Darren woke up with intense pain in his scrotum one night. It felt swollen on the left side. He was a little embarrassed, so he didn't wake his parents up at first. When the pain didn't go away after an hour, though, Darren woke his father and they called a doctor.

The doctor listened to Darren's description of his symptoms, then told him that he probably had a condition called testicular torsion and needed to get to the emergency room right away. Darren's parents took him to the hospital, and he was rushed into an operating room.

What Is Testicular Torsion?

Testicular torsion, or testis torsion, is an emergency condition. It happens when the spermatic cord, which provides blood flow to the testicle, rotates and becomes twisted. The twisting cuts off the testicle's blood supply and causes sudden pain and swelling.

Testicular torsion requires immediate surgery to save the testicle. If testicular torsion goes on for more than a few hours, it can permanently damage the testicle, and a damaged testicle must be removed. Testicular torsion can happen to boys and men of any age, but is most common in 10- to 25-year-olds.

The amount of twisting can be anywhere from 180-720 degrees. The degree of twisting affects how quickly a testicle gets damaged. As a general rule, after 6 hours, the testicle can be saved 90% of the time; after 12 hours, this drops to 50%; after 24 hours, the testicle can be saved only 10% of the time.

What Causes Testicular Torsion?

The scrotum is the sack of skin beneath the penis. Inside the scrotum are two testes (plural of testis), also called testicles. Each testicle is connected to the rest of the body by a blood vessel called the spermatic cord. Testicular torsion happens when a spermatic cord becomes twisted, cutting off the flow of blood to the attached testicle.

Most cases of testicular torsion affect guys who have a condition called a bell clapper deformity. In most males, the testicles are attached to the scrotum, making it hard for them to twist. In males who have the bell clapper deformity, the testicles are unsecured and can move and twist in the scrotum.

Testicular torsion can happen after strenuous exercise, while someone is sleeping, or after an injury to the scrotum. A lot of times, though, there is no apparent cause.

What Are the Symptoms of Testicular Torsion?

If you have a testicular torsion, chances are you'll know it. You'll feel a sudden, possibly severe, pain in your scrotum and one of your testicles. The pain might increase and decrease but generally won't go away completely. Other symptoms include:

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

What Should You Do?

If you have a sudden pain in your scrotum, call a doctor and get to a hospital or doctor's office as soon as you can. Don't eat or drink anything until you've seen a doctor and found out if you'll need surgery. Testicular torsion is an emergency: When it happens, a guy needs surgery — fast. Saving the testicle becomes more difficult the longer the spermatic cord stays twisted.

Sometimes, the spermatic cord can become twisted and then untwist itself without treatment. This is called torsion and detorsion, and it can make testicular torsion more likely to occur in the future. If your spermatic cord untwists and the pain goes away, it might be easy to ignore it, but you should call the doctor anyway. He or she can check you out and take steps to make testicular torsion unlikely in the future.

How Is Testicular Torsion Diagnosed?

When you arrive at the hospital or doctor's office and describe your condition, the staff and doctors will assume you have a testicular torsion, even if the pain turns out to be something different.

A doctor will examine your scrotum, testicles, abdomen, and groin and might test your reflexes by rubbing or pinching the inside of your thigh. This normally causes the testicle to contract, which probably won't happen if you have a testicular torsion.

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

• Ultrasound. High-frequency (Doppler) waves are used to make an image of the testicle and check the blood flow.
• Urine tests or blood tests. These can determine if the pain and symptoms are being caused by an infection instead of a torsion.
• Nuclear scan. Tiny, safe amounts of radioactive material are injected into your bloodstream. The radioactive material is detected by special cameras that can see which part of your testicles are receiving less blood. This test isn't as common as it once was because most hospitals do ultrasound tests.

Sometimes, doctors will need to do surgery to be sure a problem is testicular torsion. A doctor may also perform immediate surgery without any other testing in order to save the testicle. This is more likely if the torsion has been going on for a while or if the doctor suspects a guy has a torsion after examining him.

How Is Testicular Torsion Treated?

Testicular torsion almost always requires surgery to correct. In rare cases, the doctor may be able to untwist the spermatic cord by pushing on the scrotum, but most guys will still need surgery to attach one or both testicles to the scrotum to prevent torsion from happening in the future.

Usually, surgery for a testicular torsion doesn't require a stay in the hospital. If you have a torsion, you'll be taken into an operating room at the hospital or doctor's office. You'll most likely be given a pain killer and a general anesthetic, meaning you'll be unconscious for the surgery.

A surgeon or urologist will make a small cut in the scrotum, untwist the spermatic cord, and stitch the testicles to the inside of the scrotum to prevent future torsions. When that's finished, the doctor will stitch up the scrotum, and the patient will be taken to a room and allowed to recover for an hour or two.

Guys need to avoid strenuous activities and avoid sex or sexual stimulation (like masturbation) for a few weeks after testicular torsion surgery. Talk to your doctor about when it will be safe to go back to your normal activities.

Sometimes, if the torsion goes on too long, doctors won't be able to save the affected testicle, and it will have to be removed. This will be done through a type of surgery called an orchiectomy.

Guys who have a testicle removed may be able to get a prosthetic, or artificial, testicle a few months after the surgery. Most guys will still be able to father children with one working testicle, but it can help some guys to feel more confident about their appearance if they have a prosthetic testicle.

Get Help Right Away

Talking to someone about your private parts might seem a little embarrassing. It's vitally important, though, to tell a parent or contact a doctor if you have pain in your scrotum. Ignoring pain for too long or simply hoping it goes away can result in severe damage to your testicle and can often lead to your testicle being removed.

Even if a pain in your scrotum goes away on its own, you still need to tell a parent or doctor. A torsion that goes away makes you more likely to have another torsion in the future. Doctors can greatly reduce your risk of another torsion by performing a simple surgical procedure that secures your testicles to your scrotum.

If you've had a testicle removed, don't despair. It's not the end of the world. Chances are you'll still be able to father children and lead a perfectly normal life. In fact, if you do lose a testicle, nobody but you, your family, and the doctor ever need to know about it.

Reviewed by: T. Ernesto Figueroa, MD
Date reviewed: July 2011