Testicular Torsion · What Is It, Causes, Pain, Appearance, Treatment, and More

Published: Apr 08, 2026

Author: Michail Mavrogiannis, MD•

Editor: Antonella Melani, MD•

Editor: Ahaana Singh•

Editor: Lisa Miklush, PhD, RN, CNS•

Editor: Mary Roberts, MSN, RN •

Editor: Arianna Succi, MD

Illustrator: Aileen Lin

7-day free trial

Go deeper with Osmosis

Osmosis is a learning platform with videos, questions, and AI tools to help you master topics like this.

4.8 · 12,000+ reviews

Watch quick, visual videos

Practice with Qbank-style questions

Use AI to explain, quiz, and review

Study anytime with the mobile app

Start free trial

No credit card · Cancel anytime

What is testicular torsion?

Testicular torsion occurs when the testicle rotates around the spermatic cord – a bundle of nerves, blood vessels, and ducts that run to and from the testicles – resulting in twisting of the cord and subsequent compromise of blood flow. Testicular torsion typically affects adolescents, although it can occur at all ages, including newborns and older adults.

Learn deeper with Osmosis

Master this topic faster with videos, questions, and AI.

Used by 8M+ healthcare learners.

Start free trial

No credit card · Cancel anytime

Is testicular torsion serious?

Testicular torsion is a very serious condition and is considered a medical emergency. Rotation of the testicle around the spermatic cord can cause obstruction of arterial blood flow to the testicle and of venous outflow, which can ultimately lead to necrosis or death of the testicular tissue. Treatment should be sought immediately — ideally within the first six hours from onset – to maximize the likelihood of testicular salvage and avoid permanent damage and necrosis. After 12 hours, the testicle may not be salvageable.

What does testicular torsion feel like?

Testicular torsion is characterized by the sudden onset of acute, severe pain in the scrotum and lower abdomen, typically involving the side of the affected testicle. If testicular torsion occurs during sleep, the sudden onset of severe pain may awaken the individual. Individuals may also experience dizziness, nausea, and vomiting.

What does testicular torsion look like?

Testicular torsion typically occurs in one testicle, while bilateral testicular torsion is very rare. The condition can manifest with sudden severe pain of the affected testicle, along with swelling and redness of the scrotum (the pouch of skin containing the testes). Elevation of the scrotum typically worsens the pain. Additionally, the affected testicle may appear elevated within the scrotum due to twisting and shortening of the spermatic cord.

What causes testicular torsion?

The exact causes of testicular torsion are not clear. Most cases are associated with a testicle’s failure to strongly attach to the scrotum at birth, allowing it to rotate within the pouch. Most cases are associated with a congenital anatomic abnormality known as the bell-clapper deformity, in which the testis is inadequately attached to the scrotal wall, allowing it to rotate freely within the tunica vaginalis (a pouch covering the front and sides of the testis and epididymis). Occasionally, testicular torsion occurs after minor trauma to the scrotal area. It can also occur during sleep or after vigorous physical activity.

How do you diagnose testicular torsion?

The diagnosis is mostly clinical, based on the presentation of the typical signs and symptoms of testicular torsion. These include severe pain in the scrotum and lower abdomen on the side of the affected testis, tender lumps in the scrotum, scrotal swelling, blood in semen, nausea, and vomiting.

On physical examination, the cremasteric reflex is usually absent. Normally, stroking the upper inner thigh triggers contraction of the cremaster muscle (i.e., the muscle surrounding the testicle and spermatic cord), causing elevation of the ipsilateral testicle. With testicular torsion, this reflex is often absent.

Additional diagnostic methods include urinalysis to exclude infection, scrotal color Doppler ultrasonography to assess blood flow to the affected testicle, or even surgical exploration, for both diagnostic and therapeutic purposes.

How do you treat testicular torsion?

Testicular torsion is typically treated with immediate surgical detorsion, ideally within 6 hours of symptom onset. Surgical detorsion involves entering the scrotum through a small incision and untwisting the spermatic cord. The affected (or both) testicles are also stitched to the scrotum via a procedure called orchiopexy to prevent recurrence. In some cases, manual detorsion (untwisting the spermatic cord by hand) can be performed while awaiting definitive surgical treatment. However, orchiopexy is often still required to prevent further episodes.

If the testicle is nonviable due to prolonged ischemia, it is surgically removed in a procedure called orchiectomy.

What are the most important facts to know about testicular torsion?

Testicular torsion is the rotation of the testicle around the spermatic cord, potentially obstructing its blood supply and leading to necrosis. It most commonly affects adolescents but can occur at any age. The most common cause is the congenital failure of the testicles to strongly attach to the scrotum. Symptoms include sudden severe pain of the affected testicle, scrotal swelling and redness, nausea, and vomiting. Testicular torsion is a medical emergency and requires treatment within the first six hours of onset to avoid permanent damage.

Key Takeaways

Definition	Rotation of the testicle around the spermatic cord, causing twisting that can compromise blood flow to the testicle.
Seriousness	- Medical emergency - Should be treated within first 6 hours from onset - Testicle might not be salvageable after 12 hours - Rotation can cause obstruction of blood supply and outflow → necrosis
Symptoms	- Sudden acute, severe pain in the scrotum and lower abdomen on the side of the affected testicle - Dizziness - Nausea - Vomiting
Signs	- Usually unilateral - Swelling - Redness - Worsening pain with scrotal elevation - Elevation of the affected testicle (twisting → shortening)
Causes	- Failure of the testicle to attach to attach to the scrotum - Minor trauma to the scrotal area - Can occur during sleep or after vigorous physical activity
Diagnosis	- Clinical diagnosis - Severe pain - Tender lumps in the scrotum - Blood in semen - Nausea - Vomiting - Absence of cremasteric reflex - Urine tests - Scrotal color Doppler ultrasonography - Surgical exploration
Treatment	- Immediate surgical detorsion - Manual detorsion can be performed as a temporary measure - Orchiopexy

References

Campbell MF, Walsh PC, Wein AJ. Campbell-Walsh-Wein Urology. 12th ed. Edited by Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, Wein AJ. Elsevier; 2020.

DaJusta DG, Granberg CF, Villanueva C, Baker LA. Contemporary review of testicular torsion: new concepts, emerging technologies and potential therapeutics. J Pediatr Urol. 2013;9(6 Pt A):723-730. doi:10.1016/j.jpurol.2012.08.012

Sharp VJ, Kieran K, Arlen AM. Testicular torsion: diagnosis, evaluation, and management. Am Fam Physician. 2013;88(12):835-840.

Sheikh, Y., Gaillard, F., et al. (n.d.). Testicular torsion. In Radiopedia. Retrieved August 17, 2020, from https://radiopaedia.org/articles/testicular-torsion