How quickly do I need to get to hospital?

Immediately. The testicle can usually be saved if blood flow is restored within about six hours of the pain starting, and the chance drops sharply after that. Do not wait to see if the pain passes, and do not eat or drink on the way, in case surgery is needed. Call emergency services if you cannot get to a hospital quickly.

Can torsion be mistaken for something else?

Yes. Epididymitis (infection), a twisted testicular appendage, hernia, and injury can all cause scrotal pain, and torsion can even present as abdominal pain. Because torsion is time-critical, doctors treat sudden testicular pain as torsion until proven otherwise, and will often operate rather than risk delay.

Will losing one testicle affect fertility or hormones?

A single healthy testicle usually produces enough testosterone and sperm for normal sexual function and fertility. Some studies show slightly reduced sperm quality after torsion, which is why prompt treatment matters. A prosthetic testicle can be placed for cosmetic reasons if desired.

Can torsion happen again?

After surgery with fixation of both testicles, recurrence is rare. If only one side was fixed, or if an episode resolved on its own without surgery, the risk of torsion remains, which is why surgeons typically secure both testicles during the operation.

UrologicalICD-10: N44.0Uncommon but a leading cause of acute scrotal pain in boys and young men

Testicular Torsion

Also known as: Twisted testicle, Torsion of the testis

Testicular torsion is a surgical emergency in which the spermatic cord that supplies blood to the testicle twists, cutting off its blood supply. It causes sudden, severe pain and swelling in one side of the scrotum, often with nausea and vomiting. Without treatment, the testicle begins to suffer irreversible damage within hours, so the chance of saving it is highest when surgery takes place within about six hours of the pain starting. Torsion is most common in newborns and in boys and young men between puberty and the mid-20s, but it can happen at any age. Anyone with sudden testicular pain should go to an emergency department immediately rather than waiting to see if it settles.

At a Glance

Common symptoms: Sudden, severe pain in one testicle, sometimes waking you from sleep or occurring during activity, Swelling and redness of the scrotum, A testicle that sits higher than usual or at an unusual angle
Main treatments: Emergency surgery to untwist the spermatic cord and restore blood flow, Fixing the testicle to the scrotal wall (orchiopexy) to prevent recurrence, usually on both sides because the anatomical susceptibility is often bilateral, Removal of the testicle (orchiectomy) if it is no longer viable
Category: Urological · Uncommon but a leading cause of acute scrotal pain in boys and young men
See a doctor if: Sudden severe testicular pain, with or without swelling (go to an emergency department immediately)

Symptoms

Sudden, severe pain in one testicle, sometimes waking you from sleep or occurring during activity

Swelling and redness of the scrotum

A testicle that sits higher than usual or at an unusual angle

Nausea and vomiting

Abdominal or groin pain

Pain that does not ease when the scrotum is lifted

Occasionally, pain that comes and goes if the cord twists and untwists on its own (intermittent torsion)

Causes

A congenital variation called the bell-clapper deformity, where the testicle is not well anchored within the scrotum and can rotate freely
Rapid growth of the testicle during puberty
Vigorous activity, minor injury, or cold temperatures triggering a twist in a susceptible testicle
Twisting of the cord above the scrotum in newborns, which can occur before or around birth
Sometimes no identifiable trigger, including during sleep

Risk Factors

Age between 12 and 25, with a second peak in newborns
A previous episode of torsion or intermittent testicular pain
A family history of torsion
An undescended testicle
The bell-clapper deformity, which often affects both sides

Diagnosis

Urgent physical examination; the diagnosis is often made clinically
Absence of the cremasteric reflex (the testicle normally lifts when the inner thigh is stroked)
Doppler ultrasound to assess blood flow to the testicle, if it will not delay surgery
Urine tests to help exclude infection as an alternative cause
Immediate surgical exploration when torsion is strongly suspected, even without imaging

Treatment

Emergency surgery to untwist the spermatic cord and restore blood flow
Fixing the testicle to the scrotal wall (orchiopexy) to prevent recurrence, usually on both sides because the anatomical susceptibility is often bilateral
Removal of the testicle (orchiectomy) if it is no longer viable
Manual untwisting by a doctor in some cases as a temporary measure before surgery
Pain relief and anti-nausea medication while awaiting surgery
Supportive after surgery: rest, scrotal support, avoiding strenuous activity and sport for a few weeks, and follow-up to check healing

Prevention

Torsion cannot be predicted or prevented in most cases, but prompt action prevents loss of the testicle
Teach boys and young men that sudden testicular pain is an emergency
Seek evaluation for episodes of testicular pain that come and go, since preventive surgery may be advised
Having both testicles fixed after an episode of torsion protects the other side
Wear protective equipment during contact sports

When to See a Doctor

Sudden severe testicular pain, with or without swelling (go to an emergency department immediately)
Testicular pain with nausea, vomiting, or abdominal pain
Scrotal pain following an injury that does not quickly settle
Repeated brief episodes of testicular pain that resolve on their own
A newborn with a swollen, discolored, or hard scrotum

Frequently Asked Questions

Related Conditions

Varicocele

Reproductive

Hernia

Digestive

Testicular Cancer

Cancer

Infertility

Reproductive

Urinary Tract Infection

Urological

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