Testicular Torsion

Overview

Testicular torsion is a medical emergency that happens when a testicle twists around the spermatic cord. The spermatic cord contains blood vessels that supply the testicle. When it twists, blood flow can be reduced or blocked, which can quickly damage the testicular tissue.

This condition most often affects teenagers and young adults, but it can occur at any age, including in newborns and older men. Testicular torsion usually affects one testicle. It can happen suddenly, often without any clear warning.

Because the testicle depends on continuous blood flow, urgent medical care is essential. Rapid assessment and treatment can help protect testicular function and reduce the risk of complications. Any sudden or severe testicular pain should be treated as an emergency until a doctor confirms the cause.

Symptoms

The main symptom of testicular torsion is sudden pain in one testicle. The pain may be severe and may start during rest, sleep, sports or normal daily activity.

• Sudden, intense pain in one testicle
• Swelling of the scrotum
• A testicle that appears higher than usual or sits at an unusual angle
• Lower abdominal or groin pain
• Nausea or vomiting
• Redness or tenderness of the scrotal skin
• Discomfort that does not improve or comes and goes

In some cases, pain may briefly improve if the testicle twists and untwists on its own. This can still be serious, because torsion may return and cause a complete blockage of blood flow.

Causes and Risk Factors

Testicular torsion is usually related to how the testicle is positioned inside the scrotum. In some people, the testicle has more freedom to move and rotate than usual. This can allow the spermatic cord to twist.

Risk factors may include:

• Age, especially adolescence and young adulthood
• A personal history of short episodes of testicular pain that resolved on their own
• A family history of testicular torsion
• Previous torsion in the other testicle
• Recent injury to the scrotum, although torsion can occur without trauma
• Rapid growth during puberty

Testicular torsion is not caused by infection and is not a sexually transmitted condition. However, other conditions, such as infection or inflammation, can cause similar symptoms. This is why urgent medical evaluation is important.

Diagnosis

Diagnosis begins with a medical history and physical examination. The doctor will ask about the timing and nature of the pain, whether there has been nausea or vomiting, previous similar episodes, injury and any urinary symptoms.

During the examination, the doctor may assess the position of the testicle, tenderness, swelling and reflexes. Because testicular torsion is time-sensitive, doctors may decide to treat urgently based on the examination and symptoms.

Tests may include:

• Scrotal ultrasound to evaluate blood flow to the testicle
• Urine tests to look for signs of infection or other urinary problems
• Blood tests in selected cases, depending on the overall situation

Imaging can be helpful, but treatment should not be delayed if torsion is strongly suspected. The priority is to restore blood flow as quickly as possible.

Treatment Options

Testicular torsion is typically treated with urgent surgery. The aim is to untwist the spermatic cord, restore blood flow and secure the testicle in place to reduce the risk of twisting again. The other testicle is often secured during the same operation because the same anatomical tendency may be present on both sides.

If the testicle has been without blood flow for too long and the tissue is no longer healthy, removal of the affected testicle may be necessary. The doctor will make this decision during surgery based on the condition of the tissue.

In rare situations, a doctor may attempt to manually untwist the testicle as an emergency measure, but this does not replace surgical treatment. Surgery is still usually needed to secure the testicle and prevent recurrence.

After treatment, follow-up care is important. The healthcare team may discuss wound care, activity restrictions, fertility considerations, hormonal function and emotional concerns. Many people continue to have normal hormonal function with one healthy testicle, but individual outcomes depend on the specific case.

When to See a Doctor

Seek emergency medical care immediately for sudden testicular pain, especially if it is severe, associated with swelling, nausea, vomiting or a testicle that appears higher or differently positioned than usual.

Do not wait to see if the pain goes away. Even if symptoms improve, urgent evaluation is still needed because the testicle may twist again. Delays can increase the risk of permanent damage.

Also see a doctor promptly for any scrotal swelling, persistent discomfort, pain after injury, fever with testicular pain, or urinary symptoms such as burning or difficulty urinating. These symptoms may be caused by other conditions, but they still require medical assessment.

For international patients, if testicular torsion is suspected while traveling or living abroad, go to the nearest emergency department without delay. Early medical attention is the most important step in protecting testicular health.