Testicular torsion: Causes, symptoms, and treatment

The spermatic cord provides blood flow to the testicle. When a testicle rotates on this cord, it is referred to as testicular torsion; it causes the flow of blood to stop, causing sudden, often severe pain, and swelling.

Prolonged testicular torsion and loss of blood flow can lead to the death of the testicle and surrounding tissues. Testicular torsion is serious but treatable.

Causes of testicular torsion

[man in pain]
Severe pain the groin is a sign of a twisted testicle.

Each testicle is attached to the spermatic cord and the scrotum. Testicular torsion happens if the testicle rotates on the cord that runs upward from the testicle into the abdomen.

The rotation twists the spermatic cord and reduces blood flow. If the testicle rotates several times, blood flow can be entirely blocked, causing damage more quickly.

Males who experience testicular torsion may have an inherited trait that allows one or both testicles to rotate freely inside the scrotum. The testicle is only attached to the spermatic cord, and not to the scrotum. This is called a “bell clapper scrotum,” because the testicle “swings” like a bell clapper.

Testicular torsion can happen at any time, while standing, sleeping, exercising, or sitting, and with no apparent trigger in those who are susceptible. Sometimes it is prompted by an injury or because of rapid growth during puberty.

Factors that increase the chance of testicular torsion are:

Age: Testicular torsion is most common in males aged 10-25 years. It can occur at any age, but it is rare over the age of 30 years. About 65 percent of cases occur in adolescents aged 12-18; it affects around 1 in 4,000 males before the age of 25.

Previous testicular torsion: If the torsion occurs once and resolves without treatment, it is likely to happen again in either testicle, unless surgery is performed to correct the underlying problem.

Climate: Torsions are sometimes called “winter syndrome,” because they often happen when the weather is cold. The scrotum of a man who has been lying in a warm bed is relaxed. When he leaves the bed, his scrotum is exposed to the colder room air. If the spermatic cord is twisted while the scrotum is loose, the sudden contraction that results from the abrupt temperature change can trap the testicle in that position. The result is a testicular torsion.

Testicular torsion in newborns and infants

Sometimes, testicular torsion happens before birth. In this case, the testicle cannot normally be saved, but correctional surgery is recommended after birth to diagnose and correct testicular torsion in the other testicle and to prevent future reproductive problems.

[male reproductive system]
The testicles are attached by a cord.

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