Testicular torsion happens when a testicle rotates and that rotation twists the spermatic cord, compromising blood flow to the testicle.

This restriction of blood flow can cause sudden and severe pain and swelling. Testicular torsion can happen at any age, but it is most common between ages 12 and 18. Testicular torsion is a medical emergency.

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This serious condition should be treated as an emergency. As such, seek medical attention if you notice these symptoms:

  • Sudden, severe pain located on one side of the scrotum
  • Scrotal swelling—one side quickly becomes larger than the other side
  • Abdominal pain
  • Nausea and vomiting
  • Fever
  • A testicle that is physically higher than normal or seems like it is positioned at an unusual angle
  • Change in color of the scrotal sac, especially redness or darkening
  • Those who get testicular torsion may wake up in the middle of the night or early morning with severe scrotal pain.


It is not clear why testicular torsion occurs and it is not a common problem. Physical activity does not in itself cause torsion, however, torsion may happen during exercise. Torsion may also happen while sitting, standing or sleeping.

The chances of testicular torsion occurring are about 1 in 4,000 males under the age of 25, but can also occur in newborns and older males. Most testicles are attached to the scrotal tissue in such a way that they will not twist. Some males are born without this attachment which allows the testes to turn more freely inside the scrotal sac. Testicular torsion typically occurs on one side, to one testis, but it is possible to develop testicular torsion on both sides.


Testicular torsion requires emergency surgery to untwist the spermatic cord and reestablish the blood supply. If the flow of blood to the testicle has been cut off for too long, typically no more than 6 hours, the testicle can become so badly damaged that it has to be removed. The quicker the testicle is treated the higher the chances are of it being saved.

It is possible to untwist the cord in the Emergency Department, however, all patients need to follow up with a urologist for surgery. During the surgery the urologist will untwist the testicle and spermatic cord, making sure to take measures to prevent torsion from recurring. If the testicle cannot be saved, it will be removed and stitches will be placed around the other testicle to prevent torsion from happening on that side.

Remember, the sooner testicular torsion is diagnosed and treated, the better the odds of saving the testicle.

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