Testicular torsion

Also called Twisted testicle

Sudden testicle pain is a surgical emergency with a six-hour window. Embarrassment is the main reason boys lose a testicle to this.

What it is

The testicle twisting on its cord and cutting off its own blood supply.

It is a genuine surgical emergency on a clock. Surgery within about six hours saves the testicle in most cases; by 12 hours the odds fall sharply; by 24 hours the testicle is usually lost.

It is most common in boys and young men between about 12 and 25, and it can happen at any age including in newborns. It often happens at night, and often with no injury or trigger at all.

The reason this entry exists is not clinical complexity. It is that teenage boys do not tell anybody their testicle hurts. They wait, hope it passes, and lose the window. Adults who are clear that this is an emergency worth waking somebody for, and who say so before it ever happens, prevent the loss.

Nausea and vomiting alongside the pain is a strong pointer. Pain that is relieved by lifting the testicle points more towards infection, but that distinction is not reliable enough to act on. When in doubt, go.

Signs you might notice

Sudden severe pain in one testicle, usually coming on over minutes.

Swelling of the scrotum, redness, and the testicle sitting higher than usual or lying at an odd angle.

Nausea and vomiting with the pain.

Tummy pain, which in younger boys may be the only complaint. Any boy with sudden lower abdominal pain should have his testicles examined.

Pain that comes and goes in episodes, which can mean intermittent torsion and still needs assessment.

Go to A and E immediately. Do not wait for a GP appointment, do not wait until morning, and do not eat or drink on the way in case surgery is needed.

How it can affect day-to-day life

The prevention is a conversation, and it needs to happen before adolescence rather than during a crisis: sudden testicle pain means hospital tonight, whoever you have to wake up, and nobody will be embarrassed except briefly.

The same applies in schools, residential settings and foster care, where a boy may have no adult he would tell.

For a boy with a learning disability or limited communication, sudden distress, holding the groin, refusing to sit, or vomiting with no other cause deserves an examination rather than an explanation.

After surgery, both testicles are usually fixed in place to prevent it happening on the other side. If only one was done, ask why.

Losing a testicle does not usually affect fertility or hormone levels, and saying so plainly matters to a teenager who will not ask.

Supporting someone well

Have the conversation early, in plain words, with any boy in your care.

Go straight to A and E. Say the words testicular torsion at reception. It changes the priority.

Do not let the person eat or drink on the way.

Note the exact time the pain started. The surgical decision turns on it.

Do not accept a wait-and-see, and do not accept a diagnosis of infection without an urgent surgical opinion or ultrasound in a young male with sudden pain.

Any lump, swelling or ache that is not sudden still needs a GP appointment. See testicular cancer.

Where to get help

A and E immediately for sudden testicular pain, at any hour.

A GP practice for lumps, gradual swelling or ongoing ache.

NHS: testicle lumps and swellings sets out which symptoms are urgent and which are not.