Testicular Torsion

Medically Reviewed by Minesh Khatri, MD on August 14, 2022
3 min read

Testicular torsion is when a man's testicle twists around. (The word torsion means “to twist.”) The motion also twists the spermatic cord that connects to the testicle. Inside this cord are 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 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.

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 rare. 

You're more likely to have testicular torsion if you:

  • Are between the ages of 12 and 16 (though it can happen at any age)
  • 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 or someone in your family has

When blood flow is cut off, the pain from torsion is severe. The testicle 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:

  • Sudden, severe pain on one side of the scrotum
  • Redness and swelling of the scrotum
  • One testicle suddenly sits higher than the other
  • Abdominal pains
  • Nausea, vomiting
  • Fever
  • Needing to pee often
  • Feeling dizzy
  • Lumps in your scrotum
  • Blood in your semen

In many cases, an emergency room (ER) doctor will diagnose testicular torsion. The doctor will ask questions about your symptoms and give you a physical exam to check 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)
  • An imaging test of your scrotum, usually an 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.

If you have testicular torsion, you’ll see a specialist called a urologist for treatment. Sometimes doctors can untwist the testicle and spermatic cord by hand, but in most cases, you'll need surgery, called orchiopexy, to fix testicular torsion. 

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. This is called surgical detorsion. Then they 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.

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, the blocked blood flow can cause permanent damage. The testicle may need to be surgically removed. It can also lower your fertility. 

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.

After the orchiopexy, you’ll need to rest and avoid any physical activities that might injure the area for a while. For example, you shouldn’t ride a bicycle for at least a week, and you shouldn’t play sports for 4-6 weeks.