Testicular Torsion: Sudden Severe Pain in One Testicle Is an Emergency

Zuletzt aktualisiert: August 29, 2026

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If this is happening now

Sudden severe pain in one testicle means going to an emergency department immediately — not in the morning, not after trying a painkiller. The testicle’s blood supply may be cut off, and what can be saved is decided in hours. In Thailand, call 1669.

Do not eat or drink on the way, in case an operation is needed straight away. Take someone with you — the pain is usually severe enough that driving is not sensible.

The rest of this page explains why the urgency is real, and three things that are commonly got wrong.

What happens

The testicle hangs from the spermatic cord, which carries its blood supply. In torsion the testicle rotates on that cord, the vessels are twisted shut, and the tissue begins to die.

The reason it can happen at all is usually anatomical: in some men the testicle is not properly anchored within its covering and hangs free, able to rotate — the so-called bell clapper arrangement. Autopsy studies find it in roughly 5% to 16% of testes, and it is present on both sides in most of those men; the great majority never come to any harm. Among men who actually present with torsion, the same anatomy is found on the opposite side in most cases, which is why the other testicle is fixed during the same operation. A contraction of the muscle that lifts the scrotum, in response to cold or exercise or nothing in particular, is then enough to set it spinning.

It is uncommon — of the order of one in four thousand males under 25 each year — and most frequent in adolescence, when it is thought that rapid growth and hormonal change make the lifting reflex more vigorous.

Three things that are commonly got wrong

1. A normal ultrasound does not rule it out

This is the most important addition to this article, and it was not in the earlier version.

Doppler ultrasound looks for blood flow, and it is useful — but it is not perfect. Flow can still be detected in a testicle that is twisted, particularly where the rotation is partial or the scan is done early, and the quality of the study depends heavily on who performs it. Torsion is a clinical diagnosis. Where the history and examination point to it, the right answer is to operate, not to wait for a scan or to be reassured by one.

If you are told your scan was normal but the pain came on suddenly, is severe, and is not settling, say so and ask to be seen by a urologist before you are sent home. That request has saved testicles.

2. It is frequently mistaken for an infection

Epididymitis — inflammation of the tube behind the testicle — causes pain in the same place and is far commoner. The difference is usually in the story: infection builds over days, often with burning on passing urine or a fever, while torsion arrives abruptly, at full severity, frequently waking someone from sleep, and commonly brings nausea or vomiting.

The consequence of confusing them is being sent away with antibiotics while the testicle dies. Where there is genuine doubt, the safe course is to explore surgically rather than to observe. The infection side of that distinction is covered in Hodeninfektion.

3. It is not only a teenage condition

Adolescence is the peak, but torsion occurs in newborn babies, and it occurs in men in their thirties, forties and beyond. Men outside the typical age band are more likely to be assumed to have an infection, and therefore more likely to be diagnosed late. Age is a probability, not a rule out.

On that last point: the cold-weather pattern is better supported than it might sound. A 25-year Scottish study found torsion rates rose as ambient temperature fell, a 10-year nationwide Taiwanese study found a January peak with the same inverse relationship, and an Israeli series reported roughly three times the odds at low temperatures. These are population-level observations rather than proof of a mechanism, and the practical implication is small — but it is a real and repeated finding, not folklore.

The warning episodes that come first

Some men describe repeated attacks of sudden severe testicular pain that last minutes to an hour and then settle completely, sometimes over months or years. That is intermittent torsion — the testicle twisting and untwisting on its own — and it identifies someone whose anatomy will eventually catch him out.

These episodes are worth acting on precisely because they resolve. The testicles can be fixed to the scrotal wall as a planned operation, in daylight, with no clock running. Men who mention this pattern only after losing a testicle are among the most frustrating cases in urology, because the opportunity was there and nobody knew to ask.

The operation, and the clock

The scrotum is opened, the cord is untwisted, and the testicle is watched to see whether its colour returns. If it recovers it is stitched to the scrotal wall so it cannot rotate again — and the other side is fixed at the same time, because the anatomy that allowed it is usually present on both.

The largest pooled series, covering more than two thousand patients, gives a clear picture of how the odds fall with time:

• Within 6 hours — the testicle is saved in around 97% of cases.
• 7 to 12 hours — around 79%.
• 13 to 18 hours — around 61%.
• 19 to 24 hours — around 43%.
• 25 to 48 hours — around 24%.
• Beyond 48 hours — around 7%.

Two things follow from those numbers, and they pull in opposite directions.

First: the first six hours are not a slogan. The drop from 97% to 79% happens in the time it takes to decide whether to bother going in.

Second: late presentation is still a reason to go, not a reason to stay home. Roughly one testicle in five is still salvaged beyond 24 hours. Beyond that, a dead testicle left in place causes problems of its own, the other side still needs fixing to protect it, and the diagnosis needs confirming rather than assuming. Nobody should conclude from a delay that it is now pointless.

One honest qualification about all of these figures: salvaged is not the same as normal. Saving a testicle means avoiding its removal at the operation. Long-term follow-up shows that a proportion of testicles that were saved go on to shrink anyway, and some series find that beyond about six hours the testicle rarely ends up fully normal even when it was not removed. The figures above describe what is taken out on the day, not what works years later.

If a testicle is lost

It is a real loss and worth being honest about — but it is not the end of fertility or of normal hormone levels. One healthy testicle is generally enough for both, which is why fixing the remaining side matters so much. A prosthesis can be placed later for appearance if wanted, and it is entirely reasonable to ask about it rather than assume it is vanity. A Sperma-Analyse some months afterwards answers the fertility question for an individual.

Häufig gestellte Fragen zur Hodenverdrehung

What are the symptoms?

Sudden severe pain in one testicle that does not ease with rest, position or painkillers, often with nausea or vomiting and scrotal swelling. It typically arrives abruptly at full intensity and frequently wakes someone from sleep. Anyone with this needs emergency assessment.

My ultrasound was normal. Can I go home?

Not on that basis alone. Doppler ultrasound can show flow in a testicle that is twisted, particularly with partial rotation or early scanning, and its accuracy depends on the operator. Torsion is diagnosed clinically, and where the story and examination fit, surgical exploration is the correct step regardless of the scan.

How is it different from an infection?

Epididymitis usually builds over days, often with burning on passing urine or fever. Torsion arrives suddenly and at full severity, commonly with nausea. The two are confused often enough that where there is doubt, exploring surgically is safer than treating with antibiotics and waiting.

How quickly does it need treating?

Within six hours the testicle is saved in around 97% of cases. That falls to roughly 79% at 7 to 12 hours, 61% at 13 to 18 hours, 43% at 19 to 24 hours, and around 24% between one and two days. Beyond 48 hours it is about 7%. Two things follow: the first six hours genuinely matter, and a delay is never a reason to stay at home, because roughly one in five is still saved beyond a day. Note also that avoiding removal on the day is not the same as a testicle that works normally years later.

I keep getting brief attacks of severe testicular pain that go away. Does that matter?

Yes, and it is worth raising specifically. That pattern suggests intermittent torsion, and it identifies anatomy that will eventually cause a full episode. Both testicles can be fixed as a planned operation before that happens.

Am I too old for this?

No. Adolescence is the peak, but torsion occurs in newborns and in men well into adulthood. Being outside the usual age band makes a wrong diagnosis more likely, not the condition impossible.

Will losing a testicle affect fertility?

Usually not, provided the remaining testicle is healthy — one is generally sufficient for both fertility and hormone production. That is precisely why the other side is fixed during the same operation. A semen analysis some months later answers the question for an individual.

Arranging a consultation

Torsion is not a condition to arrange an appointment for — go to an emergency department. For non-urgent matters, including recurrent brief episodes of testicular pain that have settled, Dr. Soarawee Weerasopone sees patients at Bangkok Hospital Hauptsitz and at Samitivej Sriracha Hospital in Chonburi on 088-022-1445.

Bangkok Hospital Telemedicine is available for non-urgent consultations, including for international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital, not by this website.

Referenzen

• Mellick LB, Sinex JE, Gibson RW, Mears K. A systematic review of testicle survival time after a torsion event. Pediatr Emerg Care. 2019;35(12):821–825.
• Taghavi K, Dumble C, Hutson JM, Mushtaq I, Mirjalili SA. The bell-clapper deformity of the testis: the definitive pathological anatomy. J Pediatr Surg. 2021;56(8):1405–1410.
• Molokwu CN, Ndoumbe JK, Goodman CM. Cold weather increases the risk of scrotal torsion events: results of an ecological study of acute scrotal pain in Scotland over 25 years. Sci Rep. 2020;10(1):17958.
• Milivojevic S, Topalovic D, Dasic I, et al. Testicular atrophy following torsion in pediatric patients: results of a long-term follow-up. Urologie. 2025;198:118–124.

Haftungsausschluss: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters, and is intended for education only. It is not medical advice, diagnosis or a prescription for any individual, and no advice, diagnosis or prescription is given through personal messaging channels or social media. Dr. Soarawee operates no public social media account; any account offering private consultation in his name is fraudulent. In an emergency in Thailand, call 1669.