Testicular torsion is a medical emergency. It happens when the spermatic cord,
which provides blood flow to the testicle, rotates and becomes twisted. This cuts
off the testicle's blood supply and causes sudden pain and swelling.Testicular
torsion usually requires immediate surgery to save the testicle.
For most boys, talking seriously about their private parts can be a little embarrassing.
But if you have a son, it's important that he knows to tell you or a health care provider
if he ever has genital pain, especially in his scrotum or testes.
How Does Testicular Torsion Happen?
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.
Testicular torsion (also called testis torsion) requires immediate
surgery to fix. If it goes on too long, it can result in severe damage to the testicle
and even its removal.
Who Gets It?
Most cases of testicular torsion are in males who have a genetic condition called
the bell clapper deformity. Normally, the testicles are attached
to the scrotum, but in this condition the testicles aren't attached, and are more
likely to turn and twist within the scrotum.
Torsion can happen to boys and men of any age, but is most common in 12- to 18-year-olds.
It can happen after strenuous exercise, while someone is sleeping, or after an injury
to the scrotum. Often, though, the exact cause isn't known.
What Are the Symptoms?
If your son has testicular torsion, he'll feel a sudden, possibly severe pain in
his scrotum and one of his testicles. The pain can get worse or ease a bit, but probably
won't go away completely.
If your son has sudden groin pain, get him to a hospital emergency
room as soon as you can. Because surgery might be necessary, it's important to not give
your son anything to eat or drink before seeking medical care.
swelling, especially on one side of the scrotum
nausea and vomiting
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 detorsion, and it can make
testicular torsion more likely to happen again in the future.
If your son's spermatic cord untwists and the pain goes away, it might be easy
to dismiss the episode, but you should still call a doctor. Surgery can be done to
secure the testicles and make testicular torsion unlikely to happen again.
How Is Testicular Torsion Diagnosed?
When you get to the hospital, a doctor will examine your son's scrotum, testicles,
abdomen, and groin and might test his reflexes by rubbing or pinching the inside of
his thigh. This normally causes the testicle to contract, which probably won't happen
if he has a testicular torsion.
The doctor also might do tests to see if the spermatic cord is twisted, including:
High-frequency waves are used to make an image of the testicle and check blood flow.
Urine testsor blood tests: These can help determine whether symptoms are being
caused by an infection instead of a torsion.
Sometimes, a doctor will have to do surgery to make a diagnosis of testicular torsion.
Other times, when the physical exam clearly points to a torsion, the doctor will do
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's one entire revolution or several) determines
how quickly the testicle will become damaged. As a general rule:
within about 4-6 hours of the start of the torsion, 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
How Is Testicular Torsion Treated?
Testicular torsion almost always needs surgery to fix. In rare cases, the doctor
might be able to untwist the spermatic cord by pushing on the scrotum, but most guys
will still need surgery to attach both testicles to the scrotum to prevent torsion
from happening in the future.
Most torsion surgeries are done on an outpatient basis (with no overnight hospital
stay). If your son has a torsion, he'll be given a painkiller and general
anesthesia to make him unconscious for the procedure.
Surgery consists of making a small cut in the scrotum, untwisting the spermatic
cord, and stitching both testicles to the inside of the scrotum to prevent future
torsions. Afterward, your son will be taken to a recovery room to rest for an hour
After surgery, your son will need to avoid strenuous activities for a few weeks,
and if he's sexually active, he'll need to avoid all sexual activity. Talk to the
doctor about when it will be safe for your son to return to his normal activities.
If a torsion goes on too long, doctors won't be able to save the affected testicle
and it will be removed in a surgical procedure called an orchiectomy.
Most boys who have a testicle removed but still have a viable testicle can father
children later in life. However, many also opt for a prosthetic, or artificial, testicle
a few months after surgery. This can help make some boys feel more comfortable about
With newborn boys, saving the testicle depends on when the torsion happens. If
it's before a boy 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 torsion symptoms appear after a baby is born, the doctor may recommend emergency
surgery to correct the testicle.
Don't Ignore Symptoms
Boys need to know that genital pain is serious. Ignoring pain or simply hoping
it goes away can lead to severe damage to the testicle and even its removal.
Even if your son has pain in his scrotum that goes away, he still needs to tell
you or a doctor and get checked out. A torsion that goes away makes him more likely
to have another one in the future. Doctors can greatly reduce the risk of another
torsion by securing the testicles to the scrotum.
If your son had a torsion that resulted in the loss of a testicle, it's important
to let him know that he can still lead a normal life, just like anyone else. The loss
of one testicle won't prevent a man from having normal sexual relations and is unlikely
to interfere with fathering children.