About Testicular Torsion

For some males, a serious discussion about their private parts can be a little embarrassing. If you are a male, however, it is important that you know to tell a parent or a health care provider if you ever experience genital pain, especially in the scrotum or testes.

Genital pain is usually nothing more than a mild and fleeting discomfort. When it is more painful, however, it can be caused by a critical condition called testicular torsion. Testicular torsion is a medical emergency that usually requires immediate surgery in order to save the testicle.

Testicular torsion, or testis torsion, occurs when the spermatic cord that provides blood flow to the testicle rotates and becomes twisted, usually due to an injury or medical condition. This cuts off the testicle’s blood supply and causes sudden and severe pain and swelling.

Treatment for testicular torsion requires immediate surgery. Call an ambulance immediately if you feel this has happened to you. If it goes on too long, the testis can be permanently damaged and the male may risk losing the affected testicle. This problem can happen to males of any age, including newborns and infants, but is most common in 10- to 25-year-olds and teens who have recently gone through puberty, because the testicles have descended and are more likely to twist.

Causes

The scrotum is the sack of skin beneath the penis. Inside the scrotum are two testes, or testicles. Each testicle is connected to the rest of the male reproductive system by a blood vessel called the spermatic cord.

Most cases of testicular torsion occur in males who have a genetic condition called the bell clapper deformity.¹ Normally, the testicles are attached to the scrotum, but with this condition the testicles are not attached, and therefore are more likely to turn and twist within the scrotum. Testicular torsion also can occur after strenuous exercise, while someone is sleeping, or after an injury to the scrotum. More often than not, the cause is unknown.

Symptoms

If you experience sudden groin pain, call a doctor and get to a hospital as soon as you can. Testicular torsion is considered a surgical emergency, meaning that when it happens, immediate surgery is needed to save the testicle. Because surgery may be necessary, it is important to not eat or drink before seeking medical care.¹

If you have testicular torsion, you will feel a sudden, possibly severe pain in the scrotum and one or both of the testicles. The pain can get worse or subside a bit, but generally will not go away completely.

Other symptoms of testicular torsion:

• swelling, especially on one side of the scrotum
• nausea and vomiting
• abdominal pain
• one testicle appears to be higher than the other

Sometimes, the spermatic cord can become twisted and then untwist itself without treatment. This is called torsion and de-torsion, and it can make testicular torsion more likely to occur in the future.¹

If the spermatic cord untwists and the pain goes away, it might be easy to dismiss and trivialize the episode; however, you should still call a doctor. Surgery can be performed to secure the testicles and make testicular torsion unlikely to occur in the future.

Diagnosis

When you arrive at the hospital or doctor’s office, a doctor will examine your scrotum, testicles, abdomen, and groin and might test his reflexes by rubbing or pinching the inside of your thigh.² This normally causes the testicle to contract, which probably will not happen if you have a testicular torsion.

The doctor also might perform tests to determine if the spermatic cord is twisted, including:

• Doppler ultrasound. High-frequency waves are used to make an image of the testicle and check blood flow.
• Urine tests or blood tests. These can help determine whether symptoms are being caused by an infection instead of torsion.²

Sometimes, it will be necessary for the doctor to perform surgery to make a diagnosis of testicular torsion. When the physical exam clearly points to a torsion, the doctor will perform emergency surgery without any other testing in order to save the testicle.

Saving a testicle becomes more difficult the longer the spermatic cord stays twisted. The degree of twisting (whether it is one entire revolution or several) determines how quickly the testicle will become damaged. As a general rule, after 6 hours, the testicle can be saved 90% of the time; after 12 hours, the success rates drop to 50%; after 24 hours, the testicle can be saved only 10% of the time.¹

Treatment

Testicular torsion almost always requires surgery to fix. In rare cases, the doctor may be able to untwist the spermatic cord by physically manipulating the scrotum, but surgery will generally still be needed to attach one or both testicles to the scrotum to prevent torsion from happening again.²

Usually, surgery for a testicular torsion is performed on an outpatient basis. If you have a torsion, you will be given a painkiller and a general anesthetic that will make you unconscious for the procedure. Surgery consists of making a small cut in the scrotum, untwisting the spermatic cord and stitching the testicles to the inside of the scrotum to prevent future torsions. When that is finished, the doctor will stitch up the scrotum, and you can go home after a few hours.¹

Following the surgery, you should avoid strenuous activities for a few weeks, and if you are sexually active, you will need to avoid all sexual activity, too. Talk to the doctor about when it will be safe for you to resume normal activities.¹

If a testicular torsion goes on too long, doctors may not be able to save the affected testicle, and it will have to be removed surgically (a procedure known as an orchiectomy).² Most males who have one testicle removed but still have one viable testicle can father children later in life. However, many males also opt for a prosthetic, or artificial testicle a few months after surgery. This can help make some males feel more comfortable about their appearance.

With newborn boys, saving the testicle is dependent upon when the torsion occurs. If it takes place before the male child is born, it may be impossible to save the testicle. In this case, the doctor may recommend a surgery at a later date to remove the affected testicle. If the symptoms of torsion appear after a boy is born, the doctor may recommend emergency surgery to correct the testicle.

Don’t Ignore Symptoms

Males need to know that genital pain is serious and should not be ignored. Ignoring pain for too long or simply hoping it goes away can result in severe damage to the testicle and even its removal.

Remember that a torsion that goes away makes a male more likely to have another one in the future.² Doctors can greatly reduce the risk of another torsion by performing a simple surgical procedure that secures the testicles to the scrotum.

If you had a torsion that resulted in the loss of a testicle, it is important to know that you can still lead a normal, fulfilling and happy life, just like anyone else. The loss of one testicle typically will not prevent a male from having normal sexual relations or fathering children.

Resources

1. http://emedicine.medscape.com/article/778086-overview
2. http://www.patient.co.uk/doctor/torsion-of-the-testis-pro

Last Updated 09 January 2014.