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For most boys, discussing the topic of their private parts can be a little embarrassing. Young boys, especially around puberty, are often shy and unaware and do not report testicular pain until it becomes unbearable. But it's important that they know to tell a parent or a healthcare provider if they ever have genital pain, especially in the scrotum or testes, and also pain in the lower abdominal area.
This seemingly minor discomfort can sometimes indicate serious underlying conditions that require immediate medical attention. Testicular pain can result from various causes, such as infections, trauma, hernia, or hydroceles, but the most serious cause is testicular torsion. Torsion is when the spermatic cord (containing the blood supply to one of the testicles) gets twisted, cutting off the blood supply to the testicle. Ignoring the pain, assuming it will subside with time, or delaying the cure for testicular torsion can lead to long-term complications, including infertility or loss of the affected testicle.
Synopsis
Testicular Torsion Symptoms
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Sudden sharp pain affecting one of the testicles
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Nausea
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Vomiting
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Lower abdominal pain
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History of intermittent pain, especially after running and sports activity
Pain can worsen despite all measures, and the testicle and the scrotum may become:
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Red
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Swollen
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Painful to touch
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Positioned higher or horizontally instead of vertically
Sometimes, only lower abdominal pain is present, so examination of the abdomen should include examining the genitalia as well.
Testicular Torsion Causes
Testicular torsion can occur in newborns, especially in babies with undescended testis, and in any age group, especially around puberty. In most cases, the cause is the bell clapper deformity. Normally, the testicles are attached to their coverings called Tunica, but in this condition, the testicles are not attached snugly to the tunica and are more likely to turn and twist freely around their blood-supplying cord within the scrotum. It can happen after strenuous exercise, while someone is sleeping, or after an injury to the scrotum.
Why is the ‘Golden Hour’ Crucial?
If there is torsion, it should be diagnosed and treated early within 4-6 hours of symptom onset. There is a high probability that the affected testicle can be saved. After 12 hours, the chance of recovery drops to 20-50%, and after 24 hours, the likelihood drops to 10%.
Testicular Torsion Diagnosis
When you get to the hospital, a doctor will examine your son's scrotum, testicles, abdomen, and groin and might test his reflexes by stroking or pinching the inside of his thigh. This normally causes the testicle to contract, which probably won't happen if he has a testicular torsion. The doctor might also get a few tests to see if the spermatic cord is twisted, including:
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Ultrasound Doppler: High-frequency waves are used to see the parenchyma of the testicle and check blood flow inside it.
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Urine or blood tests: These can help the doctor see if symptoms are due to an infection instead of a torsion.
Sometimes, a doctor will have to do surgery to make a diagnosis of testicular torsion. Other times, when the physical exam points to a torsion, the doctor will do emergency surgery without other tests to save the testicle as soon as possible.
Treatment of Testicular Torsion
Testicular torsion almost always needs surgery to fix. In rare cases, the doctor might be able to untwist the spermatic cord by pushing on the scrotum, but most males will still need surgery to attach both testicles to the scrotum to prevent torsion from happening in the future.
If your son has a torsion testis, he will need general anaesthesia to sleep and not feel pain during the procedure. The paediatric surgeon will make a small cut in the scrotum, untwist the spermatic cord, and stitch both testicles to the inside of the scrotum to prevent future torsions. Afterwards, your son will go to a recovery room to rest for an hour or two. Once he passes urine and he can take water and food orally, he can be discharged on the same day.
After surgery, your son will need to avoid strenuous activities for a few weeks, and if he's sexually active, he'll need to avoid all sexual activity. Talk to the doctor about when it will be safe for your son to return to his normal activities.
Testicle Removal
If a torsion goes on too long, the testis becomes gangrenous and the doctors can't save the affected testicle will have it removed in a procedure called an orchiectomy. Most boys who have a testicle removed still have a viable testicle on the opposite side and can father children later in life. Many also opt for a prosthetic, or artificial, testicle a few months after surgery. This can help make some boys feel more comfortable about their appearance.
With newborn boys, saving the testicle depends on when the torsion happens. If torsion happens before a baby is born, it may be impossible to save the testicle. In this case, the doctor may recommend surgery at a later date to remove the affected testicle. If torsion symptoms appear after a baby is born, the doctor may recommend emergency surgery to correct the testicle.
Essential Information
Boys need to know that genital pain is serious. Ignoring pain or simply hoping it goes away can lead to severe damage to the testicle and even lead to its removal. Even if the pain in the scrotum goes away, your son still needs to tell you or a doctor and get checked out by a pediatric surgeon. A torsion that goes away makes him more likely to have another one. Pediatric surgeons can greatly reduce the risk of another torsion by securing the testicles to the scrotum.
Even if your son had a torsion that led to the loss of a testicle, he can still lead a normal life, just like anyone else. The loss of one testicle won't prevent a man from having growth and development as males is unlikely to interfere in future sexual activity and with fathering children.
Parents and caregivers must encourage young boys to report any signs of testicular torsion without fear or embarrassment. Timely intervention can resolve many conditions effectively. Early diagnosis and early surgery with detorsion and orchiopexy can prevent permanent damage. By fostering awareness and breaking the stigma, we can ensure better health outcomes for young boys and protect their future well-being.
Testicular pain should never be ignored, as early diagnosis and treatment can be testis-saving.
Summary
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Topic |
Details |
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Embarrassment and Awareness |
Boys, especially around puberty, may feel embarrassed discussing their private parts. It's crucial they report any genital pain to a parent or healthcare provider. |
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Seriousness of Testicular Pain |
Testicular pain can indicate serious conditions like infections, trauma, hernia, hydroceles, or testicular torsion. Ignoring it can lead to complications like infertility or loss of the testicle. |
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Symptoms of Testicular Torsion |
Sudden sharp pain in one testicle, nausea, vomiting, lower abdominal pain, red and swollen scrotum, and testicle positioned higher or horizontally. |
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Causes of Testicular Torsion |
Can occur in newborns with undescended testis, and in boys especially around puberty. Often caused by bell clapper deformity, strenuous exercise, injury to the scrotum or even after sleeping. |
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Golden Hour |
Early diagnosis and treatment within 4-6 hours of symptom onset can save the testicle. After 12 hours, recovery chances drop to 20-50%, and after 24 hours, to 10%. |
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Testicle Removal |
If torsion goes untreated too long, the affected testicle may need to be removed (orchiectomy). Boys can still lead a normal life with one testicle and may opt for a prosthetic testicle |
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Parental Role |
Educate sons about the importance of reporting genital pain immediately. Encourage open communication and break the stigma around discussing genital health. |
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Essential Information |
Genital pain should never be ignored. Early diagnosis and treatment can save the testicle. Timely intervention ensures better health outcomes and protects future well-being. |
FAQ's
Diagnosis involves a physical examination, ultrasound to check blood flow, and urine or blood tests to rule out infections. In some cases, emergency surgery is performed without additional tests to save the testicle
Delayed treatment can lead to the loss of the affected testicle, requiring its removal in a procedure called an orchiectomy. This can result in long-term complications, including infertility.
Yes, boys can lead a normal life with one testicle. The remaining testicle can produce enough sperm for fertility, and many opt for a prosthetic testicle for cosmetic reasons.
Testicular torsion can occur at any age but is common in newborns with undescended testis and in young boys especially around puberty. It can also happen after strenuous exercise while sleeping, or following an injury to the scrotum.
Parents should educate their sons about the importance of reporting any genital pain immediately. Timely medical intervention can prevent severe damage and ensure better health outcomes. Encouraging open communication and breaking the stigma around discussing genital health is crucial.
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