Testicular Torsion: Symptoms, Causes, Diagnosis and Treatment — What You Need to Know
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Testicular torsion is a medical emergency in which a testicle rotates and twists the spermatic cord, cutting off blood supply to the scrotum. It causes sudden, severe pain and swelling and is most common in males aged 12 to 18. It needs emergency surgery: the sooner the testicle is untwisted, the greater the chance it can be saved. Go to an emergency room immediately for sudden or severe testicle pain, because after 12 hours the chance of needing testicle removal rises to at least 75%.
Seek emergency care right away for sudden or severe testicle pain, especially if it comes with:
Swelling of the scrotum
Nausea or vomiting
A testicle that sits higher than normal or at an unusual angle
Pain that woke a child from sleep
What the research says
Delay is the biggest threat to the testicle. A systematic review of 12 studies of children and teens found a mean early testicle loss rate of 39% and late loss approaching 50%; time from symptom onset to presentation consistently predicted poor outcomes (MacDonald et al., J Pediatr Urol, 2018).
A simple score can speed up decisions. A meta-analysis of the TWIST score (testicular swelling, hard testis, high-riding testis, absent cremasteric reflex, nausea or vomiting) in 5 pediatric studies (1,060 patients, 199 torsions) found that its low-risk group had a sensitivity of 98.4%, which helps rule torsion out, and its high-risk group had a specificity of 97.5%, which supports urgent surgical exploration; the intermediate group needed further work-up with ultrasound (Qin & Qu, J Urol, 2022).
Ultrasound helps, but it is not a perfect rule-out. A meta-analysis of 26 studies (2,116 adults with acute scrotal pain) found pooled ultrasound sensitivity of 0.86 and specificity of 0.95, rising to 0.94 and 0.98 in prospective studies (Ota et al., J Med Ultrason, 2019). Even so, a normal or unclear scan does not replace a surgeon's judgment when the exam suggests torsion.
TL;DR
Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. It is most common between ages 12 and 18 but can occur at any age, even before birth.
Most males who get torsion have an inherited trait that lets the testicle rotate freely inside the scrotum. It often strikes hours after vigorous activity, after a minor injury, or during sleep. It usually needs emergency surgery. After six hours of pain, the chance of needing removal is greatly increased, and after more than 12 hours there is at least a 75% chance of needing the testicle removed. If the pain disappears on its own, that may signal intermittent torsion, which usually still needs surgery to prevent the next twist.
When to Seek Emergency Care
Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of the testicle if it is torsion.
Situation | What to Do |
|---|---|
Sudden, severe testicle pain | Get emergency care immediately; every hour counts. |
Pain that goes away on its own | Seek prompt medical help; intermittent torsion often needs surgery to prevent a repeat. |
After 6 hours of pain | The chance of needing testicle removal is greatly increased. |
After more than 12 hours of pain | There is at least a 75% chance of needing testicle removal. |
What Is Testicular Torsion?
Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum, the loose bag of skin under the penis that contains the testicles. The reduced blood flow causes sudden and often severe pain and swelling.
It is most common between ages 12 and 18, but it can occur at any age. It usually requires emergency surgery. If treated quickly, the testicle can usually be saved, but when blood flow has been cut off for too long, the testicle can become so badly damaged that it has to be removed.
What Are the Symptoms of Testicular Torsion?
Symptoms can start suddenly. One detail matters for parents: young boys with torsion typically wake up from scrotal pain in the middle of the night or early in the morning.
Symptom | Notes |
|---|---|
Sudden, severe scrotal pain | The hallmark sign; treat it as an emergency. |
Scrotal swelling | Usually on the affected side. |
Abdominal pain | Can occur along with scrotal pain. |
Nausea and vomiting | Common with severe pain. |
High or angled testicle | The testicle is positioned higher than normal or at an unusual angle. |
Frequent urination | A listed symptom. |
Fever | A listed symptom. |
Night-time onset | Young boys typically wake from sleep with scrotal pain. |
What Causes Testicular Torsion?
Torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow can be entirely blocked, causing damage more quickly.
It is not clear exactly why it happens. Most males who get torsion have an inherited trait that lets the testicle rotate freely inside the scrotum, and this trait often affects both testicles, but not every male with the trait will have torsion. Torsion often occurs several hours after vigorous activity, after a minor injury to the testicles, or while sleeping. Cold temperature or rapid growth of the testicle during puberty also might play a role.
What Increases the Risk?
Risk Factor | Detail |
|---|---|
Age | Most common between ages 12 and 18. |
Previous torsion | Pain that went away without treatment (intermittent torsion and detorsion) is likely to happen again, and more frequent bouts raise the risk of testicular damage. |
Family history | The condition can run in families. |
What Happens If It Is Not Treated Quickly?
When torsion is not treated for several hours, blocked blood flow can cause permanent damage to the testicle. If the testicle is badly damaged, it has to be surgically removed. In some cases, damage or loss of a testicle affects a man's ability to father children.
How Is Testicular Torsion Diagnosed?
Your doctor will ask questions to find out whether your symptoms are caused by torsion or something else. Torsion is often diagnosed with a physical exam of the scrotum, testicles, abdomen, and groin. Your doctor might also test your reflexes by lightly rubbing or pinching the inside of your thigh on the affected side. Normally this makes the testicle contract, and this reflex might be absent with torsion.
Sometimes tests are needed to confirm the diagnosis or find another cause. If you have had pain for several hours and the exam suggests torsion, you might be taken directly to surgery without any more testing, because delaying surgery might result in loss of the testicle.
Diagnostic Step | Purpose and Key Details |
|---|---|
History and physical exam | Exam of the scrotum, testicles, abdomen, and groin; often enough to make the diagnosis. |
Reflex test | Rubbing or pinching the inner thigh normally makes the testicle contract; the reflex may be absent with torsion. |
Urine test | Checks for infection. |
Scrotal ultrasound | Checks blood flow; decreased flow suggests torsion, but it can miss reduced flow and might not rule torsion out. |
Direct to surgery | Used when pain has lasted for hours and the exam suggests torsion; delays risk losing the testicle. |
How Is Testicular Torsion Treated?
Surgery is required to correct torsion. In some cases the doctor can untwist the testicle by pushing on the scrotum, which is called manual detorsion, but you will still need surgery to prevent it from happening again.
Surgery is usually done under general anesthesia. Your doctor makes a small cut in the scrotum, untwists the spermatic cord if necessary, and stitches one or both testicles to the inside of the scrotum.
Timing decides the outcome. The sooner the testicle is untwisted, the greater the chance it can be saved. After six hours from the start of pain, the chance of needing removal is greatly increased, and if treatment is delayed more than 12 hours there is at least a 75% chance of needing the testicle removed.
What About Newborns and Infants?
Torsion can occur in newborns and infants, though it is rare. The infant's testicle might be hard, swollen, or a darker color. Ultrasound might not detect reduced blood flow in an infant's scrotum, so surgery might be needed to confirm torsion.
Treatment in infants is controversial. If a boy is born with signs of torsion, it might be too late for emergency surgery to help, and general anesthesia carries risks. But emergency surgery can sometimes save all or part of the testicle and can prevent torsion in the other testicle, and treating torsion in infants might prevent future problems with male hormone production and fertility.
How Should You Prepare for an Appointment?
Torsion will likely happen as an emergency, leaving little time to prepare. You will probably first be seen in the emergency room or by a family doctor, and then by a urologist. If you have some advance warning, write down your symptoms, including any that seem unrelated, and questions to ask.
Your doctor is likely to ask when the symptoms began, what you were doing when they started, whether they were continuous or came and went, how severe they are, what makes them better or worse, whether anyone in your family has had torsion, and whether this has happened to you before.
Can Testicular Torsion Be Prevented?
Having testicles that can rotate in the scrotum is a trait inherited by some males. If you have this trait, the only way to prevent torsion is surgery to attach both testicles to the inside of the scrotum. This is also what the treatment surgery does: stitching one or both testicles to the inside of the scrotum treats the current torsion and is meant to prevent the next one.
Conclusion
Testicular torsion is one of the few truly time-critical conditions, and its warning signs are easy to recognize: sudden, severe testicle pain, often with swelling, abdominal pain, nausea, and a testicle sitting higher than normal. The message is the same everywhere: do not wait, do not sleep on it, and do not assume that pain that fades means the problem is over.
The clock matters enormously. If treated quickly, the testicle can usually be saved. After six hours the odds of removal rise sharply, and after more than 12 hours there is at least a 75% chance of removal. For boys aged 12 to 18 and their parents, the single takeaway is this: sudden or severe testicle pain is an emergency-room visit, not a wait-and-see situation.
Next Steps
If sudden or severe testicle pain is happening now, for you or your son, seek emergency care immediately. If you have had episodes of scrotal pain that went away on their own, see a doctor promptly and ask whether preventive surgery is appropriate.
Related Reading
Frequently Asked Questions
1. What is testicular torsion?
It occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.
2. Is testicular torsion an emergency?
Yes. Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of the testicle.
3. Who is most at risk?
Torsion is most common between ages 12 and 18, but it can occur at any age, even before birth. It can also run in families.
4. What causes it?
The testicle rotates on the spermatic cord, blocking blood flow. Most males who get torsion have an inherited trait that lets the testicle rotate freely inside the scrotum, often affecting both testicles. It often occurs hours after vigorous activity, after a minor injury, or during sleep, and cold temperature or rapid testicle growth during puberty might play a role.
5. What are the symptoms?
Sudden, severe scrotal pain; scrotal swelling; abdominal pain; nausea and vomiting; a testicle positioned higher than normal or at an unusual angle; frequent urination; and fever.
6. Why do young boys often wake at night with the pain?
Young boys who have torsion typically wake up because of scrotal pain in the middle of the night or early in the morning.
7. Can pain that goes away on its own be ignored?
No. Sudden testicle pain that disappears without treatment can happen when the testicle twists and then untwists on its own (intermittent torsion and detorsion). Seek prompt medical help, because surgery is frequently needed to prevent it from happening again.
8. How is it diagnosed?
Often with a physical exam of the scrotum, testicles, abdomen, and groin, plus a reflex test. A urine test checks for infection, and a scrotal ultrasound checks blood flow, but ultrasound can miss reduced flow and cannot always rule torsion out. If the exam suggests torsion after several hours of pain, you may go straight to surgery.
9. How is it treated?
Surgery is required. It is usually done under general anesthesia: a small cut in the scrotum, untwisting the spermatic cord, and stitching one or both testicles to the inside of the scrotum. Sometimes a doctor can untwist the testicle by hand first (manual detorsion), but surgery is still needed to prevent it from happening again.
10. What happens if treatment is delayed?
The sooner the testicle is untwisted, the greater the chance it can be saved. After six hours of pain, the chance of needing removal increases greatly, and after more than 12 hours there is at least a 75% chance of needing the testicle removed.
11. What are the complications?
Permanent damage or loss of the testicle and, in some cases, a reduced ability to father children.
12. Can a newborn get testicular torsion?
Yes, though it is rare. The infant's testicle might be hard, swollen, or a darker color. Surgery might be needed to confirm it, and emergency surgery can sometimes save all or part of the testicle and prevent torsion in the other one.
13. Can it be prevented?
If you have the inherited trait that lets the testicles rotate, the only way to prevent torsion is surgery to attach both testicles to the inside of the scrotum, which is also part of the treatment surgery.
14. What questions should I ask the doctor?
Why this happened, whether there are other possible causes, what happens without surgery, possible surgical complications, activity restrictions, when you can be sexually active again, whether you will be able to father children, and how to prevent it from happening again.
15. Which doctor treats testicular torsion?
You will likely first be seen in the emergency room or by a family doctor, then by a urologist, a doctor who specializes in urinary tract problems and disorders affecting male genitals.
Trusted External Resources
References
Mayo Clinic Staff. Testicular torsion: symptoms & causes. Mayo Clinic. February 24, 2022. https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270
Mayo Clinic Staff. Testicular torsion: diagnosis & treatment. Mayo Clinic. February 24, 2022. https://www.mayoclinic.org/diseases-conditions/testicular-torsion/diagnosis-treatment/drc-20378274
MacDonald C, Kronfli R, Carachi R, et al. A systematic review and meta-analysis revealing realistic outcomes following paediatric torsion of testes. J Pediatr Urol. 2018;14(6):503-509. PMID 30404723. https://doi.org/10.1016/j.jpurol.2018.09.017
Qin KR, Qu LG. Diagnosing with a TWIST: systematic review and meta-analysis of a testicular torsion risk score. J Urol. 2022;208(1):62-70. PMID 35238603. https://doi.org/10.1097/JU.0000000000002496
Ota K, Fukui K, Oba K, et al. The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis. J Med Ultrason. 2019;46(3):325-334. PMID 30847624. https://doi.org/10.1007/s10396-019-00937-3
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Sudden or severe testicle pain is a medical emergency: seek emergency care immediately. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
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