Sudden and severe pain in the testicles. Testicular torsion.

Severe pain in the testicles is an urgent medical problem.  If the doctor diagnoses testicular torsion then you will need to have a (small) emergency operation to put the problem right.

In this article we’re going to look at the symptoms and treatment for testicular torsion but if you have been experiencing bad testicular pain for more than an hour or 2 then see your doctor urgently.  Without prompt treatment the affected testicle can die.

‘Testicular torsion’ means ‘twisted ball’ and we will explain how this happens below.

Testicular torsion is relatively rare. It happens in about 1 in 4000 boys and young men.  It’s most common in the under 25s but can happen in newborns and older men.

What are the symptoms of testicular torsion?

  • Pain on one side of the scrotum (balls’ sack) that’s severe in nature. It is very rare that both testicles twist at the same time.
  • You may have pain in the middle of the abdomen instead of/as well as the pain in the scrotum.  This is because of the way the nerves feed that part of the body.
  • It may wake you from sleep, as more than half cases occur at night.
  • You may find that you can’t find a position that’s comfortable.
  • There may be no swelling to begin with but after a short time the scrotum is swollen, tender and red or purple.
  • You may feel sick or vomit as well as having the pain.
  • Boys sometimes have these pains that recover on their own.  This is the testicle twisting but sorting itself out.  Eventually it will twist and not untwist, so see your doctor to have corrective surgery before it becomes an emergency.

The testicle has twisted its blood supply and will die if corrective treatment is not carried out within 6 hours. 

What tests will the doctor do for testicular torsion?

As this is an urgent problem it’s a good idea to go to the Emergency Room/Casualty Department if you have a sudden one-sided pain in the testicles.  When you see the doctor he will examine you and ask about your medical history, including any recent trauma to the scrotum.

If he’s in doubt about the diagnosis he may ask for a scan of the scrotum, urine specimen to rule out a urine infection, and take a swab of any fluid/discharge at the end of the penis to rule out other infections.

What is the treatment for twisted testicles?

A small operation, performed via a small cut in the skin in of the scrotum.  The surgeon will untwist the testicle and stitch it in place inside the balls’ sack.

He will also secure the other testicle at the same time as there is a high chance that the same thing can happen to this one.

The stitches are not bothersome after the operation and don’t need to be removed.

You will be able to return to normal activities after a few weeks, with your surgeon’s guidance, but don’t do any vigorous sports or activities until you’re told it’s safe.

The testicle may shrink a little after it has recovered.

If the testicle has died because of the lack of blood supply then it will be removed from the scrotum and the other testicle will be stitched in place.  A prosthetic testicle may be considered at a later date.

What causes testicular torsion?

In most men and boys the testicle sits snugly and securely in the scrotum.  But in some there is a looser ‘fit’.

You can see from the diagram that there is a cord looping from above the testicles.

twisted balls, testicular torsion,

The testicle twists on the spermatic cord.

This is the spermatic cord and is like a pipe containing the sperm ducts (vas deferens) and the blood supply to the testicle.  If the testicle is quite loose in the scrotum it can move more freely and therefore may twist on itself.

This twisting is the testicular torsion.

It is not caused by vigorous sports and can come on at any time.

Will my sex life be affected?

The function of the testicles is to make sperm and testosterone.   The sperm is essential for reproduction and the testosterone is the hormone that gives men their characteristic male appearance.

Doctors generally agree that one testicle will do this as well as two.  Your sex life should therefore not be affected.

However some patients (about 1/3) have a reduced sperm count and reduce motility of the sperm (they can’t swim well).  This will affect fertility.

How can I prevent testicular torsion?

Testicular torsion can’t be prevented as men often don’t realise they’re prone to it.

If you have had one testicle that has needed corrective treatment, the other will have been stitched in place at the same operation.  However it’s advisable to wear proper protection when playing contact and ball-throwing sports such as baseball and cricket.

However boys sometimes have these pains that recover on their own.  This is the testicle twisting but sorting itself out.  Eventually it will twist and not untwist so see your doctor to have corrective surgery before it becomes an emergency.

If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault in some way, read this page now:  How to talk to a doctor about an embarrassing problem.

Elspeth Raisbeck

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