The word torsion means “to twist.” Testicular torsion is when a man's testicle twists around. The motion also twists the spermatic cord that connects to the testicle. This cord contains vessels that carry blood to the testicle.
Torsion can slow or cut off blood flow to the testicle. A lack of blood makes the affected testicle swell up and become painful.
Testicular torsion is a medical emergency. You need to be treated as soon as possible to prevent infertility and other complications, and to save the testicle.
What Causes It?
The two testes sit in a pouch that hangs below the penis. It’s called the scrotum. The spermatic cord connects the testicles to the body. Normally, the testicles are attached to the inside of the scrotum so they don't move around.
Some men are born without the tissue that holds their testicles in place. Without this tissue, their testicles are free to move around inside the scrotum. This is called a bell clapper deformity. Newborns can get testicular torsion because the connecting tissue hasn't yet formed.
Testicular torsion is very rare. It usually affects boys between the ages of 12 and 16, but it can happen at any age. Newborn babies or middle-aged men can sometimes get it, too.
You're more likely to have testicular torsion if you:
- Often do intense exercise
- Injure your testicles
- Are exposed to the cold
- Have a growth spurt of the testicles during puberty
- Had testicular torsion in the past
The only way to prevent testicular torsion is to have surgery to attach your testicles to the insides of your scrotum, but this is only done if you have already had torsion or are currently experiencing it. This is not done as a preventive measure.
What Are the Symptoms of Testicular Torsion?
When blood flow is cut off, the pain from torsion is severe. The testice becomes swollen, and it can die if not treated. Quick treatment can save your testicle from permanent damage. See a doctor right away if you have any of the following symptoms:
How Do I Know If I Have It?
In many cases, an emergency room (ER) doctor will diagnose testicular torsion. A specialist called a urologist will treat it. The doctor will ask questions about your symptoms and examine your scrotum and testicles.
He might gently touch the inside of your thigh on the side of the affected testicle. Normally this should make your testicle contract, or rise up. If it doesn't, you could have testicular torsion.
You might get one or more of these tests to diagnose testicular torsion:
- Urine test (checks for an infection)
- Ultrasound (uses sound waves to check for reduced blood flow to your testicle)
Your doctor might need to do surgery to confirm that you have testicular torsion.
What's the Treatment?
Sometimes doctors can untwist the testicle by hand. But in most cases, you'll need surgery to fix testicular torsion. You'll have the best odds of saving your testicle if you have surgery within 6 hours of the time the pain started. After 12 hours, you have just a slim chance of saving the testicle and your fertility.
You’ll be asleep and won’t feel pain during the surgery. The surgeon will make a small cut in your scrotum and untwist your spermatic cord. Then he will attach your testicles to the inside of your scrotum to prevent them from twisting again.
If your testicle is too badly damaged, the surgeon will remove it. This surgery is called orchiectomy.