Testicular Torsion "Double Outch!"
If you got to this article after reading the "Penile Fracture" article, then you will be surprised to learn that there is such a thing as even more painful as a penile fracture: and that's the infamous "Testicular Torsion" - basically one of the testicles starts twisting around the cord from which it hangs until it literally strangulates itself.
This is another unplanned article that I am writing after seeing one too many young men with testicular torsions that they have mis-treating with "bedrest" at home. Testicular torsion is a medical emergency and needs to go to the operating room within 4 hours if the testicle is to be saved.
Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.
Testicular torsion is most common between ages 12 and 16, but it can occur at any age, even before birth. The last patient I treated for testicular torsion was in his early 20's, so take your testicles seriously when they ask for attention!
Testicular torsion requires emergency surgery. If treated quickly, the testicle can usually be saved. But when blood flow has been cut off for too long, a testicle might become so badly damaged that it has to be removed.
Signs and symptoms of testicular torsion include:
- Sudden, severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
- Swelling of the scrotum
- Abdominal pain
- Nausea and vomiting
- A testicle that's positioned higher than normal or at an unusual angle
- Painful urination
Young boys who have testicular torsion typically wake up due to scrotal pain in the middle of the night or in the morning.
When to see a doctor
Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if you have testicular torsion.
You also need to seek prompt medical help if you've had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Surgery is frequently needed to prevent the problem from happening again.
Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.
It's not clear why testicular torsion occurs. Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion.
Testicular torsion often occurs several hours after vigorous activity, a minor injury to the testicles or sleep. Cold temperature or rapid growth of the testicle during puberty also might play a role.
- Age. Testicular torsion is most common between ages 12 and 16.
- Previous testicular torsion. If you've had testicular pain that went away without treatment (intermittent torsion and detorsion), it's likely to occur again. The more frequent the bouts of pain, the higher the risk of testicular damage.
- Family history of testicular torsion. The condition can run in families.
Testicular torsion can cause the following complications:
- Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed.
- Inability to father children. In some cases, damage or loss of a testicle affects a man's ability to father children.
Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent testicular torsion is surgery to attach both testicles to the inside of the scrotum.