Testicular Torsion Symptoms, Causes & More

By shirley

Reviewed: dr. stavarache

Article Sources

1. 'NCI Dictionary of Cancer Terms.' National Cancer Institute, www.cancer.gov/publications/dictionaries/cancer-terms/def/testis
2. 'What Should My Testicles Look and Feel Like?' NHS Choices, NHS, www.nhs.uk/common-health-questions/mens-health/what-should-my-testicles-look-and-feel-like/
3. Jha, Praveen. 'Spermatic Cord: Radiology Reference Article.' Radiopaedia Blog RSS, radiopaedia.org/articles/spermatic-cord?lang=us
4. 'Testicular Torsion.' Mount Sinai Health System, www.mountsinai.org/health-library/diseases-conditions/testicular-torsion
5. 'Testicular Torsion.' Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Apr. 2020, www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270
6. Staff, Familydoctor.org Editorial. 'Testicular Torsion.'Familydoctor.org, 25 July 2019, familydoctor.org/condition/testicular-torsion/
7. Testicular Torsion By Patrick J. Shenot, et al. 'Testicular Torsion - Genitourinary Disorders.' Merck Manuals Professional Edition, Merck Manuals, www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/testicular-torsion
8. Publishing, Harvard Health. 'Testicular Torsion.' Harvard Health, www.health.harvard.edu/a/to/z/testicular-torsion-a-to-z
9. 'Testicular Torsion.' UCSF Department of Urology, urology.ucsf.edu/patient-care/children/testicular-torsion
10. 'Testicular Torsion.' Testicular Torsion: Symptoms, Diagnosis & Treatment - Urology Care Foundation, www.urologyhealth.org/urologic-conditions/testicular-torsion
11. 'Testicular Torsion.' Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Apr. 2020, www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274

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The testicles are two ovular glands housed within a male's scrotum. They're suspended from the abdominal wall by the spermatic cord, which also supplies blood to the testicles. These glands that produce sperm and male hormones are usually similar in size, although it's not unusual for one testicle to be a bit larger than the other.¹‘NCI Dictionary of Cancer Terms.’ National Cancer Institute, www.cancer.gov/publications/dictionaries/cancer-terms/def/testis^,²‘What Should My Testicles Look and Feel Like?’ NHS Choices, NHS, www.nhs.uk/common-health-questions/mens-health/what-should-my-testicles-look-and-feel-like/^,³Jha, Praveen. ‘Spermatic Cord: Radiology Reference Article.’ Radiopaedia Blog RSS, radiopaedia.org/articles/spermatic-cord?lang=us

Sometimes one of the testicles twists on the spermatic cord, restricting blood flow and causing severe pain. This is called testicular torsion. Immediate medical attention is necessary when this occurs to prevent irreparable damage to the testicle.⁴‘Testicular Torsion.’ Mount Sinai Health System, www.mountsinai.org/health-library/diseases-conditions/testicular-torsion

Symptoms of Testicular Torsion

Sudden, severe pain in the testicles or scrotum is a common symptom of testicular torsion, but abdominal pain, nausea and vomiting may be present as well. The scrotum may appear to be swollen. One testicle may seem to be in a higher position or tilted at a different angle than usual.

In addition, males with this condition may urinate more frequently, experience a fever or dizziness and see blood in their semen.⁵‘Testicular Torsion.’ Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Apr. 2020, www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270^,⁶Staff, Familydoctor.org Editorial. ‘Testicular Torsion.’Familydoctor.org, 25 July 2019, familydoctor.org/condition/testicular-torsion/ Occasionally the torsion may resolve temporarily, only to recur and present with the same severe symptoms.⁷Testicular Torsion By Patrick J. Shenot, et al. ‘Testicular Torsion - Genitourinary Disorders.’ Merck Manuals Professional Edition, Merck Manuals, www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/testicular-torsion

Causes of Testicular Torsion

Some males are born with an anatomical anomaly in which the testicles aren't correctly attached. This may allow the testicles to twist out of place spontaneously.⁷Testicular Torsion By Patrick J. Shenot, et al. ‘Testicular Torsion - Genitourinary Disorders.’ Merck Manuals Professional Edition, Merck Manuals, www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/testicular-torsion

An injury to the scrotum that results in swelling may cause testicular torsion.⁴‘Testicular Torsion.’ Mount Sinai Health System, www.mountsinai.org/health-library/diseases-conditions/testicular-torsion The condition may also develop a few hours after a person engages in strenuous activity. Sometimes, testicular torsion takes place while the person is sleeping. Some research indicates cold temperatures and rapid testicle growth during puberty may play a role in testicular torsion.⁵‘Testicular Torsion.’ Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Apr. 2020, www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270

Testicular Torsion

Who Gets Testicular Torsion?

Testicular torsion may affect males of all ages, but it commonly occurs in newborn baby boys and boys between 12 and 18 years old.⁹‘Testicular Torsion.’ UCSF Department of Urology, urology.ucsf.edu/patient-care/children/testicular-torsion Approximately one in 4,000 males under age 25 experience testicular torsion.¹⁰‘Testicular Torsion.’ Testicular Torsion: Symptoms, Diagnosis & Treatment - Urology Care Foundation, www.urologyhealth.org/urologic-conditions/testicular-torsion

The condition seems to run in families, so there may be a hereditary component involved in testicular torsion. A person who has had testicular torsion that resolved on its own is more likely to have additional incidents of the condition.⁵‘Testicular Torsion.’ Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Apr. 2020, www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270

How Is Testicular Torsion Diagnosed?

To diagnose testicular torsion, a doctor asks about the symptoms and conducts a physical examination, noting any tenderness and swelling. They may pinch the inside of the person's thigh to see if the testicles contract. Failure of a testicle to contract may help confirm a diagnosis of testicular torsion.

The doctor may order an ultrasound examination of the scrotum to check blood flow. Decreased blood flow to the testicle is a common sign of testicular torsion.¹¹‘Testicular Torsion.’ Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Apr. 2020, www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274

Testicular Torsion

Treatment for Testicular Torsion

The physician may try to untwist the testicle manually, a procedure called detorsion. Testicles usually rotate inward, so the doctor tries to turn the affected testicle in the opposite direction. If the patient experiences pain relief, the detorsion is deemed to be successful.

If detorsion isn't successful, immediate surgery is necessary. Damage to the testicle may be prevented if the torsion is resolved within six to eight hours of the onset of symptoms.⁷Testicular Torsion By Patrick J. Shenot, et al. ‘Testicular Torsion - Genitourinary Disorders.’ Merck Manuals Professional Edition, Merck Manuals, www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/testicular-torsion

Complications of Testicular Torsion

If the blood supply is restricted for too long a time, the testicle may shrink and require removal. This shrinkage may take months to show. The interrupted flow of blood may also cause serious infection of the scrotum and testicle. In some cases, damage or loss of a testicle affects a man's ability to father children.⁴‘Testicular Torsion.’ Mount Sinai Health System, www.mountsinai.org/health-library/diseases-conditions/testicular-torsion

With immediate intervention, the testicle usually makes a full, complete recovery. In this scenario, fertility is unlikely to be impaired and sexual function is probably not impacted.⁸Publishing, Harvard Health. ‘Testicular Torsion.’ Harvard Health, www.health.harvard.edu/a/to/z/testicular-torsion-a-to-z

Testicular Torsion

Prosthesis

If a testicle is surgically removed following testicular torsion, some people opt to have a testicular prosthesis placed. The prosthesis may be made of silicone and filled with saline solution, and it may provide a more natural appearance.

Placing a testicular prosthesis involves a separate surgical procedure several months after surgery for testicular torsion. Since a young boy requires a smaller prosthesis, it's best to have a testicular prosthesis placed following puberty to avoid multiple surgeries.⁹‘Testicular Torsion.’ UCSF Department of Urology, urology.ucsf.edu/patient-care/children/testicular-torsion

Testicular Torsion in Infants

While the incidence is rare, testicular torsion may occur in newborns. The reason for this is unclear, but it may be related to difficult deliveries.⁹‘Testicular Torsion.’ UCSF Department of Urology, urology.ucsf.edu/patient-care/children/testicular-torsion

In infants, testicular torsion may present as a testicle that's hard, swollen and a dark color. Ultrasound doesn't always detect decreased blood flow to the testicle. Although surgery can be performed, it's often too late to save the baby's testicle. There are also risks involved in using general anesthesia on a newborn.¹¹‘Testicular Torsion.’ Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Apr. 2020, www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274

Testicular Torsion

Preventing Testicular Torsion

In most cases, testicular torsion can't be prevented, but men and boys should take steps to prevent injury to the scrotum.⁴‘Testicular Torsion.’ Mount Sinai Health System, www.mountsinai.org/health-library/diseases-conditions/testicular-torsion

If testicular torsion surgery takes place early enough, and the testicle doesn't require removal, the surgeon usually stitches the testicle to the wall of the scrotum to prevent further twisting incidents. They are likely to secure the unaffected testicle to the scrotal wall as well during the same procedure.⁸Publishing, Harvard Health. ‘Testicular Torsion.’ Harvard Health, www.health.harvard.edu/a/to/z/testicular-torsion-a-to-z

Life After Testicular Torsion

Early treatment for testicular torsion often saves the testicle and preserves fertility. If the testicle needs to be removed, the person may have a lower sperm count but still be able to father children. Testosterone levels in the blood may decrease at an early age.

Men who have had a testicle removed should guard the remaining testicle by using protective devices while playing sports. If they're self-conscious about their appearance, they may consider implantation of a prosthesis.⁹‘Testicular Torsion.’ UCSF Department of Urology, urology.ucsf.edu/patient-care/children/testicular-torsion^,¹⁰‘Testicular Torsion.’ Testicular Torsion: Symptoms, Diagnosis & Treatment - Urology Care Foundation, www.urologyhealth.org/urologic-conditions/testicular-torsion