doctor examining man's balls for testicular torsion, Malegenix

Your spermatic cord runs from your abdomen down to your scrotum. Your spermatic cord is responsible for delivering blood to your testicles. At the end of the spermatic cord, your testes are suspended. However, when one of your testicles rotates, it can also twist your spermatic cord. When this happens, the condition is referred to as testicular torsion.

Testicular torsion is very painful. If it happens to you, you should get it treated right away, not just because of the pain, but also because there’s a danger that your testicular blood supply may get cut off. This can lead to various complications. Read on to learn more about this urological emergency.

Causes Of Testicular Torsion

Testicular torsion is actually quite common in babies and young boys aged 12-18 years. However, it can also occur in adult men at any age. There are instances when testicular torsion occurs even before birth.

In this case, surgery will be required after birth to correct the deformity and prevent testicular torsion from happening again. But the affected testicle while the baby was still in the womb can no longer be saved.

Babies with undescended testes or cryptorchidism often suffer from testicular torsion. When the testes are undescended, they remain in the abdomen and don’t go down to the scrotum. Since the testes are not positioned properly, they’re more likely to twist and rotate, causing testicular torsion.

Bell clapper scrotum is also another common cause of testicular torsion. Your testicles are supposed to be attached to your spermatic cord and your scrotum. However, your testicles may be poorly attached to your scrotum.

This can happen if you have an inherited trait which causes one or both of your testicles to swing around freely in the scrotal sac. When your testicles rotate freely, it can twist the spermatic cord and lead to testicular torsion.

diagram of healthy and twisted spermatic cord and testicles, MalegenixYou may experience testicular torsion anytime, whether you’re asleep, standing still, sitting, or while you’re working out. There’s no standard trigger or warning sign to tell you that your spermatic cord is about to get twisted suddenly and painfully. However, there are instances wherein injuries or rapid growth during adolescence prompt testicular torsion.

Several factors increase your chances of experiencing testicular torsion. Most cases of testicular torsion happen to young men between 12 and 18 years, but it’s quite rare in men over thirty years old.

If you’ve previously experienced testicular torsion, chances are high that it may happen to you again, in the same testicle or even in the other one. Interestingly, testicular torsion often happens during winter. When your scrotum is exposed to cold temperature, a sudden contraction can trap your testicles in a twisted position, causing testicular torsion.

Symptoms Of Testicular Torsion

The most indicative symptom of testicular torsion is a sudden and severe pain in your scrotum. The pain is so intense that if you’re asleep, it will definitely wake you up. You may also feel pain in the lower portion of your abdomen.

Other common symptoms of testicular torsion include scrotal swelling or redness. Because of the twisting inside your scrotum, one of your testicles may be positioned at an abnormal position.

The twisted testicle may also turn darker in color or become larger. You may also feel nausea and experience vomiting. In many instances, testicular torsion is accompanied by fever and frequent urination.

If you happen to engage in sexual activities right after you experienced testicular torsion, you may notice blood in your semen. These symptoms may show gradually over a period of several days or you may experience them at the onset of testicular torsion.

However, some of these symptoms are similar to other medical conditions, so you may not know right away that your testicle has become twisted inside your scrotum. For instance, acute orchitis or inflammation of the testicles can also cause similar symptoms.

Other medical conditions that also have similar symptoms include epididymitis or inflammation of the epididymis, scrotal injuries, testicular tumors, renal colic, and strangulated inguinal hernia.

Treatment Options For Testicular Torsion

Once testicular torsion is diagnosed, it’s considered a urological emergency. This is because you only have a window of a few hours to prevent severe damage to your testicle. Your spermatic cord is crossed by various veins, arteries, and nerves. This means that when your spermatic cord gets twisted, it can reduce the blood flow to your testicles.

testicular necrosis due to torsion represented by eggs on man's crotch, MalegenixThere are also cases when the blood supply to the testicles is completely cut off due to testicular torsion. When your testicles don’t receive enough blood supply, your testicular cells and tissues can start dying. In fact, if testicular torsion is not treated within the first six hours after its onset, it can result in testicular necrosis and atrophy.

When testicular necrosis happens, it means that parts of the affected testicle are already dead. Depending on the severity of the damage to the affected testicle, it may still be saved if treated right away. However, when the affected testicle has become grossly necrotic or a huge part of it has already died, then surgery will be necessary to remove it.

If the testis is still viable or if it hasn’t been badly damaged due to testicular torsion, your doctor may fix the testicle to your scrotum using a suture. This is to ensure that testicular won’t happen again.

The problem with testicular torsion is that if it gets treated more than 6 hours after the onset, the chances of being able to save the affected testicle decreases rapidly. If it gets treated more than 12 hours after the onset, chances are high that the affected testicle has already become grossly necrotic and can no longer be saved.

The surgical procedure for treating testicular torsion is actually quite simple and minimally invasive. Your doctor will need to cut open your scrotum to untwist your spermatic cord and set your testicle in the right position. The testicles are then stitched to the scrotum so that they won’t swing and rotate anymore.

Surgery for testicular torsion does not normally require hospitalization, so you can just recover at home after your surgery. However, you should avoid sexual activities and strenuous physical activities after your surgery.

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