Testicular torsion is what occurs when the testicle rotates inside the scrotum, which then twists the spermatic cord, cutting off blood flow to the testicle. Often, this will present as severe pain and swelling, as well as a testicle that’s positioned higher than normal or at an unusual angle. This can be accompanied by abdominal pain, fever, nausea and vomiting, frequent urination, discoloration, or a visible lump. While rare, testicular torsion is considered a medical emergency, and anyone experiencing these symptoms should seek immediate medical attention. If blood flow does not return to the testicle within 6 hours, there can be serious consequences, and the longer you wait for treatment, the more likely it is that you may lose the affected testicle.

The average age range of individuals affected by testicular torsion is usually between 12-18 years old, with around 68% of reported cases in this age range. However, it is still possible it will affect people at other ages. Typically, testicular torsion occurs in the left testicle, due to the way the veins are arranged. Both testicles could be affected, but this is very rare, with about 2% of all cases affecting both testicles.

Causes

It is unknown exactly what causes testicular torsion; however, you may be at higher risk if you are between 12 and 18 years of age, have had torsion occur previously, have a family history of testicular torsion, or have the bell clapper deformity. The bell clapper deformity is a genetic trait in which the testicles are detached from the scrotum and swing freely inside. Otherwise, testicular torsion may occur following an injury to the testicle or scrotum.

If testicular torsion is not treated immediately there becomes severe risk of testicular damage, testicular death (due to a cut off of blood flow, the testicular tissues die), or infertility. If the testicle dies or becomes damaged, then surgery is needed to remove the affected tissue, so that infection does not develop or spread.

Treatments

Because testicular torsion presents as general pain in the region, doctors may perform tests like scrotal ultrasounds or urine analysis to check for other issues that may be causing pain. Some issues that may cause pain in this area are sexually transmitted infections or diseases, varicoceles, kidney stones, etc. If loss of blood flow is not clear via scrotal ultrasound, surgery may be performed to identify the issue. Again, the longer you wait to seek medical attention, the more at-risk you are of needing to remove the affected testicle. If treatment is delayed by more than 12 hours, there’s about a 75% chance of testicle removal.

Generally speaking, testicular torsion is treated through a surgery known as an orchiopexy, which is designed for both testicular torsion and undescended testicles. The procedure involves making an incision in the scrotum, untwisting the affected testicle, and attaching it to the scrotal wall via stitches. If the affected testicle appears to look unhealthy (damaged or dead), it may be removed (a surgery called orchiectomy) and replaced with an artificial testicle.

Testicles may untwist on their own, or a healthcare professional can perform what is called a “manual detorsion,” which is exactly what it sounds like; if possible, the testicle is untwisted via manipulation of the scrotum. However, to avoid another instance of testicular torsion, it’s recommended to have the orchiopexy conducted so that the testicles cannot move around on their own anymore.

Conclusion

Testicular torsion is an emergency situation in which blood flow is cut off to the affected testicle via twisting of the spermatic cord. The longer the wait for diagnosis and treatment, the more likely it is that the testicle will become damaged or need to be removed. Testicular torsion is more likely in younger individuals, around pubescent age, and in those who have the bell clapper deformity. Surgery will almost always be needed (and is highly recommended) regardless of whether the issue resolves itself or if the testicle is untwisted manually. If you are experiencing severe pain in the groin area, speak with a healthcare professional as soon as possible.

References:

• Mayo Foundation for Medical Education and Research. (2022, February 24). Testicular torsion. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270
• Ranjiv I Mathews, M. (2024, November 25). Testicular torsion. Medscape. https://emedicine.medscape.com/article/2036003-overview
• Testicular Torsion. Cleveland Clinic. (2023, February 27). https://my.clevelandclinic.org/health/diseases/15382-testicular-torsion
• What is an orchiopexy?. Cleveland Clinic. (2025, January 15). https://my.clevelandclinic.org/health/treatments/17297-orchiopexy