Torsion: A cause of testicular pain
October 15, 1999
Web posted at: 11:43 AM EDT (1543 GMT)
By Steven Gange, M.D.
At age 18, Josh began experiencing recurrent pain and swelling in his right testicle. Five years later, the symptoms have continued. The pain occurs spontaneously and usually lasts an hour before subsiding. When the pain is absent, the testicle feels smooth and soft -- like a normal testicle. What could be the cause?
Testicular pain can stem from any number of sources, but in Josh's case, his symptoms and history suggest a condition known as intermittent testicular torsion, which can be confirmed in a physical examination.
What is testicular torsion?
The testicle is attached to the body by the spermatic cord, which is made up of nerves, blood vessels, the vas deferens (the tubes that carry sperm) and muscle fibers. Torsion occurs when the cord twists, cutting off blood flow to the testicle. Most testicles are well supported in the scrotum and can't twist. Those that do twist tend to lack good scrotal support and hang free, like a bell clapper.
Torsion occurs most commonly between the ages of 12 and 18, the years when testicles are growing rapidly. "Acute torsion" usually comes on suddenly and requires an operation within approximately six hours of onset in order to restore blood flow and ultimately save the testis.
"Intermittent torsion" is a rare condition in which a patient experiences recurrent episodes of scrotal pain caused by temporary twisting of the spermatic cord.
It's much more common for males to experience sudden, acute testicular torsion than years of intermittent torsion. It's believed that during episodes of intermittent torsion, the spermatic cords are becoming untwisted, or "detorsed," either on their own or as the man manipulates his testicle to try to alleviate the pain. (Even in the case of acute torsion, doctors can manually untwist the testicle to restore blood flow as temporary relief prior to surgery.)
Intermittent torsion is difficult to diagnose. It requires careful examination and often an ultrasound or special X-ray during an episode of pain to demonstrate diminished blood flow to the affected testis.
Treatment for intermittent torsion
Anyone experiencing sudden testicular pain should seek immediate medical help. If a patient is experiencing recurrent testicular pain, he should see a urologist. If diagnosed with intermittent torsion, he can be treated with an orchiopexy (a procedure to fix the testicle more firmly to the wall of the scrotum).
Since it is likely that this bell-clapper deformity exists on both sides, men with intermittent torsion should have both testicles fixed. This outpatient procedure takes less than an hour and is performed through a small incision in the scrotum while the patient is under general anesthesia.
Ignoring the problem or choosing not to have surgery may result in the loss of a testicle.
Copyright 1999 WebMD, Inc. All rights reserved.
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