk. Torsion can still occur without a known risk factor, including in younger patients.

When should someone go to the emergency department for pelvic pain?

Urgent care is recommended for sudden, severe, or one-sided pelvic pain, especially with vomiting, dizziness, pregnancy, fever, or a known ovarian cyst. These symptoms may be caused by Ovarian Torsion or another urgent condition. Prompt assessment helps doctors protect health and choose the safest treatment.

References

• American College of Obstetricians and Gynecologists
• Royal College of Obstetricians and Gynaecologists
• European Society of Human Reproduction and Embryology
• Merck Manual Professional Edition
• Society of Obstetricians and Gynaecologists of Canada

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.