When the cord twists, it cuts off blood supply to the testicles. This causes severe pain. It can also permanently damage or destroy the testicles.
Another name for this condition is testicular torsion. According to the American Urological Association (AUA), it is rare, affecting only about one in 4,000 young men (AUA).
Torsion is most common in adolescent males. However, older men and infant boys can also be affected.
Most men who have testicular torsion are born with a predisposition to the condition. Normally, the testicles cannot move freely inside the scrotum. The surrounding tissue is strong and supportive. Men and boys who experience torsion sometimes have weaker connective tissue in the scrotum. This is called a “bell clapper” deformity.
If you have a bell clapper deformity, your testicles can move more easily in the scrotum. This movement increases the risk of the spermatic cord becoming twisted.
Torsion of the testes can also occur after an injury to the groin. Rapid growth during puberty may also cause the condition.
Testicular torsion usually occurs in only one testicle. Bilateral torsion is rare.
Pain and swelling of the scrotal sac are the main symptoms of testicular torsion. The onset of pain may be quite sudden, and pain can be severe. Swelling may be limited to just one side, or it can span the entire scrotum. You may notice that one testicle is higher than the other. Some men also experience:
- lumps in the scrotal sac
- blood in the semen
A number of tests can be used to diagnose torsion. These include:
- physical examination
- urine tests, which look for infection
- imaging of the scrotum
During a physical exam, your doctor will check your scrotum for swelling. He or she may also pinch the inside of your thigh. Normally this causes the testicles to contract. However, this reflex may disappear if you have torsion.
You might also receive an ultrasound on your scrotum. This shows blood flow to the testicles. If it is lower than normal, you may be suffering from torsion.
Surgical repair is usually required to treat testicular torsion. In rare cases, your doctor may be able to untwist the spermatic cord by hand. This procedure is called “manual detorsion.”
Surgery is performed as quickly as possible to restore blood flow to the testicles. If blood flow is cut off for more than six hours, testicular tissue can die. The affected testicle would then need to be removed.
Surgical detorsion is performed under general anesthesia. You will be asleep and unaware of the procedure. Your doctor will make a small incision in your scrotum and untwist the cord. Tiny sutures will be used to keep the testicle in place in the scrotum. This prevents rotation from occurring again. The surgeon then closes the incision with stitches.
Testicular torsion surgery is highly effective if the condition is caught early. Ninety-five percent of patients make a full recovery when surgery is performed within six hours after symptoms appear (Mayo Clinic).
Approximately 75 percent of patients require removal of the testicle when surgery is postponed for more than 12 hours (AUA).
Removal of a testicle, called orchidectomy, can affect hormone production in infants. It may also affect future fertility by lowering sperm count.
If your body begins to make anti-sperm antibodies because of torsion, this can also lower sperm motility.