Question:

Hi! I'm a 16-year-old boy, and yesterday, after riding my bike, I discovered one of my testicles had twisted. I tried the usual method, and it twisted back 180 degrees. But I don't think it's in the right position yet. If it's twisted 360 degrees, could it happen without any pain?

Answered by Pediatric Urologist John Makari, MD, FAAP, FACS:

About 1 in 4,000 males experience testicular torsion. It’s a phenomenon in which the testicle twists within the scrotum and cuts off the blood supply into and out of the testicle. If left untreated, the testicle can be lost. Males who experience testicular torsion have been found to have inadequate fixation of the testicle within the scrotum, allowing it to twist freely.

This particular individual may have intermittent testicular torsion, where the testicle twists and untwists, either by itself or by the patient. Even intermittent or partial torsion can lead to decreased blood flow, so it’s a condition that’s best treated. Typically, we recommend surgery to fix the testicles within the scrotum so they can’t twist in the future. The risk of not treating intermittent testicular torsion is having an episode where the testicle twists and does not untwist, leading to the loss of the testicle. We would recommend pediatric urological consultation to discuss surgical treatment options. Unfortunately, there are no medications available to treat testicular torsion. 

Testicular torsion should not be embarrassing; we frequently see patients with this condition. It’s better to see us in an elective or scheduled setting instead of meeting in the emergency department when a testicle is twisted and cannot be untwisted. The Division of Pediatric Urology at Children’s Nebraska is part of the Nebraska Medicine Division of Urology, and we treat testicular torsion in newborns to adolescent males.

Children’s Pediatric Urology specialists are experts in urological care and offer several multidisciplinary clinics for different patients’ needs. To make an appointment, call 402.955.4002.