Testicular torsion occurs when a testicle rotates on the spermatic cord, which provides blood flow to the testicle. This rotation cuts off the flow of blood and causes sudden, often severe pain and swelling. Testicular torsion is most common in males under 25, but it can occur at any age, including in newborns and infants.

Testicular torsion requires emergency treatment. If it's treated within a few hours, the testicle can usually be saved. But waiting longer can cause permanent damage and may affect the ability to father children. When blood flow has been cut off for more than 12 hours, a testicle may become so badly damaged it has to be removed.  

Although doctors can sometimes untwist a testicle by pushing on the outside of the scrotum, surgery is needed to prevent testicular torsion from recurring.

Signs and symptoms of testicular torsion include:

• Sudden or severe pain in one testicle
• Swelling of the scrotum (a loose bag of skin under your penis that contains your testicles)
• Nausea and vomiting
• Abdominal pain
• Fever

Other signs of testicular torsion can include:

• A testicle positioned higher than normal or at an odd angle
• Sudden testicle pain that went away without treatment — this can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion)

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Testicular torsion

Testicular torsion occurs when the testicle rotates on the cord that runs upward from the testicle into the abdomen (spermatic cord). This rotation twists the spermatic cord and reduces blood flow. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

Males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. About one in 10 males is at risk of testicular torsion because one or both of the testicles aren't securely attached to the inside of the scrotum. This inherited condition often affects both testicles.

In men and boys who are at risk of testicular torsion, the condition often occurs with no apparent trigger. Signs and symptoms of testicular torsion may start following:

• Physical activity
• An injury to the scrotum
• Sexual arousal or activity
• Sexual arousal or reflexes during sleep
• Exposure to cold weather

• Age. Testicular torsion is most common in young men and adolescent boys.
• Previous testicular torsion. If you've had testicular torsion that went away without treatment, it's likely to occur again in either testicle unless you have surgery to correct the underlying problem.

Seek emergency care for sudden or severe testicle pain. While your signs and symptoms may be caused by another condition, if you do have testicular torsion, prompt treatment can prevent severe damage or loss of your testicle.

• If the testicle is untwisted within six hours, it can be saved in 90 percent of cases.
• After 12 hours, chances of saving the testicle fall to about 50 percent.
• After 24 hours, the testicle can be saved only about 10 percent of the time.

Seek prompt medical help if you've had sudden testicle pain that went away without treatment. This occurs when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Even though the testicle untwisted on its own, you still need to see a doctor because surgery is needed to prevent the problem from recurring.

Your doctor asks you questions to verify whether your signs and symptoms are caused by testicular torsion or something else. He or she also examines your scrotum, testicles, abdomen and groin.

Your doctor may also test your reflexes by lightly rubbing or pinching the inside of your thigh on the affected side. Normally this causes the testicle to contract. This reflex probably won't occur if you have testicular torsion.

Doctors often diagnose testicular torsion with just a physical exam. Sometimes medical tests are necessary to confirm a diagnosis or to help identify another cause for your symptoms. These include:

• Urine tests or blood tests, to see whether your signs and symptoms are caused by an infection.
• Scrotal ultrasound, which uses high-frequency sound waves to create images of your testicle and check for blood flow. Decreased blood flow to the testicle is a sign of testicular torsion.
• Nuclear scan of the testicles, which involves injecting tiny amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion.
• Surgery. Sometimes surgery is necessary to identify whether symptoms are caused by testicular torsion or another condition.

When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage or death of the testicle. If the testicle is badly damaged, it has to be surgically removed. In some cases, damage or loss of a testicle affects a man's ability to father children.

Surgery is required to treat testicular torsion. In some cases, the doctor may be able to untwist the testicle by pushing on the scrotum (manual detorsion), but you'll still need surgery to prevent torsion from occurring again. If testicular torsion occurs before birth, surgery may not be possible.

Surgery for testicular torsion is usually done under general anesthesia, which means you won't be conscious. The surgery is straightforward and generally doesn't require a stay in the hospital. During surgery, your doctor will:

• Make a cut in your scrotum (a loose bag of skin under your penis that contains your testicles)
• Untwist your spermatic cord, if necessary
• Stitch one or both testicles to the inside of the scrotum to prevent rotation

Surgery to correct testicular torsion takes about an hour. After surgery, you'll need to avoid strenuous activity for one to two weeks. You can probably resume sexual activity after four to six weeks.

Testicular torsion in newborns and infants
In some cases, surgery is needed to diagnose and correct testicular torsion. This can prevent future issues with fertility or male hormone production. Deciding whether a newborn or infant should have surgery depends on the judgment of the doctor, and in some cases, the desires of the parent.

• If a boy is born with signs and symptoms of testicular torsion, it may be too late for emergency surgery to help. In some cases, the doctor may recommend a later, non-emergency surgery.
• If signs and symptoms of testicular torsion occur after birth, the doctor may recommend emergency surgery.

Having testicles that can rotate is an inherited trait, which some males have and others don't. The only way to prevent testicular torsion is through surgery to attach both testicles to the inside of the scrotum so that they can't rotate freely.