Site Map

Testicular torsion

Torsion of the testis; Testicular ischemia; Testicular twisting

Testicular torsion is twisting of the spermatic cord, which supports the testes in the scrotum. When this occurs, blood supply is cut off to the testicles and nearby tissue in the scrotum. This may cause permanent damage to the testicle.

Images

Presentation

Causes

Some men are more prone to this condition because of defects in the connective tissue within the scrotum. The problem may also occur after an injury to the scrotum that results in a lot of swelling, or following heavy exercise. In some cases, there is no clear cause.

The condition is more common during the first year of life and at the beginning of adolescence (puberty). However, it may happen in older men.

Symptoms

Symptoms include:

• Sudden severe pain in one testicle. The pain may occur without a clear reason.
• Swelling within one side of the scrotum (scrotal swelling).
• Nausea or vomiting.

Additional symptoms that may be associated with this disease:

• Testicle lump
• Blood in the semen
• Testicle pulled to a higher position in scrotum than normal (high riding)

Exams and Tests

Your health care provider will examine you. The exam may show:

• Extreme tenderness and swelling in the testicle area.
• The testicle on the affected side is higher.

You may have a Doppler ultrasound of the testicle to check the blood flow. There will be no blood flowing through the area if you have complete torsion. Blood flow may be reduced if the spermatic cord is partly twisted.

Treatment

Most of the time, surgery is needed to correct the problem. The procedure involves untwisting the cord and sewing the testicle to the inside wall of the scrotum. Surgery should be done as soon as possible after symptoms begin. If it is performed within 6 hours, most of the testicle can be saved.

During surgery, the testicle on the other side is often secured into place as well. This is because the unaffected testicle is at risk of testicular torsion in the future.

Outlook (Prognosis)

The testicle may continue to function properly if the condition is found early and treated right away. The chances that the testicle will need to be removed increase if blood flow is reduced for more than 6 hours. However, sometimes it may lose its ability to function even if torsion has lasted fewer than 6 hours.

Possible Complications

The testicle may shrink if blood supply is cut off for an extended time. It may need to be surgically removed. Shrinkage of the testicle may occur days to months after the torsion has been corrected. Severe infection of the testicle and scrotum is also possible if the blood flow is limited for a long period.

When to Contact a Medical Professional

Get emergency medical attention if you have symptoms of testicular torsion as soon as possible. It is better to go to an emergency room instead of an urgent care in case you need to have surgery right away.

Prevention

Take steps to avoid injury to the scrotum. Many cases cannot be prevented.

Related Information

Scrotum
Testicular torsion repair

References

Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 560.

Germann CA. Urologic disorders. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 89.

Kryger JV, Jarosz SL. Acute and chronic scrotal swelling. In: Kleigman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 24.

Palmer LS, Palmer JS. Management of abnormalities of the external genitalia in boys. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 44.

BACK TO TOP

Review Date: 7/1/2023  

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Health Content Provider 06/01/2025

A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics. This site complied with the HONcode standard for trustworthy health information from 1995 to 2022, after which HON (Health On the Net, a not-for-profit organization that promoted transparent and reliable health information online) was discontinued.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2024 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.