Genital pain is usually nothing more than a mild and fleeting discomfort. But when it's more painful, it can be caused by a very serious condition called testicular torsion. Testicular torsion is a medical emergency that usually requires immediate surgery to save the testicle.

About Testicular Torsion

Testicular torsion, or testis torsion, occurs when the spermatic cord that provides blood flow to the testicle rotates and becomes twisted, usually due to an injury or medical condition. This cuts off the testicle's blood supply and causes sudden and severe pain and swelling.

Testicular torsion requires immediate surgery to fix. If it goes on too long, the testis can be permanently damaged and a boy can risk losing the affected testicle. This problem can happen to males of any age, including newborns and infants, but is most common in 10- to 25-year-olds and teens who've recently gone through puberty.

Causes

The scrotum is the sack of skin beneath the penis. Inside the scrotum are two testes, or testicles. Each testicle is connected to the rest of the body by a blood vessel called the spermatic cord.

Testicular torsion occurs when a spermatic cord becomes twisted, cutting off the flow of blood to the attached testicle.

Most cases of testicular torsion occur in males who have a genetic condition called the bell clapper deformity. Normally, the testicles are attached to the scrotum, but in this condition the testicles aren't attached, and therefore are more likely to turn and twist within the scrotum.

Testicular torsion also can occur after strenuous exercise, while someone is sleeping, or after an injury to the scrotum. Often, however, the cause isn't known.

Symptoms

If your son experiences sudden groin pain, call a doctor and get him to a hospital or doctor's office as soon as you can. Testicular torsion is considered a surgical emergency, meaning that when it happens, immediate surgery is needed to save the testicle.

Because surgery may be necessary, it's important to not give a boy with testicular pain anything to eat or drink before seeking medical care.

If your son has testicular torsion, he'll feel a sudden, possibly severe, pain in his scrotum and one of his testicles. The pain can get worse or subside a bit but generally won't go away completely.

Other symptoms:

• swelling, especially on one side of the scrotum
• nausea and vomiting
• abdominal pain
• one testicle appears to be higher than the other

Sometimes, the spermatic cord can become twisted and then untwist itself without treatment. This is called torsion and detorsion, and it can make testicular torsion more likely to occur in the future.

If your son's spermatic cord untwists and the pain goes away, it might be easy to dismiss the episode, but you should still call a doctor. Surgery can be performed to secure the testicles and make testicular torsion unlikely to occur in the future.

Diagnosis

When you arrive at the hospital or doctor's office, a doctor will examine your son's scrotum, testicles, abdomen, and groin and might test his reflexes by rubbing or pinching the inside of his thigh. This normally causes the testicle to contract, which probably won't happen if he has a testicular torsion.

The doctor also might perform tests to determine if the spermatic cord is twisted, including:

• Doppler ultrasound. High-frequency waves are used to make an image of the testicle and check blood flow.
• Urine tests or blood tests. These can help determine whether symptoms are being caused by an infection instead of a torsion.

Sometimes, it will be necessary for the doctor to perform surgery to make a diagnosis of testicular torsion. Other times, when the physical exam clearly points to a torsion, the doctor will perform emergency surgery without any other testing in order to save the testicle.

Saving a testicle becomes more difficult the longer the spermatic cord stays twisted. The degree of twisting (whether it's one entire revolution or several) determines how quickly the testicle will become damaged. As a general rule, after 6 hours, the testicle can be saved 90% of the time; after 12 hours, this drops to 50%; after 24 hours, the testicle can be saved only 10% of the time.

Treatment

Testicular torsion almost always requires surgery to fix. In rare cases, the doctor may be able to untwist the spermatic cord by physically manipulating the scrotum, but surgery will generally still be needed to attach one or both testicles to the scrotum to prevent torsion from happening again.

Usually, surgery for a testicular torsion is performed on an outpatient basis. If your son has a torsion, he'll be given a painkiller and a general anesthetic that will make him unconscious for the procedure.

Surgery consists of making a small cut in the scrotum, untwisting the spermatic cord and stitching the testicles to the inside of the scrotum to prevent future torsions. When that's finished, the doctor will stitch up the scrotum, and your son will be taken to a recovery room to rest for an hour or two before he's released.

Following the surgery, your son will need to avoid strenuous activities for a few weeks, and if he's sexually active, he'll need to avoid all sexual activity, too. Talk to the doctor about when it will be safe for your son to resume his normal activities.

If a torsion goes on too long, doctors won't be able to save the affected testicle and it will have to be removed surgically, a procedure known as an orchiectomy. Most boys who have a testicle removed but still have a viable testicle can father children later in life. However, many also opt for a prosthetic, or artificial, testicle a few months after surgery. This can help make some boys feel more comfortable about their appearance.

With newborn boys, saving the testicle is dependent upon when the torsion occurs. If it takes place before a boy is born, it may be impossible to save the testicle. In this case, the doctor may recommend a surgery at a later date to remove the affected testicle. If the symptoms of a torsion appear after a boy is born, the doctor may recommend emergency surgery to correct the testicle.

Don't Ignore Symptoms

Boys need to know that genital pain is serious and shouldn't be ignored. Ignoring pain for too long or simply hoping it goes away can result in severe damage to the testicle and even its removal.

Even if your son experiences pain in his scrotum that goes away, he still needs to tell you or a doctor and get checked out. A torsion that goes away makes him more likely to have another one in the future. Doctors can greatly reduce the risk of another torsion by performing a simple surgical procedure that secures the testicles to the scrotum.

If your son had a torsion that resulted in the loss of a testicle, it's important to let him know that he can still lead a normal life, just like anyone else. The loss of one testicle won't prevent a man from having normal sexual relations or fathering children.

Reviewed by: T. Ernesto Figueroa, MD
Date reviewed: July 2011