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Testicle Pain & Testicular Torsion

​​​Testicular pain in teens could be a sign of testicula​r torsion.

The most important thing to know about testicular torsion is that it is an emergency that must be treated immediately. But, it can be difficult for teenage boys to talk about their testicles or tell a parent if they are having pain. Boys need to know that any genital pain is serious and should not be ignored. Ignoring testicle pain for too long or simply hoping it goes away can result in severe damage to the testicle and even its removal.

Time is critical!

If your son has pain in his testes, take him to the emergency room right away. The time from the start of symptoms until treatment is the most important factor in being able to save the testicle. The longer someone waits to seek treatment, the greater the risk of permanent injury. 

  • If treated within 6 hours of the start of pain à over 90% chance of saving the testicle.
  • If treated after 24 hours of pain à​ less than 10% chance of saving the testicle.

This includes the time it takes to get to a hospital, get evaluated, and get treated. 

What is Testicular Torsion?

Testicular torsion most often occurs in teenage boys and is the most common pediatric emergency of the genitourinary tract.

Boys usually have two testicles sitting in the scrotum, and each one hangs from a cord – the spermatic cord. The cord carries important structures such as blood vessels, which give the testicle oxygen. If the cord were to twist, the testicle would lose its blood supply and oxygen.

The pain is excruciating, but somehow many boys or their parents try to ignore it.  That denial comes at a cost. If the torsion isn't corrected quickly, the testicle may die. 30-40% of cases of testicular torsion results in loss of the testicle.

What are Symptoms of Testicular Torsion?

The symptoms of testicular torsion may involve one or both of the testes. The following are the most common symptoms of testicular torsion. However, each child may experience symptoms differently.

Symptoms may include:

  • Pain in the scrotum (Usually on one side, sudden, and severe)
  • Swollen, red, tender scrotum
  • Enlarged testicle
  • Abdominal pain
  • Nausea or vomiting

Not all severe scrotal pain is torsion, but since the cause of pain isn't known until a boy is evaluated, all cases of severe scrotal pain need to be treated as an emergency.

Who is At Risk for Testicular Torsion?

  • Age: It most commonly occurs in teenage boys, shortly after puberty, however it can occur in younger children. It is uncommon over the age of 25.
  • Family history: Having a relative who had torsion increases the risk of torsion, (but this is not always known). 
  • Setting: Torsion can occur at any time (even when asleep). Sometimes, torsions happen from a sports injury. Wearing a cup for any contact or high-impact sport may help prevent torsion or other injuries to the testicle.

How is Testicular Torsion Diagnosed?

  • Physical examination
  • Scrotal Doppler ultrasound (a wand-like instrument  placed on the scrotum to assess blood flow to the testicles)
  • Some urologists will take a patient with typical symptoms of torsion directly to the operating room.

How is Testicular Torsion Treated?

Immediate surgery to untwist the testicle is required to potentially save the testicle. After untwisting, the testicle is secured in the proper position. If the torsion has caused too much damage, the testicle may need to be removed. It may also be necessary to secure the other testicle to prevent it from twisting. Some urologists may untwist the testicle with a bedside maneuver before surgery, but surgery is still required.

Can Testicular Torsion Fix Itself?

Occasionally, a testicle can twist and untwist. This is called intermittent torsion. In intermittent torsion, severe pain may suddenly appear and then just as suddenly get better.

This type of pain still needs to be evaluated by a healthcare professional for several reasons:

  • Most torsions don't improve on their own. Waiting for the testicle to untwist increases the risk of losing a testicle.
  • Even after untwisting, the testicle is at risk for a future episode of torsion.
  • Sometimes the untwisting is not complete and there is less blood reaching the testicle, which causes damage even though the pain is much better. 
  • Twisting and untwisting can still injure the testicle, even if it doesn't cause loss of the testicle.
  • When one side has torsion, the other testicle is at higher risk for torsion. Both sides need to be evaluated and possibly treated.
  • Not all scrotal pain is a torsion. Pain that comes and goes may be due to other causes, which also need to be evaluated.

What if a Testicle Needs to Be Removed?

The testicle is removed (orchiectomy) if the torsion is severe, the blood supply is lost, and the tissue in the testicle dies. Fortunately, only one testicle is generally needed to carry out the functions of a testicle:

  • Making hormones (testosterone)
  • Contributing to pregnancy

So, even if someone loses a testicle to torsion, they are still usually able to carry out these functions. However, in some rare cases, testicular torsion can increase the risk for infertility.

Testicular Implants

While there is nothing to be ashamed about in losing a testicle, loss of a testicle can be emotionally difficult for some boys. At a later time, if you and your son desire a more cosmetic appearance, testicular implants exist that can be placed surgically.

What Should Parents of Teen Boys Keep in Mind?

While it may be awkward to discuss genital anatomy with your preteen and teenage son, they need to know that any pain in their genitals is an emergency.

  • Talk to your son about the risks of keeping severe scrotal pain a secret.
  • Reassure him that there is nothing to be embarrassed about.
  • Encourage him to tell you or an adult if they are having sudden, severe scrotal pain. This is the best way to prevent loss of a testicle.

Watch and share this video 

School health programs and or to anyone wishing to educate a friend or relative about testicular torsion are encouraged to watch this video for additional information.

Last Updated
Section on Urology (SOU) (Copyright © 2015 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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