Testicular Torsion: What You Should Know
There are certain pains that come with competing in a sport. Some are preventable, like wearing cups and shin guards to avoid injuries, while others are unavoidable, such as soreness after a tough game. Pain is simply part of athletics. In my experience, I have taken a soccer ball to the testicles trying to block a kick in a game. Getting hit below the belt is not something you can prepare for. After some agony you can usually get up and continue playing. But some testicular pain you can’t walk off.
Far worse than the pain from a ball to the testicles is a condition called testicular torsion. To learn more about testicular torsion, I spoke with Dr. Ariella Friedman, Pediatric Urology Fellow at Cohen Children’s Medical Center in New Hyde Park, New York.
Sex, Etc.: What is testicular torsion?
Dr. Friedman: Testicular torsion is a medical problem in which the blood supply to the testicle is twisted. Males generally have two testicles that each hang from a cord (the spermatic cord). If the cord that supplies blood to the testicle becomes twisted (inside of the scrotum), the blood vessels become compressed, and blood can’t flow to the testicle. If this happens for a prolonged period of time, the testicle is at risk for permanent damage and there may even be risk of death of the testicle. In about 30 to 40 percent of cases, testicular torsion results in loss of a testicle.
The main symptoms associated with testicular torsion are sudden, severe pain in the scrotum, nausea or vomiting, and redness or swelling in the scrotum. Not all severe scrotal pain is due to testicular torsion, but because the cause of pain isn’t always known until someone gets evaluated by a health care provider, all cases of severe scrotal pain need to be treated as an emergency.
Sex, Etc.: How common is the condition? What should teens know about testicular torsion?
Dr. Friedman: Testicular torsion occurs in one in 1,500 to one in 4,000 males by the age of 25. It is most common in pre-adolescents and adolescents ages 11 to 19. To put the incidence in perspective, it is roughly four times as common as testicular cancer yet not discussed nearly as frequently.
The most important thing to know about testicular torsion is that it is an emergency. The time from the start of symptoms until treatment is the most important predictor of the ability to save the affected testicle. If treatment is given within six hours of the start of pain, there is a more than 90-percent chance of being able to save the testicle. The ability to save a testicle drops with each hour, and if the pain has been occurring for more than 24 hours, there is a 10-percent chance or less of being able to save the testicle.
Sex, Etc.: Can testicular torsion fix itself, or is medical treatment necessary?
Dr. Friedman: Most cases of testicular torsion do not resolve on their own, so evaluation by a health care professional is necessary. Evaluation typically involves an ultrasound test where a wand-like instrument is placed on the scrotum to evaluate blood flow to the testicle. Treatment may involve untwisting the testicle, but usually emergency surgery is required. During surgery, the patient is asleep, a small incision in the scrotum is made, and the testicle is untwisted. If the twisted testicle appears healthy enough, it can be saved, and it is secured in position to prevent a future torsion episode. If the torsion has caused too much damage by the time of surgery, the testicle may need to be removed.
Sex, Etc.: Are there any long-term effects of testicular torsion? After treatment, will a guy be able to contribute to pregnancy in the future?
Dr. Friedman: The good news is that only one testicle is generally needed to carry out the functions of a testicle—namely, making hormones (testosterone) and contributing to pregnancy. Even if someone loses a testicle to torsion, he is still usually able to carry out these roles. However, in some rare cases, testicular torsion can put someone at risk for infertility or difficulty in creating a pregnancy. Finally, while there is nothing to be ashamed about in losing a testicle, loss of a testicle can be emotionally difficult for some.
Sex, Etc.: Can testicular torsion be prevented?
Dr. Friedman: [Most] of the time, there is no identifiable cause for testicular torsion. That is why the most important tool in preventing testicular loss in torsion is seeing a health care professional immediately if someone has sudden and severe scrotal pain.