How do you know if your testicles are reversed?

Testicular reversal, medically known as testicular torsion, is a urological emergency that requires immediate medical attention. It can be initially judged by symptoms such as sudden severe testicular pain, abnormally elevated testicular position, scrotal redness and swelling, accompanied by nausea and vomiting. Testicular torsion is usually caused by the rotation of the spermatic cord leading to interruption of blood flow. If not treated within 6 hours, testicular necrosis may occur.

1. Sudden severe unilateral testicular pain

The most typical manifestation of testicular torsion is sudden tearing pain in the affected testicle, which may radiate to the groin or lower abdomen, and the pain worsens with movement or touch. It may be related to cremaster muscle spasm during strenuous exercise or sleep. Urgent medical attention is required to confirm the diagnosis by scrotal color ultrasound. Delay in treatment may lead to testicular ischemia and necrosis.

2. Abnormal upward shift of testicular position

Torsion of the testicle often results in an elevated position due to shortening of the spermatic cord. The affected testicle is higher than the contralateral side and is fixed in the transverse position. You can try to observe the morphological changes of the scrotum in a standing position, but it is forbidden to reduce it by manual manipulation. Wrong operation may aggravate the injury. Confirmation requires color Doppler ultrasound to check blood flow signals.

3. Scrotal skin is red, swollen and hot

The skin of the scrotum becomes red and swollen 4-6 hours after the onset of symptoms, and the temperature rises when touched. This is a typical progressive manifestation of testicular ischemia and may be accompanied by systemic symptoms such as fever. Pediatric patients need to be alert to cryptorchidism torsion, and parents need to promptly check the perineum when they find abnormal crying.

4. Reflex gastrointestinal symptoms

About half of the patients will experience gastrointestinal reactions such as nausea and vomiting, which are related to testicular nerve reflexes and can easily be misdiagnosed as gastroenteritis. If adolescents experience abdominal pain and scrotal discomfort at the same time, testicular torsion should be ruled out first. Emergency treatment includes manual reduction and surgical fixation.

5. Positive Prehn's sign

Pain that worsens when the scrotum is elevated is called a positive Prehn's sign, which is an important sign in distinguishing testicular torsion from epididymitis. However, those with atypical clinical symptoms need to be diagnosed by ultrasound. If necrosis is found during the operation, orchiectomy is required. Those who retain fertility function need to undergo contralateral fixation at the same time.

If suspected symptoms occur, you should immediately lie down and immobilize, use a towel to support the scrotum to relieve pain, and the golden treatment period is within 6 hours. Preventive fixation of the contralateral testicle is performed routinely, strenuous exercise is avoided after surgery, and tight-fitting underwear is worn to reduce the risk of recurrence. Regularly review semen quality to assess the impact on reproductive function.