Intermittent Testicular Torsion: Difficult clinical diagnosis

Last updated: May 18, 2026

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I have been seeing several cases related to the Intermittent testicular torsion’s patients throughout my practicing in urological. Patients were always at the emergency room with a severe testicular pain. The pain was extremely bad, so bad to make patient couldn’t do anything besides laid down on the bed and sobbing to get help. First, I’m sure that there’re some Urologists will assume this emergency condition that called a “Testicular torsion” which I was written this article previously.

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Realistically, it is not simply as in the textbook. The Classical torsion must show there’s no a sign of “blood supplying” during perform a doppler ultrasonography. What if there still has blood supplying from the imaging showed? How can we tell them what’s going on for the diagnostic? This is why we need to figure out the Intermittent torsion today.

Intermittent testicular torsion is a state of testis which can release torsion by itself. Once the torsion release, the pain is dramatically gone. Failure to identify this condition can lead to the real testicular torsion which resulting in testicular loss.

Clinical suspicious on intermittent testicular torsion

1. A sudden onset of testicular painful
2. Very severely on testicular painful
3. Always complain at one side of the testicular: most of it is on the left side
4. The pain usually interfered right to the groin area
5. The pain should be gone itself just within 1 hour
6. The pain can be recurred within weeks or a months later
7. Horizontal lie of testis during torsion period is a classical physical examination sign

Imaging on Intermittent testicular torsion

• Normal testicular blood supplying from doppler ultrasound will be reported

Once Intermittent testicular torsion is being suspected, that would be recommended to do the operation called “Orchiopexy” or testicular fixation operation to avoid recurrent testicular torsion in the future. Any questions, talk to your trusted urologist, or it would be my honor if you text me.

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Frequently Asked Questions About Intermittent Testicular Torsion

What is intermittent testicular torsion and how is it different from classical torsion?

Intermittent testicular torsion is a condition where the testicle twists on the spermatic cord but spontaneously untwists on its own, causing the pain to resolve without intervention. Unlike classical testicular torsion where blood flow is absent on Doppler ultrasound, intermittent torsion shows normal blood flow because the torsion has already resolved by the time of imaging. This makes it significantly harder to diagnose, and failure to identify it can eventually lead to true torsion and testicular loss.

What are the warning signs of intermittent testicular torsion?

Key warning signs include: sudden onset of severe one-sided testicular pain (most commonly left-sided), pain radiating to the groin, pain that resolves completely within one hour, and recurrence of similar episodes weeks to months later. A classic physical sign is a horizontally lying testis during the torsion episode. These recurring episodes of spontaneously resolving severe testicular pain should always raise suspicion for intermittent torsion.

What is the treatment for intermittent testicular torsion?

Once intermittent testicular torsion is suspected based on clinical history and examination, elective surgical fixation called orchiopexy (testicular fixation) is recommended. This procedure secures the testicle to prevent future torsion events. Without treatment, patients are at ongoing risk of acute testicular torsion that could lead to permanent testicular loss.

If you or your son has experienced recurring episodes of sudden, severe testicular pain, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.