How does Testicular Torsion Present?

Signs and Symptoms

Symptoms of testicular torsion include:

- Blood in semen
- Pain in the groin and lower abdomen
- Hard testicle and redden testicle
- Swelling of the testicle
- Nausea and vomiting
- Sudden, severe testicular pain

Clinical Examination

When an individual presents with testicular torsion, pain is a common feature. The patient may not allow the examiner to touch the testes because of the pain. The spermatic cord is shortened because it is twisted and the testes may be higher compared to the unaffected testes. This finding of an elevated testes is quite specific and provides strong evidence for testicular torsion. The affected testes will also appear swollen and engorged.

Another important finding which may provide a clue to the diagnosis of testicular torsion is the absence of what is called the cremasteric reflex. This reflex is elicited by stroking or pinching the skin on the medial thigh, causing contraction of the cremasteric muscle, which elevates the testis. The cremasteric reflex is considered positive if the testicle moves at least 5 mm. This reflex is almost always present in healthy young males and the loss of the cremasteric reflex is at least 99% sensitive for testicular torsion.