Nov 6, 2019, 10:31:38 AM CST Nov 6, 2019, 10:54:39 AM CST

Testicular torsion: Signs, causes and what to do

Learn the signs and symptoms of this medical emergency in boys to avoid permanent damage

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If you are a male who experiences sudden and severe pain in your belly, groin or testicle, Bruce Schlomer, M.D., Pediatric Urologist at Children's Health℠ and Associate Professor at UT Southwestern, has an important message for you: "Don't try to tough it out!"

These may be signs of testicular torsion – a relatively common medical condition that requires immediate emergency care.

Testicular torsion occurs when a testicle twists inside of the scrotum so much that it chokes the blood flow to the testicle. "This leads to sudden, severe pain in the belly and testicle, but guys may try to tough it out or not clearly communicate the symptoms," says Dr. Schlomer. "Unfortunately, a delay in treatment can severely impact reproductive health, since the testicle is responsible for making sperm and the male hormone, testosterone."

Time is of the essence for untwisting a testicular torsion: It can take just 4-6 hours for permanent damage to set in. Unfortunately, about 35-40% of patients with testicular torsion wait so long that the testis is dead when they finally seek help.

Learn how to recognize the signs of testicular torsion and how to avoid permanent testicle damage.

What causes testicular torsion?

Like a cherry on its stem, the testicle hangs inside the scrotum on its arteries and veins. The scrotum is the skin covered sac that contains and protects the testicles. Testicular torsion occurs when the testicle rotates and twists inside the scrotum, choking the blood flow through the arteries and veins. Without proper blood flow, the testicle can die.

This twisting may occur due to rapid growth during puberty; about 65% of cases of testicular torsion occur in adolescents ages 11-19. Testicular torsion may also occur following an injury to the groin area. However, the condition can happen at any age, without provocation or a known cause.

"We believe that some males are more susceptible to testicular torsion than others because of the looseness of the way the testis is attached inside the scrotum," says Dr. Schlomer. Some males may be born with this looseness due to a congenital trait known as a bell clapper anomaly. With the rapid growth of the testicles during puberty, the testis can flop and twist, which increases the risk of the spermatic cord becoming twisted.

How do you know if you have testicular torsion?

Males who experience sudden and severe pain in the scrotum, testicle ("ball"), belly or groin should be seen immediately by a doctor.

Signs and symptoms of testicular torsion include:

  • Scrotal or testicular pain, often severe, that develops suddenly
  • Abdominal pain, nausea and vomiting
  • Swelling, where one testis quickly becomes larger than the other and more hard
  • Change in scrotal skin color (especially red or darkening)
  • One testicle appears to be higher than the other
  • Tenderness

Many boys and adolescents might first feel bad belly pain and then the scrotal pain. Parents should talk to their sons about communicating any problems or pain, and never ignoring it.

How to treat testicular torsion

Testicular torsion is a medical emergency which requires immediate surgery (called an orchiopexy with detorsion) to restore blood flow to the testicles. Since it can take just four to six hours for permanent damage to set in, anyone concerned about testicular torsion should not wait. Instead, seek emergency care right away at the hospital.

"Time is critical," says Dr. Schlomer. "Six hours is not much time to get to the hospital, have the necessary diagnostic tests and get into surgery."

Delayed diagnosis and treatment can lead to testicular loss, which has lasting physical and psychological impacts. "If there's any concern at all, we recommend a scrotal exam and an ultrasound to rule out torsion," says Dr. Schlomer.

How to prevent testicular torsion

While testicular torsion cannot be prevented, being aware of this emergency condition can help prevent permanent damage.

Parents should talk to their sons about any pain they may experience in their belly, groin or genitals. Research shows that most treatment delays occur at home. One study found that males under age 18 years old waited up to 20 hours before heading to the emergency room.

"Teach your sons that any pain is serious and should not be ignored," says Dr. Schlomer. Although it may feel awkward to discuss genital anatomy with your son, they need to understand the seriousness of the condition and that they should never keep severe pain a secret. "Reassure your son that there is nothing to be embarrassed about and that you care about his long-term health."

Learn more

The Pediatric Urology department at Children's Health offers comprehensive care for the full range of urologic conditions, from simple problems such as bedwetting to the most complex conditions requiring advanced surgical intervention. Learn more about the Urology program and services.

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