Testicular Torsion: Symptoms, Diagnosis & Treatment

The testes are a critical part of a man’s reproductive system. They are responsible for two very important functions1. First, the testicles produce sperm. This is the main ingredient in semen and makes reproduction possible.

Another essential function served by the testes is testosterone production. This hormone is critical to a man’s health. Testosterone plays a role in both physical and mental health. 

Some conditions can affect the testes. Testicular torsion is one of the more painful conditions that a man can suffer. When this happens, urgent medical treatment is usually needed. Failure to treat testicular torsion when it occurs can lead to severe complications. 

We take a look at what testicular torsion is in this post. We will share the symptoms men should look out for. The post will also consider potential causes behind testicular torsion and provide an overview of the treatment options. 

What Is Testicular Torsion?

Testicular torsion is a condition that affects testes2. It is generally seen as a medical emergency since serious complications develop when a man is not treated quickly. Testicular torsion is associated with severe pain. 

The condition refers to an abnormality with the tests and the patient’s spermatic cord. The testes twist around a patient’s spermatic cord. The spermatic cord is responsible for carrying sperm from the testes to other areas of the reproductive system

Testicular torsion causes the blood supply toward the testes to become restricted. The testicles depend on a steady supply of blood. When blood circulation to the testes is cut off, serious complications develop. This is especially the case when the issue is not attended to quickly. The longer the spermatic cord is restricted, the more damage will be dealt with the testes. 

In most cases, only a single testicle will be affected by testicular torsion. When the patient does not receive medical treatment on time, the affected testicle may need to be removed. This is a common complication associated with testicular torsion. Sometimes, the affected testicle does not need to be removed. It may, however, be weakened in the process. 

There is little data available on the specific epidemiology of testicular torsion. According to one particular study3, about one in every 160 men will experience this type of event before they reach 25 years of age. Unlike some of the other male reproductive conditions, this particular event is more common among younger men. 

What Causes Testicular Torsion?

Even though not a very common event in men, it is still important for male patients to understand what may cause them to experience testicular torsion. 

When looking at the causes behind the condition, a man must understand how the testicles are attached. There is a tissue that ensures the testicles are attached. The tissue helps to keep the testes in place. In this case, it is generally not possible for the testes to twist around the man’s spermatic cord. 

There are some cases where a man does not have this tissue. This is considered a congenital problem. It means the man is born with the issue. The condition is sometimes referred to as bell clapper deformity. It means the testes are left to swing around in the scrotum area. In this case, it is easier for the testes to twist around a man’s spermatic cord. 

Testicular torsion can happen at any time. Men need to understand that exercise is not going to cause this condition. It can happen during exercise – but physical activity is not the case. Some men may even experience testicular torsion while they are sleeping. 

What Are The Symptoms?

Studies suggest that men have between four and eight hours to act upon the problem when it happens4. When the man is not treated at this time, complications will develop. Acute scrotal pain happens with this event. 

Since there is such a short time period before permanent damage happens, men should be able to recognize the symptoms of testicular torsion.

When the symptoms are mistaken for something else, it delays the time at which treatment will be initiated—the type of testicular torsion matters. Intermittent testicular torsion is one example. Intravaginal torsion and extravaginal torsion are more examples.

The symptoms of testicular torsion tend to develop suddenly and quickly. The man may go from no pain to a severe level of pain in their groin area within just a few seconds. Severe pain is also the most common symptom associated with testicular torsion.

In most cases, only a single testicle will be affected. Thus, most men will experience sudden pain symptoms in only one side of their groin region. Cremasteric reflex may be affected. 

In rare cases, both of the testes may be affected. If this happens, the entire groin area may radiate severe testicular pain. 

There may also be a sudden change in one testicle’s size. This is due to swelling that happens with the testicular torsion. The swelling sometimes only develops a while after the man starts to experience severe scrotal pain. 

There are a few other symptoms that may indicate testicular torsion. These may include:

  • There may be darkening in the scrotum’s color. 

  • Sometimes, the scrotum appears red instead of darker. 

  • Some men experience nausea when they develop testicular torsion. 

  • Nausea sometimes leads to vomiting too. 

  • Some patients experience abdominal pain

These symptoms should signal a medical emergency for a male patient. Emergency surgery is needed. It is generally advised to ensure medical assistance is obtained when pain or discomfort is experienced within the man’s testis. The man should not wait for the swelling or change in scrotum color to develop. This is an acute scrotum symptom. 

If treatment is not provided soon enough, the affected testicle may die. The medical term is infarct. Prolonged testicular torsion causes more symptoms to appear, particularly in the affected testicle. The patient needs to understand the risk of intermittent torsion when no treatment is administered.

The testicle’s size may eventually decline. This means the testicle goes from being swollen to having a smaller size than usual. The decrease in size is usually a sign of testicular infarction. 

The man may also find that their scrotum is red and inflamed. The scrotum will also be extremely tender when the man experiences an infarction of one testicle. When this happens, the man will not be able to feel comfortable – whether he is standing, sitting down, or lying on a flat surface. At this point, testicular salvage is likely not possible. The testis torsion is too severe at the point. 

How Is It Diagnosed?

Testicular torsion is a condition that needs a quick medical response. This is why a fast diagnosis process is essential. 

When a patient show signs of testicular torsion, the first step is for the doctor to conduct a physical examination. The doctor will feel the testicles for abnormalities. If there are abnormalities, then the doctor will be able to determine if the testicular torsion is suspected. 

There are times where other conditions may be suspected too.

A urine test is sometimes done. The doctor will request that the test is done quickly by the laboratory. This is because the doctor needs to take action based on their findings. If the patient has testicular torsion, the doctor needs to request surgery immediately. 

A urine test can help the doctor determine if the patient has an infection. Testicular torsion is not the only condition that can cause groin pain. There are times when these infections can affect a testicle in a man’s body. If this is the case, the infection can also cause painful symptoms in the scrotum and surrounding areas. 

A doctor may also decide to order imaging tests. Different types of imaging tests may be used. 

X-ray tests are sometimes ordered. An ultrasound is also a common imaging test used in the diagnosis of testicular torsion. The use of a testicular ultrasound helps the doctor see how much blood is flowing to the man’s testicles. It also helps the doctor determine if the man has testicular torsion. Sometimes, a doppler ultrasonography is ordered too. The Doppler ultrasound can provide a view on the testicles and blood flow to the testes. 

Conditions like epididymis and testicular infections also need to be ruled out. The treatment for these conditions differs from what is used to fix testicular torsion. Problems with the contralateral testis are taken into consideration too. The doctor will ask the patient questions, such as whether they experience testicular tenderness. The unaffected testicle may be examined too. 

These procedures ensure the doctor can diagnose acute testicular torsion. Surgical intervention can then be arranged to help fix the decreased blood flow. This is the case when either the right or left testicle is affected. 


When a man has testicular torsion, he needs to be treated for it immediately. It takes four to eight hours for testicular tissue to die when the condition is not treated. The average time is around six hours. Treatment needs to be provided within this time to ensure the man does not lose a testicle. 

The patient needs to see a urologist if they need treatment for testicular torsion. This type of specialist is highly skilled in diagnosing the condition faster. This ensures treatment can be issued without any type of delay. 

Surgery is always the treatment for testicular torsion. Thus, men with symptoms do need to ensure they are ready for surgery and should at least understand what to expect. 

There are cases where a surgeon can untwist the patient’s spermatic cord in an emergency room. This can help to restore blood flow to the testes. Additional surgery will still be required later on. By untwisting the spermatic cord, it helps to reduce the risk of serious complications. 

The additional surgery that is done will be performed by a urologist. During the procedure, a few stitches are made around the testes. This helps to reduce the risk of the patient suffering from testicular torsion again in the future. 

There are times when the man may need to affect the testicle removed. The testicular appendage would also be removed. This happened when there was too much of a delay in providing treatment.

In this scenario, the restriction of blood caused tissue death in the tissue. The testicle is removed through surgery. The surgeon will still add some stitches around the other testicle. This helps to preserve the remaining testicle – and avoids that testicle also suffering from testicular torsion. 

There are rare cases where testicle torsion also happens in newborns. It is hard for a pediatric urologist to save a testicle affected by the condition in an infant. In most cases, the affected testicle will be dead. There are also some times where both testicles are dead. When this happens, the infant will not have testes – both need to be removed. 

Some urologists have been able to save a testicle in an infant. This happens when the pediatric urologist performs surgery within a few hours after the problem is identified. Several tissues need to be inspected, including the tunica vaginalis.

The surgery is needed within the first few days after birth. When this surgery is performed, one testicle is sometimes removed. The other one is then fixed in place with stitches. It helps to reduce the chances that the other testicle will be affected too. 

After Treatment

All treatments for testicular torsion involve surgical procedures. This means the patient needs to understand that healing takes some time. They will not recover from the procedure immediately. Knowing what to expect post-surgery helps the man be better prepared. 

First of all, the man should understand that it may sometime take a few weeks for the recovery process to complete. Most men will be able to return to work within a couple of days. There are cases where healing takes more time. The man may need about a week off from work. 

Men will be advised to avoid pushing themselves too much shortly after the surgery. Strenuous physical activity should be avoided. This can cause complications with the healing process. The man should be able to return to their usual exercise schedule after allowing their testicles a few weeks to heal. 

Most men find that the stitches in the scrotum and testicles do not cause irritation or serious discomfort. A lot of men do not even notice them. The stitches are important as they help to prevent a recurrence of the testicular torsion. 

The man will likely be provided with some pain medication. The medication should only be taken for a few days after the surgery. This helps to reduce swelling and pain caused by the surgery. It should not be needed for more than a week. 

If the man experiences swelling or pain symptoms after a couple of days, then they should contact the surgeon. This may be a sign of complications. 

Men should also ensure they understand what to expect after the surgery. If one of the testicles had to be removed during the procedure, the other one might grow larger than normal. This is a condition called compensatory hypertrophy. It usually does not pose any harm to the body. 

The risk of a recurrence is low when stitches are placed during surgery. Still, men should ensure they remain aware of any pain and swelling in their testes. 


Does testicular torsion affect fertility?

One of the most common questions that men ask is whether the condition will cause them to become infertile. Testicular torsion can cause the weakening or even loss of a testicular. When the patient only has a single testicle, they can still reproduce. 

Thus, when one testicle is affected by testicular torsion, the patient will not likely be infertile following treatment. Still, it is important to note that there may be a reduction in sperm count when the patient has only one testicle.

There are cases where testicular torsion causes the body to produce anti-sperm antibodies. In this case, sperm quality may be adversely affected. 

Is testicular prosthesis a good option?

Some men opt for a testicular prosthesis. This is a procedure where a synthetic “testicle” is added to the scrotum. It is generally only for aesthetic purposes.

The testicular prosthesis will not improve the function of the testes. It will not help with sperm quality or testosterone production. Still, some men may find that it helps with their confidence.

There are different types of testicular prosthesis products that can be used. Silicone is often used to create the fake testicle – the silicone is then filed with a saltwater solution.

It is important to consider the pros and cons. A surgical procedure will be required for a testicular prosthesis. Men should discuss their own risks and how the use of a testicular prosthesis may benefit them with the urologist.


Testicular torsion is a painful condition. It needs to be attended to by medical professionals quickly. When a man does not receive quick treatment, complications can occur. This may even lead to tissue death in one testicle.

Men should know how to recognize the signs of testicular torsion. It is also important for a male patient to understand how the treatment works. Understand what happens after the testicular torsion is treated should be important to male patients too.


  1. Endotext [Internet]. (2017) Endocrinology of the Male Reproductive System and Spermatogenesis. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK279031/
  2. StatPearls [Internet]. (2019) Testicular Torsion. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK448199/
  3. StatPearls [Internet]. (2020) Acute Scrotum Pain. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK470335/
  4. American Family Physician Journal. (2013) Testicular torsion: diagnosis, evaluation, and management. [online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/24364548

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