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Testicular Torsion: Symptoms & Getting Treated

Testicular torsion can be extremely painful and is an emergency situation.
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Written by Daniel Choi, MD.
Emergency Medicine Resident, Massachusetts General Hospital
Last updated April 29, 2024

Testicular torsion quiz

Take a quiz to find out if you have testicular torsion.

What is testicular torsion

Testicles are the male reproductive organs. Usually, there are two, located in the scrotum. The testicles produce sperm. And hormones like testosterone. When one of the testicles twists onto itself, it can lead to testicular torsion. It is a medical emergency.

Twisting can reduce blood flow to the testicle. And cause damage to the organ. It's even possible to become infertile. (Unable to have a child through sexual intercourse.)

If you think you may have a testicular torsion, get emergency care right away. You may need surgery to save the testicle.

Dr. Rx

Time is tissue. What I mean is that the longer this goes untreated, the more likely the testicles will be permanently damaged. Doctors won't be able to save it. You MUST be seen by a medical specialist as soon as possible. —Dr. Chandra Manuelpillai

Main symptom

Scrotum or groin pain that's usually on one side.

Other symptoms of testicular torsion

  • Abdominal pain. Generally around the lower part of the abdomen.
  • Nausea and vomiting in waves or feel constant—or even not at all.
  • The scrotum is red or swollen—or both.
  • Difficulty or pain when urinating.
  • Fever, though not as common.
  • One testicle seems higher than the other one.

Is testicular torsion painful?

Pro Tip

People are often embarrassed to mention they have issues with their genitals. But this is very serious. Tell your doctor what is wrong. Do not use vague words or complaints, hoping your doctor will figure it out. Remember, torsion is reversible. —Dr. Manuelpillai

Typically, there is sudden severe pain in the scrotum. Or lower abdominal pain on the side of the affected testicle. Sometimes, nausea and vomiting accompany the pain. You may also notice the scrotum appears abnormal, such as swollen, red, or bruised.

Adults usually describe it as scrotal pain. The pain may be constant or come and go. It can be severe enough to wake them up from their sleep.

Testicular torsion causes

Differences in how the scrotum develops may play a role.

Some activities may change the length of the testicle. Compression may increase risk. But the reason the torsion occurs is, for the most part, unknown.

  • Genetic risk factors. There may be a higher risk of testicular torsion if another family member has had it.
  • Environmental factors. You may be more likely to experience testicular torsion in cold weather, during physical activities like cycling, or after getting hit in that area.

Questions your doctor may ask to determine testicular torsion

  • Are you sick enough to consider going to the emergency room right now?
  • Have you lost your appetite recently?
  • How has the intensity of your vomiting changed over time?
  • How long has your vomiting been going on?
  • How many times have you vomited in the last 24 hours?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

Testicular torsion in children

Younger children or toddlers may not be able to pinpoint the location of the pain. Or they may be afraid to mention changes in their genital region. Always get medical attention for sudden abdominal pain symptoms.

Next steps

If you have sudden or severe testicular pain, immediately go to the emergency room. Or if you notice unusual testicular changes.

Also, head to the ER if your child is experiencing sudden or severe abdominal pain. You want to get a diagnosis as quickly as possible.

How common is testicular torsion?

Testicular torsion is most common in newborns and during puberty (generally ages 13 to 16). As the anatomy—the structure of the body—changes with age, the reasons for torsion may vary. However, these causes are not well understood.

When a newborn develops, the testicles should descend (move down). They then attach to the inner wall of the scrotum. Sometimes, they do not attach properly or entirely. The spermatic cord—which connects the testicles to the abdomen—may then twist onto itself. The twisting can interfere with the blood supply and damage nerves.

Sometimes during the pre-teen and teen years, testicles rotate, move around, or twist. It may be because the testicles aren't attached to the inner scrotum wall in the right location or in the correct way.

Activities involving straddling, like cycling, may play a role too. (Straddling is when legs are wide apart.) A direct hit to the area can affect the anchoring of the testicles. It can also shift the testicles. Both can lead to torsion.

Cold weather may be another factor. Low temperatures may cause muscles surrounding the testicle and spermatic cord to contract in an unusual way.

Pro Tip

Ask what the likelihood is that my complaints are from testicular torsion? And that it's not other possible diagnoses such as infection, malignancy (cancer), cyst (fluid-filled sac), etc. If this is testicular torsion, how quickly can I have surgery? What can I expect during recovery? —Dr. Manuelpillai

Testicular torsion treatment

To diagnose testicular torsion, a doctor (often a urologist) evaluate the groin and scrotum area. The doctor will also check the abdomen.

You may need an ultrasound to confirm the diagnosis. (An ultrasound creates an image with soundwaves). It allows the doctor to monitor blood flow and look for twisting. An ultrasound can confirm a testicular torsion. Though sometimes, a doctor may be able to diagnose based on the signs and symptoms and an exam.

Prevent permanent damage by getting treatment as soon as possible. The urologist may try manual techniques—using their hands—to untwist the testicle. But the primary treatment involves surgery.

Ask your doctor about scrotal support. It's a sling that relieves pressure from hanging testicles.

Acetaminophen and ibuprofen or more potent prescribed drugs can lessen pain. Currently, there aren't any specific medications to treat it.

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The surgery usually involves opening the scrotum and untwisting the testicle and spermatic cord.

If the injury is severe, the testicle will be surgically removed. This procedure is called an "orchiectomy."

Otherwise, the urologist will do a procedure called an "orchiopexy." It is surgery to attach the testicles, both the injured and the healthy ones, to the inner scrotum. It helps prevent torsion from happening again.

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.
Dr. Manuelpillai is a board-certified Emergency Medicine physician. She received her undergraduate degree in Health Science Studies from Quinnipiac University (2002). She then went on to graduated from Rosalind Franklin University of Medicine and Sciences/The Chicago Medical School (2007) where she served on the Executive Student Council, as well as was the alternate delegate to the AMA/ISMS-MSS G...
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