Testicular torsion is a painful condition that occurs when the testicle twists on the end of the spermatic cord. This cord holds blood vessels that supply the testicle with blood. This corkscrew-like twisting cuts off the testicle’s blood supply. If the testicle stays tightly twisted, it will be damaged and could die.
Testicular torsion occurs most often in young men between 12 and 20 years old and it’s also common in newborn babies, but it can happen at any age. It’s rare, occurring in 1 in 5000 males. It can occur suddenly, for no reason, or following trauma, and is a medical emergency.
Before birth, testicles start to develop inside the abdomen (belly). As the fetus grows, testicles move down until they are inside the scrotum. Testicles stay attached to the abdomen by the spermatic cord and are fixed to tissues around them. Sometimes, the attachment is too loose and the testicle hangs too freely on the spermatic cord. Testicular torsion is more common in men with this problem, but it can occur without any abnormality.
Symptoms are sudden severe pain in the testicle and sometimes lower abdominal pain with nausea. The testicle can be swollen, tender to touch, and drawn up toward the abdomen.
The health care provider will take a medical history and do a physical examination. Ultrasonography or a nuclear scan will be done to confirm the diagnosis and rule out other disorders. The scan shows low blood flow to the testicle if torsion exists.
Immediate surgery must be done to prevent permanent damage to or loss of the testicle. Surgery untwists the testicle and the spermatic cord and puts them back in their normal positions. If surgery is delayed longer than 4 to 6 hours after the pain started, the testicle may not survive. The other testicle is often fixed to prevent similar torsion. If the testicle hasn’t survived, it’s removed (called orchiectomy). If the other testicle is healthy and not removed, sex life and the ability to father children won’t be affected.
After surgery, bed rest and wearing scrotal support or a jock strap (for swelling or discomfort) may be needed. Lifting heavy items or playing contact sports should be avoided. Sex can be resumed when it’s comfortable.
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