Why testicular torsion occurs

This is where sperm and male sex hormone testosterone are made. The blood supply for each testicle comes from the spermatic cord. This cord starts in the abdomen and extends into the scrotum. This cord also contains the vas deferens, which carries sperm from the testicles to the urethra.

The testes should be about the same size. If one side quickly becomes larger than the other, this can be a problem. Change in scrotum color, especially redness or darkening, is also a problem. Early on, there may not be swelling. But very shortly after, the scrotal skin will swell and turn red. You may also feel nauseous and vomit. Testicular torsion is a medical emergency. Since all blood for the testicle comes through the spermatic cord, the blood supply is cut off with a twist.

The testicle will shrink "atrophy" if the blood supply isn't restored within 6 hours. With no blood, the testicle could die or "infarct". When the testes die, the scrotum will be very tender, red, and swollen. Often the patient won't be able to get comfortable. Any pain or discomfort in the testes is a sign to get medical help right away. Call your doctor even with no swelling or change in skin color.

Slow-onset pain in the testicle, over many hours or days, can be a sign of torsion. This is less common. Problems with urination, such as burning or having to go often are not normal signs of torsion. Torsion tends to happen on the left side more than the right. Most often, torsion is only on one side.

Only 2 in men with torsion have it in both testes. Torsion is not a common problem. It happens in about 1 in 4, males under the age of It can also happen in newborns and in older men. In most males, a testicle can't twist because the tissue around it is well attached. Some males are born with no tissue holding the testes to the scrotum. This lets the testes "swing" inside the scrotum often called a "bell clapper" deformity.

Torsion can happen on either side, but rarely on both sides. Physical activity doesn't cause torsion. It may happen during exercise, sitting, standing or even sleeping. Testicular torsion is often found with a physical exam by a doctor. X-ray tests may also be used. Ultrasound and other techniques can check blood flow to the testes.

If a urine test shows a urinary tract infection, your health care provider will do more tests. He or she will want to know if the pain is from an infection of the testicle or epididymis. The epididymis is a coiled tube on the back of the testes. The spermatic cord needs to be untwisted de-torsion to restore the blood supply. Lasting damage starts after 6 hours of torsion.

It's really 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 might 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 doing a simple surgical procedure that secures your testicles to your scrotum. 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. 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. Testicular torsion almost always requires surgery to correct. 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.

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 painkiller and general anesthesia , 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 to recover for an hour or two. The surgery to attach the testicles to the scrotum takes about 45 minutes. There may be some pain, but it shouldn't be too bad. It's much better than the torsion. Sometimes, if the torsion goes on too long, doctors won't be able to save the affected testicle.

Doctors will need to remove it through a type of surgery called an orchiectomy. Guys need to skip strenuous activities like sports and sex or sexual stimulation like masturbation for a few weeks after testicular torsion surgery. The testicle is commonly dead if the condition occurs in utero. There is usually no apparent pain or discomfort involved as typically seen in adults. Some experts say there is a genetic anomaly which allows the testicle to freely float inside of the scrotum.

Normally, the testicle is not able to twist around inside the scrotum, because the tissue is attached properly. Other factors linked with the occurrence of testicular torsion include:. Although physical activity may be the impetus that results in testicular torsion, it is not the underlying cause. The condition commonly occurs when standing, sitting down, or even during sleep. Immediate treatment is required to prevent the loss of the testicle.

Another scenario that constitutes an immediate visit to the urologist or other healthcare provider is when a person has sudden testicle pain which subsides without treatment. In this scenario, called intermittent torsion and detorsion, surgery is required to prevent torsion from occurring again.

Testicular torsion is usually diagnosed via physical exam or ultrasound which looks for lack of blood flow to the testicle by a doctor in the emergency room. From there, a urologist will be consulted to assist in the treatment of the torsion. Because testicular torsion involves the elimination of the only blood supply to the testicles, treatment must occur promptly.

This involves surgery to untwist the spermatic cord and restore the blood supply. Even if the doctor can untwist the testicle during their exam, a surgery called "bilateral orchiopexy" is still necessary to avoid a future occurrence. The surgery is done through a scrotal incision where the urologists will expose the torsed testicle and detorse it. If the testicle appears viable, the testicle will be placed back into the scrotal cavity with permanent sutures placed in three different areas attaching the testicle to the surrounding tissue.

The same stitches will be placed on the other unaffected testicle to avoid future occurrences. Long-term damage can occur if treatment is not initiated within four to six hours of the start of torsion. Other long-term side effects of torsion include pain, infertility, and low testosterone. After a person has been treated for testicular torsion, common expectations may include:. Testicular torsion, although rare, is a very serious condition that requires immediate medical attention and treatment.

It is important for a person to seek medical attention if experiencing any severe pain in the testes or scrotum. As with many medical conditions, symptoms are likely to grow worse with prolonged absence of medical treatment.

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Mayo Clinic Staff. Testicular Torsion. Mayo Clinic.