What is testicular torsion?
In testicular torsion the testicle twists around the spermatic cord. Blood vessels and the vas deferens run within this cord. If blood flow is cut off, testicular tissue can be damaged within a few hours.
Clinically this is described as an acute scrotum. That means a suddenly painful scrotum in which the time-critical causes must be excluded first.
Why this is so urgent
When torsion is present, time is the decisive factor. The faster blood flow is restored, the greater the chance that tissue and function will be preserved.
That does not mean every minute alone decides the outcome. It means that waiting and self-tests increase the risk of unnecessarily worsening a treatable problem.
Typical symptoms and warning signs
Symptoms often start suddenly and usually affect one side. For some people the pain is immediately severe; for others it increases markedly over a short period.
- Sudden severe pain in one testicle
- Swelling, redness or marked tenderness of the scrotum
- Nausea, vomiting, cold sweat
- Pain radiating to the groin or lower abdomen
- The affected testicle sits higher or appears abnormally positioned
Important: not every sign is always present. Torsion can be present even without visible redness or swelling. A clear guide to testicle pain and warning signs is available here: NHS: Testicle pain and when it is urgent.
The time window: what is realistic
Many clinical reviews state that chances are best within the first few hours. After several hours without sufficient blood flow, the risk that tissue is permanently damaged increases.
Practically this means: with sudden, one-sided testicular pain the goal is not to find out at home whether it will get better on its own. The goal is to exclude or treat torsion quickly.
What you should do immediately
If the symptoms fit possible torsion, immediate medical assessment is the right decision. This is especially true for sudden, severe, one-sided pain or when nausea and vomiting are present.
- For severe or sudden symptoms: go straight to the emergency department; in doubt call the emergency number 999 (or 112)
- Note the time symptoms began; this helps the team with assessment
- Do not try to twist or press the testicle yourself
- If possible, avoid eating or drinking in case a quick operation is required
For acute but not life‑threatening problems outside GP hours the medical on‑call service can help find the right care. A suspected torsion still requires emergency assessment. 116117: medical on‑call service
Why self-tests and myths are risky
Self-tests, gripping techniques and supposedly reliable signs circulate online. In reality these cues are unreliable. They can give false reassurance or unnecessary alarm without actually clarifying the cause.
Even pain that briefly eases is not a reliable sign that everything is fine. Symptoms can fluctuate while blood flow remains at risk.
Torsion or infection: what is often different and what is not
Many acute complaints are not torsion in the end. Common alternatives are epididymitis, torsion of appendages, injury, an inguinal hernia or, rarely, other emergencies.
As a rough guide: infections tend to start more gradually and are more often associated with burning on passing urine, discharge or fever. Torsion is more likely to start suddenly and very severely. Nevertheless, the two can overlap, which is why examination is crucial.
How assessment in hospital typically proceeds
In the emergency department speed is the priority. Assessment includes history, examination and usually an ultrasound with Doppler to assess blood flow.
If the clinical suspicion remains high, extended waiting is often avoided. Surgical exploration can be the most reliable option because it directly clarifies the situation and a twist can be corrected immediately.
A clear medical overview with typical management is also available here: Merck Manual: Testicular torsion.
Treatment: what happens if it really is a torsion
Standard treatment is rapid detorsion and subsequent fixation. The testicle is untwisted, blood flow is assessed and the testicle is fixed to reduce the chance of re‑torsion.
The other side is often fixed as well because the same anatomical predisposition frequently exists bilaterally. If tissue is already non‑viable, removal may be necessary. This is not the usual outcome but can be a consequence of delayed presentation.
Who is this particularly relevant for?
Testicular torsion can occur at any age. It is more common in adolescents and young men. Rare neonatal forms also exist that require rapid assessment.
It is not necessarily triggered by sport or sex. Torsion can also occur during sleep. The important factor is the sudden nature of the symptoms, not the trigger.
For clinical classification of the acute scrotum in children and adolescents this guideline overview is helpful: EAU Guidelines: Paediatric urology and acute scrotum.
Common pitfalls that waste time
- Pain misinterpreted as a groin problem, gastrointestinal issue or strain
- Embarrassment leads to not telling anyone or staying alone
- Waiting because swelling or redness are not yet visible
- Trying tests at home instead of using the time for rapid diagnosis
A good rule of thumb is: better a reassurance after examination than a missed time window.
Hygiene, tests and safety after the acute phase
If an infection is found to be the cause, targeted diagnostics are important, including appropriate infection tests and partner treatment if needed. If it was torsion, wound care, rest and a controlled return to activity are the priorities.
If you have had recurrent short, one-sided pain attacks, mention this actively to a urologist. Such patterns can indicate intermittent torsion.
Costs and practical planning in the UK
Emergency assessment of an acute scrotum is medically justified and is usually covered by the NHS in the UK. More important than costs is organising care: do not stay alone if you have severe pain and seek help early.
If you are under 18, inform a responsible adult. In emergencies treatment will be provided even if not all administrative details are sorted immediately.
Legal and organisational context
In the UK emergency care is organised so that the emergency department or ambulance service is the appropriate route for suspected time‑critical emergencies. Services and access routes vary internationally.
If you are abroad, follow local emergency numbers and clearly explain the situation: sudden one‑sided testicular pain, suspected torsion, time of onset. This is practical guidance and not legal advice.
When to seek medical advice even if it does not seem like torsion
Not every testicular pain is an emergency. But new, unusual or worsening symptoms should be assessed promptly, especially if they are one‑sided.
- Pain persists or worsens
- Fever, chills, nausea or vomiting
- Swelling, redness or marked asymmetry
- Symptoms after injury
- Recurrent attacks on the same side
An example of patient information (in German) is available from a university clinic: Erlangen University Hospital: Testicular torsion.
Conclusion
Testicular torsion is rare, but for that reason it is easily underestimated. Sudden one‑sided testicular pain is a symptom where speed protects, because blood supply can be rapidly threatened.
If it turns out not to be torsion, that is good news. The correct decision was still to exclude the danger early.
