Testicles twisted

A twisted testicle is called testicular torsion in medical terminology. This is the unilateral or bilateral torsion of the testicle in the scrotum due to an acute hypermobility of the entire spermatic cord. The twisted testicle represents a threatening situation, since the blood circulation of the testicle is restricted.

Introduction

The twisting of the testis can occur in different ways and at different anatomical sites. Therefore, the twisting is classified according to its type.

Intravaginal testicular torsion

In the case of intravaginal torsion of the testis, the torsion occurs in the testicular sheath itself. The twisting of the spermatic cord is closer to the testicle. In addition, this disturbs or even completely interrupts the blood flow. This form of testicular torsion is common in young adults.

Extravaginal testicular torsion

In this form of testicular torsion, the spermatic cord is twisted above the testicular sheath. This process occurs more frequently in male infants and toddlers. Also here the supply of the testicle is massively disturbed.

Causes

A twisted testicle usually occurs in people who have a certain anatomical predisposition to it. From birth there is therefore a hypermobility of the testicles, which can be caused by anatomical anomalies. A small trigger such as exertion during sports can be enough to cause the twisting of the testicles.

An incorrect anatomical position of the testicular sheaths, which can develop during embryonic development, is therefore a major risk factor for a twisted testicle. In many malformations, the testicular sheaths have not bonded together properly during the developmental phase. As a result, they leave too much room for manoeuvre, which can lead to twisting in unfortunate movements.

Another anatomical condition favors a twisted testicle. During the embryonic phase, the testicles migrate from the abdominal cavity through the inguinal canal into the scrotum. This is a natural process known as descensus testis.

Responsible for this descent of the testicles is the lower gonad leaf. If this gonad leaf is insufficiently or not at all developed, the result is an incomplete descent of the testis. The testicles then stand higher and are not held in the scrotum by the gonad leaf, which is later also responsible for the safe position of the testicles.

This can lead to a testicular torsion more easily. If the testicles descend during development, they are accompanied by a muscle strand, the cremasteric muscle. This muscle is used for protection, is involved in regulating the temperature of the testicles and, in case of erection, pulls the testicles closer to the body.

The muscle is attached to the testicles for this purpose. If the point of attachment of the muscle is anatomically unfavorable, the contraction of the muscle can also cause a twisting of the testis due to the tensile forces acting. In some patients a twisted testicle can occur during sleep due to anatomical conditions.

If the testicles have too much room to move, the movement during sleep is sufficient to twist the testicle. In these cases, one often speaks of idiopathic testicular torsion. Furthermore, twisting can occur during sports activities.

Testicular torsion can also be triggered when riding a bicycle because the testicle is constantly moved back and forth by sitting on the saddle of the bicycle. The testicles can also be twisted in accidents. Another possible cause can be the direct manipulation of the testicles during an operation.