Testicular Torsion in African Boys: Triggers and Treatment

By: Chiamaka Wisdom-Asotah, MB.BS. Medically reviewed by: A. Odutola, MB.BS, PhD, FRCSEd. 

September 29, 2025

An image showing a normal testis and another with torsion. .

 

Highlights

• Testicular torsion happens when the spermatic cord twists and blocks blood flow to the testis.

• It mostly affects boys under 18 and needs urgent surgery within 4–6 hours.

• In Africa, delays from late hospital visits, misdiagnosis, and poor access to emergency care increase the risk of losing a testis.

• Warning signs include sudden severe scrotal pain, swelling, nausea, abdominal pain, or one testicle sitting higher than the other.

• Awareness and quick action can save the testis, prevent infertility, and reduce lifelong complications.

 

Introduction

Imagine your 12-year-old boy waking up early one morning and telling you about a sudden sharp pain he felt in his lower abdomen (belly area) and scrotum (the sac that contains the testes). But then, as is sometimes the case, you give him painkillers, hoping it’s enough to handle the pain, only to find out later that he has lost a testicle.

The scene just described is one that occurs in testicular torsion - a medical emergency where every minute counts. It’s treatable, but if you delay, the damage can be permanent, leading to infertility and lifelong consequences.

In this article, you will learn about testicular torsion; what it is, how to recognise it, its harmful effects and how it is treated. But before diving deep, here is some basic information about the structure and function of the testes for your orientation. 

 

What are the Testes? 

Picture of the groin area in a male showing the testes in the scrotum and inlay of the detail structure of a testis. Clciv on image to enlarge. Image adapted from NCI

 

The testes, also called testicles (singular testis or testicle), are an important part of the male reproductive system. They are located just behind the penis in a skin sac called the scrotum. In most boys and men, there are two of them, and they’re usually about the size of small nuts or eggs. It’s also normal for one testis to be slightly bigger or hang lower than the other.

The testes hang in the scrotum, suspended by a tube-like structure called the spermatic cord, which contains several structures and delivers blood and nutrients to them. This cord is especially important because it’s the structure that twists during testicular torsion, cutting off the blood supply and causing the emergency. 

The testes play an important role in making sperm (for fertilization) and producing testosterone, the hormone responsible for male growth, puberty, and fertility.

 

What is Testicular Torsion?

In testicular torsion, the cord that carries blood to the testicle gets twisted, cutting off circulation [1]. No blood supply means no oxygen, and without oxygen, the testis starts to die. This makes testicular torsion an emergency.

The good news is that testicular torsion is treatable if caught early. However, delay in treatment can lead to permanent loss of function in the affected testicle and possible male infertility [1, 2].

Testicular torsion: Common age of occurrence. Click on image to enlarge.

 

Testicular torsion can happen to boys of any age, but it is most common within  age 12 -18 years [1, 2]. 

                      

Is Testicular Torsion a Problem in Africa?

Testicular torsion yearly occurrence rate. Click on image to enlarge.

 

Testicular torsion can happen to any boy, anywhere. But in Africa, boys are more likely to lose a testicle because of delays. This makes their situation peculiar.

In a recent study, Black/African American patients were found to be three times more likely to have testicular torsion compared to any other race. In Africa, the true number of boys affected is not well documented because of limited awareness and lack of research [2, 3]. What we do know is that boys often reach the hospital after an average of 52.5 hours – more than two days after the pain starts. In terms of rate of occurrence, 1 out of every 4000 young men worldwide develops testicular torsion every year [4].

Some of the reasons for delay in managing testicular torsion in Africa are [4]:

• Waiting too long to go to the hospital – Sometimes, pain is ignored or mistaken for something minor, so the family waits before seeking care.
• Slow attention at the clinic – Even after arriving, there can be delays in seeing the right healthcare worker.
• Wrong initial diagnosis – The pain might be confused with other conditions, leading to precious time being lost.
•  Long distances to the right hospital – Some smaller clinics can’t treat torsion, so patients have to travel far to reach a bigger hospital.
•  Extra time spent on tests – An ultrasound scan can help confirm torsion, but waiting for it may delay surgery.
•  Money problems – In emergencies, treatment may be postponed because the family needs time to raise the required funds.

 

What Causes or Triggers Testicular Torsion?

Risk factors for testicular torsion. Click on image to enlarge

 

While there are no known specific causes of testicular torsion, certain risk factors may trigger it, like:

1)  Age

Testicular torsion is most common among young African boys who are less than 18 years of age. [1, 2]

2)  Bell-clapper deformity

Some boys are born with this condition that allows the testis to move freely within the scrotum instead of being stable. This increases the risk of testicular torsion in both testicles as opposed to the usual one-sided occurrence.

3)  Vigorous activity

Activities like sports and exercise can trigger testicular torsion.

4)  Cold temperature

Testicular torsion is known to occur more in cold seasons. [3, 5, 6]

5)  Sleep positions

Deep sleep has been associated with testicular torsion. [7] This is probably due to sleeping positions that could cause the testicle to twist.

6)  Sexual activity

Testicular torsion can be triggered by sexual activity.

7)  Injury to the testis

Injury to the testis could cause testicular torsion, especially if it is forceful.

8) Puberty

Rapid growth during puberty could predispose a young boy to testicular torsion and this happens 65% of times.

  

What are the Symptoms of Testicular Torsion?

Testicular torsion can show up in the following ways:

1)    Sudden severe pain in the scrotum (often at night or early morning) [1, 6]

2)    Scrotal swelling and redness

3)    Nausea and vomiting

4)    Abdominal pain

5)    Fever

6)    One testicle sitting higher than the other one

 

How to know if a Child has Testicular Torsion 

One major reason why testicular torsion is a problem in Africa is the inability of both caregivers and healthcare staff likewise to recognise it early. [1]

A key consideration to keep in mind is that a report of a sudden severe pain in the testicles of young boys between 10 – 12 years of age should make you suspect testicular torsion and seek immediate medical attention. [2]

 

How is Testicular Torsion Diagnosed?

Your healthcare provider makes the diagnosis of testicular torsion following a review of your child’s symptoms and observations on the affected testes. While ultrasound scan confirmation is helpful in making a diagnosis, it should not take priority over immediate treatment if getting it done (as may happen in many African countries), causes delay in treatment [5].

 

What Other Conditions May be Confused with Testicular Torsion?

Here are some testicular conditions that may be mistaken for a torsion and how you can differentiate them:

• Epididymitis: A condition where the epididymis - the coiled tube beside the testicle where sperm matures - becomes inflamed. Unlike torsion, the onset is usually slower, and pain may come with swelling, fever, or urinary symptoms. It often develops from infection or pressure, and not a sudden twist.

• Varicocoele: In this condition, the veins above the testicle are enlarged. It’s usually painless or causes a mild discomfort, rarely needing emergency treatment. Unlike torsion, there is no sudden severe pain, and the testicle’s position doesn’t change.

• Hydrocoele: Hydrocoele is the buildup of fluid around the testicle. It can cause a feeling of heaviness or pressure, but the pain is mild and gradual, unlike the sudden, intense pain of torsion.

• Orchitis: The infection of one or both testicles, often due to mumps or STIs. Pain develops over hours or days, sometimes with fever. Torsion, by contrast, happens suddenly and requires immediate surgery.

• Kidney Stones: When there are stones in the kidney, they might cause pain which could be felt in the testicle, but in contrast to testicular torsion, you might feel pain in your abdomen or back and also experience some changes in your urine. 

• Testicular Tumor: Refers to a growth in the testicle which can be benign or cancerous. It usually presents as a painless lump or gradual swelling of the testicle. 

• Traumatic Hematoma: This is bleeding in the scrotum from an injury or trauma. Pain and swelling develop afterwards. However, torsion can occur without external trauma.

 

How is Testicular Torsion Treated?

Testicular torsion requires immediate surgery as delay can cost the testicle. During surgery, the surgeon untwists the testicle and stitches it in place so it doesn’t twist again. To prevent testicular torsion, the other testicle is often stitched as well [8]. If surgery is delayed and the testicle dies, it has to be removed through a procedure called orchiectomy (or orchidectomy).

 

How Quickly Should Testicular Torsion be Treated?

Table 1: Showing testicular survival rates based on time from symptom onset to time of care with information derived from here.

 

After a testicle is twisted within the scrotum, it loses its blood supply. For the testicle to retain its function, the blood supply should be restored in 4 to 6 hours. [1] This is known as the golden period. Beyond this time, the ability to function properly decreases and after 24 hours, the affected individual risks being unable to father children [1] (See Table 1). At this point, a surgeon will need to remove the testis in a process known as orchiectomy.

 

What are the Complications of Testicular Torsion?

After a testicular torsion, the following complications could occur:

1. Testicular infarction (death, shrinkage or loss of function)
2. Fertility issues (i,e, inability to father a child)
3. Cosmetic issues (this could be fixed by using a testicular prosthesis)
4. Psychological challenges like depression

These complications are not just medical issues. They can affect a boy’s confidence, relationships, and future. But most of them can be prevented if testicular torsion is treated quickly.

 

How can Testicular Torsion Treatment be improved in Africa?

Here are a few actionable solutions to the problem of adequate treatment of testicular torsion in Africa:

• Public awareness

Educate parents, teachers, and boys on what testicular torsion is, the warning signs, and the urgency of getting to a hospital immediately.

• Healthcare worker training

Equip healthcare professionals to recognize torsion quickly, make a prompt diagnosis, and avoid unnecessary delays such as waiting for ultrasound scans before surgery.

• Better access to care

Strengthen rural and underserved areas with the capacity for emergency surgical care.

• Encourage open communication

Create an environment where boys feel comfortable reporting pain or swelling early, without fear or embarrassment.

 

Final Thoughts

In testicular torsion, time is life for the testicle. In Africa, young boys with testicular torsion are more likely to lose a testicle often due to delays in seeking or receiving medical care, making timely treatment difficult.

If you remember one thing from this article, let it be this: sudden scrotal pain could be testicular torsion and you should visit the emergency department for urgent medical care.

 

Frequently Asked Questions 

• Is testicular torsion common?

Testicular torsion isn’t very common as it affects 1 in 4000 young men yearly. [4]

• Can testicular torsion cause cancer?

There’s no clear association between testicular torsion and testicular cancer.  

• Can testicular torsion fix itself?

Testicular torsion often needs surgery, not just to untwist the affected testis, but to prevent it from happening again.

• Can testicular torsion happen again after surgery?

Testicular torsion can happen again after surgery, but this is rare.

•  Can testicular torsion be painless?

While most cases of testicular torsion happen with severe pain, it can also be painless.

•  Can testicular torsion happen without symptoms?

It’s difficult for testicular torsion to happen without symptoms. Even without pain, you would usually notice other symptoms like testicular swelling and an unusually displaced testis.

• How quickly can testicular torsion happen?

Testicular torsion can happen quickly, often within minutes to hours.  

• How do I prevent testicular torsion?

There’s no guaranteed way to prevent testicular torsion. However, if it occurs, quick intervention by surgery can be done to save the testis and stop it from happening again.

• Is testicular torsion inherited?

While testicular torsion is not an inherited condition, some individuals have a genetic condition, Bell-Clapper deformity that makes them at risk of developing it.


 

References

1. Nedjim SA, Biyouma MDC, Mahamat MA, et al. Testicular torsion in Sub-Saharan Africa: a scoping review. Afr J Urol 2023;29, 50. doi: 10.1186/s12301-023-00384-0. Available from here 

2. Baruga E, Munabi IG. Case series on testicular torsion: an educational emergency for sub-Saharan Africa. Pan African Medical Journal; 2013;14:18. Available from here.

3. Bello JO. Burden and seasonality of testicular torsion in tropical Africa: analysis of incident cases in a Nigerian community. African Journal of Urology 2018;24(1):79–82.  Available from here. 

4. Urology Care Foundation. Testicular torsion. [Internet., n.d.]. Accessed 16 August 2025. Available from here.

5. Mukendi AM, Kruger D, Haffejee M. Characteristics and management of testicular torsion in patients admitted to the Urology Department at Chris Hani Baragwanath Academic Hospital. African Journal of Urology; 2020;26:34. Available from here.      

6. Gomes DO, Vidal RR, Foeppel BF, Faria DF, Saito M. Cold weather is a predisposing factor for testicular torsion in a tropical country: a retrospective study. São Paulo Medical Journal; 2015;133(3):187–190. Available from here.

7. Alzahrani MA, Alasmari MM, Altokhais MI, Alkeraithe FW, Alghamdi TA, Aldaham AS, Hakami WH, Alomair S, Hakami BO. Is There a Relationship Between Waking Up from Sleep and the Onset of Testicular Torsion? Research and Reports in Urology; 2023;15:91–98. Available from here.

8.   Paediatric Surgery Trainee Research Network (PSTRN) and British Urology Researchers in Surgical Training (BURST), et al. A national survey of practice for the emergency fixation of testis. The Annals of The Royal College of Surgeons of England; 2025;107(1):48–53. Available from here.

 

About the Author:

Dr. Chiamaka Wisdom-Asotah - Medical doctor and health writer passionate about delivering accurate, actionable health insights that empower readers to take charge of their well-being 

 

 

Published:  September 29, 2025.

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