Discussing testicles may be uncomfortable for most guys, but any genital pain should be taken seriously. Men of any age are susceptible to testicular torsion, especially after strenuous physical activity or while sleeping.
Situations arise when the blood supply to a testicle becomes twisted inside of the scrotum and rotates into itself, cutting off blood flow to it. Without help quickly, testicles may die.
Causes
Testicular torsion occurs when one of the cords that supplies blood to one of the testicles twists, cutting off its supply and leading to sudden pain and swelling in that testicle (testis). This condition should be considered medical emergency; failure to treat within six hours could lead to irreparable damage being done to that testicle (which would make treatment imperative).
Torsion of a testicle can result in a painful swollen groin area, especially at the lower portion of their abdomen, rendering them unable to bend over or lie down due to pain, feeling sick, vomiting and feverish – possibly with fever and sweating as well.
Boys affected by this condition cannot prevent it. Most commonly, their spermatic cord – the source of blood to their testicles – becomes twisted. While it tends to occur more commonly among younger people going through puberty, newborn babies and even elderly individuals may develop it.
Boys affected by testicular torsion tend to experience greater symptoms on their left testicle; less than 2% experience both testicular torsions at once.
Torsion detorsion occurs when the spermatic cord unwinds itself without medical treatment, usually as a genetic predisposition or due to thinness. Torsion detorsion may also happen with boys who have an increased genetic predisposition for twisting of the spermatic cord or have thinner than usual spermatic cords.
Teachers, school nurses, community health workers and parents who care for children must be familiar with the signs and symptoms of testicular torsion in order to act promptly should the need arise. Urologists should also be informed if someone has had history with torsion so they can check for it when performing other tests on them.
Due to severe pain, children suffering from testicular torsion may be reluctant to tell anyone of their condition; they might feel embarrassed talking about it or want no one looking at their scrotum and testicles. But it is essential they recognize its seriousness as soon as possible and go to hospital or clinic immediately for diagnosis and treatment – even if that means being humiliated in front of others.
Symptoms
Testicular torsion is a medical emergency in which one testicle’s cord that supplies its blood to it rotates and becomes twisted, cutting off its blood supply and leading to pain and swelling in that testicle. Without intervention within six hours, its blood flow could cease altogether and lead to death of that testicle – symptoms including sudden, severe pain in the scrotum (sack beneath penis).
Torsion pain typically presents itself asymmetrically, with symptoms located solely on one side of the scrotum. Touching this area may be painful; sharp and burning pain usually characterizes affected testicles while they can sometimes feel numb or cold, creating difficulty when moving legs or feet due to pain in lower abdomen and inguinal region.
Clinical diagnosis is most reliable when made based on classic symptoms, including sudden unilateral scrotal pain that does not respond to positioning, as well as loss of the cremasteric reflex. Urologists or family physicians can perform the cremasteric reflex test by gently stroking scrotum skin patches on groin areas with their fingertips while asking patients to raise one leg; activation of this reflex often is an early indicator of torsion.
Torsion in men of any age is possible, although most frequently experienced by boys and young men aged 12-18. Torsion typically results from strenuous exercise, sleep disturbance, injury to the scrotum or genetic conditions such as bell clapper deformity – where their testicles don’t connect directly to their scrotum and therefore more likely to twist within it – or from injury of any sort.
All men should know how to recognize the signs and symptoms of testicular torsion and when seeking emergency care. In particular, boys and young men need to talk openly with their parents or healthcare providers about any genital discomfort or problems, even if this makes them feel embarrassed; this will ensure they get immediate medical assistance should something go amiss.
Diagnosis
Testicular torsion should always be considered an emergency when any patient presents with pain and swelling in their scrotum, especially boys under 18. Torsion usually affects boys 12-18, when testicle tissue loosens and twists around its blood supply to form a tight knot that restricts its blood flow causing severe pain and swelling if untreated resulting in testicular infarct.
Patients suffering from testicular torsion should visit an emergency department (ED) immediately in order to avoid permanent damage. It’s crucial that their condition be identified quickly – before blood flow decreases, typically within six hours after symptoms arise.
Diagnostic criteria for testicular torsion involve history review and physical exam. Common symptoms of torsion are red and swollen scrotum as well as acutely painful testicle that often accompanies vomiting or nausea; its intensity can change depending on whether the testicle has been elevated, although in some cases patients may not even feel any pain at all.
Emergency department doctors must conduct a full assessment and rule out other potential conditions that could produce similar symptoms, such as epididymitis, strangulated inguinal hernia or traumatic hematoma. A physical exam must include careful inspection of the scrotum; specifically eliciting cremasteric reflex by gently stroking inguinal region which causes opposite testicle to rise slightly when stroked by finger.
Doppler ultrasound, which measures blood flow by placing an ultrasound probe over an area with blood, can be an extremely helpful test. A physician will look for peaks in venous Doppler waveforms of an asymptomatic testicle as well as whether there is arterial flow present or absent.
Rarely, newborn infants may suffer testicular torsion due to an unusual birth defect in the tunica vaginalis known as bell clapper deformity. With this birth defect, the spermatic cord becomes attached high on tunica vaginalis allowing it to rotate within their testicle and twist further than expected.
Treatment
Testicular torsion occurs when the cord leading into a man’s testicle twists and cuts off blood flow, potentially killing his testicle within six hours if left unattended. Therefore, men must recognize the signs of testicular torsion immediately and notify an adult immediately – it could save his testicle’s life!
Symptoms vary by age. Newborns generally show no pain; their parents may only notice a swollen scrotal mass during diaper changes or newborn exams. Older children and teens often feel abdominal discomfort and vomit, with hard or swollen testicles sometimes hardening as time goes on without blood flow to it – this could require surgery; otherwise more damage will have been done over time.
Treatment typically occurs within an emergency department setting with an interprofessional team of providers. A triage nurse must recognize the symptoms of testicular torsion and contact a urologist immediately for assistance; an ED physician should perform an exam, obtain an ultrasound scan of the scrotum and obtain confirmation that torsion has taken place before performing treatment.
After diagnosis, the priority should be restoring blood flow. Doctors may put pressure on the scrotum with a rolled towel or pillow and use a needle to break apart any blood clots within its sac. They can also prescribe numbing medicine and antibiotics as treatment options.
If the testicle remains twisted, a doctor can attempt to untwist it manually by positioning their patient on their back and gently pulling on it with both hands. They may also rotate it like they’d open a book; their goal should be to rotate it in the opposite direction so the cord rotates into its proper place before stitching it back together again.
Preventing testicular torsion involves being extra vigilant during sports and other physical activities, especially those that involve sudden one-sided pain, high-riding testicles in the scrotum and tender, red scrotal lumps. If this occurs to you, call your doctor immediately; take it easy until the discomfort subsides or you visit an ER physician; elevate scrotum, wrap in towel or cold compress and apply ice as often as needed throughout the day while taking nonsteroidal anti-inflammatory drugs like ibuprofen as necessary – take precautionary measures until help arrives if needed.