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Testicular Torsion: Embarrassing to Talk About, but a Very Serious Matter

By Joan Delto, MD July 22, 2020 Posted in: Wellness

Pain in the testicle may be difficult or embarrassing to talk about, however sometimes this can be a very serious matter and shouldn’t be ignored.  Some common causes of pain include:

  • Trauma (like getting kicked in the groin)
  • Urinary tract or sexually transmitted infection
  • Inflammation
  • Skin infection around the scrotum (skin around the testicle)
  • Hernia
  • Hydrocele (fluid around the testicle)

Testicular torsion, or twisting of the testicle, causes pain in the testicle; it is considered an emergency and should be addressed immediately. This happens when the testicle twists on itself, cutting off its own blood supply, and if this condition is not addressed within a few hours, torsion may lead to the testicle dying.

What Does Testicular Torsion Feel Like?

Testicular torsion happens most commonly in boys and men ages 12-18 years old, but can happen at any age. Patients often complain of a new onset of intense pain to the testicle, which may occur after sports or activity or sometimes the pain may awaken them from sleep. Patients may experience nausea and vomiting along with the pain, but they typically do not complain of any associated urinary complaints like burning, urgency, and frequency with urination. Sometimes the testicle can appear to be lying in a different position than usual. Boys with a history of undescended testicles (testicles that didn’t drop down into the scrotum as a child) or scrotal surgery may have a higher risk of developing torsion.

Complications With Testicular Torsion

Testicular torsion is an emergency and patients should go to the emergency room to be evaluated.

The physician will do an evaluation and obtain an ultrasound to check for blood flow to the testicle. If the testicle does not appear to be alive at the time of surgery, it will likely need to be removed. Urologists, who are surgeons of the male reproductive tract, are often involved. If there is no blood flow, the urologist will perform emergency surgery to untwist the testicle and secure it so that it will not twist again. Although the other testicle is often not involved, it is recommended that it too be secured to prevent that side from twisting in the future.

The sooner the patient undergoes surgery from the time the pain began, the better the chance of saving the testicle. Studies have shown that if surgery is delayed for longer than 24 hours after the onset of pain, there is an 80% chance of having to surgically remove the testicle versus only 5% if surgery is done within 6 hours.

Can Testicular Torsion Cause Infertility?

After surgery, patients can go on to live a normal life.  However, loss of a testicle may sometimes negatively affect body image.  In terms of fertility, if the remaining testicle is healthy and normal in size, the patient should have no issues fathering children in the future.  If the remaining testicle is smaller than normal, testosterone (a hormone produced by the testicle) production may be reduced, which could possibly affect physical characteristics and sexual development. The patient would then need to see an endocrinologist, a hormone specialist.

Boys, teenagers, and men should never ignore severe pain to the testicle, and they should be aware that this could be an emergency that may need surgery to save the testicle. Even though it may be embarrassing or awkward to talk about, new severe testicular pain or any suspicion for testicular torsion should be evaluated immediately. If you have any concerns, do not delay your care, schedule with a provider today.

Joan Delto, MD
Joan Delto, MD

Joan Delto, MD is a Urologist with CHI Health.

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