Does your child or teen suddenly complain of severe pain in the testicles, which radiates to the lower abdomen and groin? This may be due to testicular torsion. If this is the case, it is necessary to intervene within six hours to save the affected testicle. Not a minute to waste, therefore, in seeking medical advice.

Symptoms of testicular torsion

Torsion of the testicle is most often recognized by sudden pains radiating upward, sometimes so violent that it causes discomfort. They can be accompanied by paleness, nausea, or even vomiting. However, fever is rare. The discomfort is such that it makes walking very difficult. The bursae are also often swollen.

If your child, regardless of age, has these symptoms, don’t hesitate, go to the emergency room right away. By making sure from this moment not to give him any more food or drink, in case a surgical intervention under anesthesia is necessary. Not all testicular pain is synonymous with testicular torsion, but ruling out this diagnosis is essential.

Causes and risk factors

Anatomical defects in the attachment of the testis to the bursa can favor the development of testicular torsion, in particular the absence of a gubernaculum or mesorchium which leaves a testicle free in the bursa like a “bell clapper.”

The torsion is generally spontaneous but here some of the favorable circumstances:

  • Sexual intercourse or masturbation,
  • The shocks on the stock markets,
  • Sudden movements,
  • Biking accident

Keep in mind that testicular torsion mainly affects children and young adults.


The clinical examination is enough for the doctor to decide whether to intervene or not. A radiological or ultrasound assessment can be falsely reassuring and above all, by waiting for one we risk losing precious time. Indeed, during a testicular torsion, the testicle turns on itself, causing a twist of the spermatic cord which holds it and nourishes it thanks to numerous blood vessels.

If we do not act right away, the testicle risk losing its vascularity and therefore goes into necrosis, that is destruction of tissue and loss of reproductive functions.

It is therefore a race against time between the onset of the first symptoms and surgery to put the testicle back in place and fix it in order to prevent a recurrence. Often, the surgeon preemptively fixes the other testicle as well. If the blood supply is restored within six hours of the twist, there is a chance that necrosis can be avoided. If it is too late, the surgeon will remove the testicle and may replace it with a prosthesis.

More common in 12-18 year olds

Nine times out of ten, testicular torsion occurs in adolescents between the ages of 12 and 18. But it can also affect younger children, and even babies in the days following birth. In total, about 1 in 4,000 boys under 25 are affected each year. After 35 – 40 years, the incidence of testicular torsion becomes minimal.

If it is favored by trauma to the bursae, testicular torsion can also occur during heavy physical activity, during masturbation, or even spontaneously, most often during sleep.

Learn more about testicular pain here.

Arthur Marquis

Marquis was born in Paris, France and emigrated to United States at the early age of 5. He gained a medical degree from the University of Michigan and has worked as a dermatologist for over 10 years. He covers a wide-range of health related subjects for the Scientific Origin.