Overview

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Testicular torsion is most common between ages 12 and 16, but it can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.

Symptoms

Signs and symptoms of testicular torsion include:

  • Sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
  • Swelling of the scrotum
  • Abdominal pain
  • Nausea and vomiting
  • A testicle that's positioned higher than normal or at an unusual angle
  • Painful urination
  • Fever

Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or in the morning.

When to see a doctor

Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion.

You also need to seek prompt medical help if you've had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again.

Causes

Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

It's not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion.

Testicular torsion often occurs several hours after vigorous activity, a minor injury to the testicles or sleep.  Cold temperature or rapid growth of the testicle during puberty also might play a role.

Risk factors

  • Age. Testicular torsion is most common between ages 12 and 16.
  • Previous testicular torsion. If you've had testicular pain that went away without treatment (intermittent torsion and detorsion), it's likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
  • Family history of testicular torsion. The condition can run in families.

Complications

Testicular torsion can cause the following complications:

  • Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed.
  • Inability to father children. In some cases, damage or loss of a testicle affects a man's ability to father children.

Prevention

Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.

Feb. 04, 2016
References
  1. Wein AJ, et al. Abnormalities of the testis and scrotum and their surgical management. In: Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Feb. 13, 2015.
  2. Somani BK, et al. Testicular torsion. BMJ. 2010;341:c3213.
  3. Cubillos J, et al. Familial testicular torsion. Journal of Urology. 2011;185:2469.
  4. Hittelman AB. Neonatal testicular torsion. http://www.uptodate.com/home. Accessed Feb. 16, 2015.
  5. Snyder HM, et al. In utero/neonatal torsion: Observation versus prompt exploration. Journal of Urology. 2010;183:1675.
  6. Roth CC, et al. Salvage of bilateral asynchronous perinatal testicular torsion. Journal of Urology. 2011;185:2464.
  7. Eyre RC. Evaluation of the acute scrotum in adults. http://www.uptodate.com/home. Accessed Feb. 16, 2015.