Testicular Torsion & Injury                                                                           

The testicles are very sensitive organs. Since they are an external part of the male reproductive system, rather than internal, it is very painful for boys if they accidentally get hit in the testicles. As the Nemours Foundation (2016) notes, "the location of the testicles makes them prime targets to be accidentally struck on the playing field or injured during strenuous exercise and activity". Teenage boys who are involved in sports or who are very active are most at risk for these types of injuries.

Blunt trauma is the most common cause of testicular injuries, comprising 85% (WebMD, 2020). A ball strike, a kick, or a bicycle or motorcycle accident can all hurt the testicles. Most of the time, this contact is not serious. Boys may be in great pain at first, and will need comfort and reassurance from parents or caregivers. With this type of injury, it is especially important for adults to remain calm and respectful, as a teenager may not only be in pain but also embarrassed. Such sensitive injuries should never be treated as a joke or as something to laugh about. If a child is hurt, the last thing we want to do is add to his hurt by injuring his feelings. If other youngsters are present, make sure that they are not behaving in a way that will increase a boy's discomfort. 

A teen boy who has sustained a blow to his testicles may feel sick to his stomach along with the scrotal pain. A wrapped ice pack can be given to him to apply to the area along with pain medicine if necessary. Resting in bed or on the couch can eventually help boys to feel better. It is important for the atmosphere to be kept low-key, and it is best if boys take it easy for a few days (Nemours Foundation, 2016). However, if the pain does not dissipate in an hour, if a boy is continually throwing up, is feverish, and/or has bruising, swelling, or a puncture, an adult should get medical help at once (ibid). Rarely, serious injuries may result, such as testicular rupture or testicular torsion. Both of these conditions require surgery to repair the testicle and prevent its loss.     

Testicular Torsion

Testicular torsion is a medical emergency that results "when the spermatic cord, which provides blood flow to the testicle, rotates into an unnatural position and remains twisted", cutting off the supply of oxygen to the testicle (Parenting Healthy Babies, 2018). Testicular torsion can be caused by an injury, but it can also occur suddenly, for no apparent reason. It may happen even in sleep. Torsion is most common in teenage boys and is rare after age 25 (AAP, 2015). It is especially more likely to happen in boys who were born with a condition called bell-clapper deformity, in which the testicles are not attached to the scrotum. If left untreated, testicular torsion can lead to loss of the testicle, as well as life-threatening gangrene. 

According to the American Academy of Pediatrics, symptoms of torsion include:  

• Pain in the scrotum (Usually on one side, sudden, and severe)
• Swollen, red, tender scrotum
• Enlarged testicle
• Abdominal pain
• Nausea or vomiting

If a teenage boy exhibits these symptoms, he should immediately be taken to the emergency room. He should not be given anything to eat or drink. Surgery will be carried out to untwist the spermatic cord and save the testicle. Boys are given medicine and put under general anesthesia for this procedure so that they do not have to feel any pain. Typically, they can rest in the recovery room after surgery and go home the same day (Nemours Foundation, 2017). Teen boys who have had surgery for torsion should abstain from sports and strenuous exercise for a few weeks (ibid).   

Time is of the essence. The testicle can almost always be saved if surgery is done within 6 hours; if 24 hours elapse, the testicle may be lost. If the testicle has died, boys must undergo a more complicated operation called an orchiectomy. In an orchiectomy, a testicle that is damaged beyond repair is removed to prevent gangrene. Thankfully, even if one testicle is lost, an adolescent boy will likely still be able to father children in the future. The remaining testicle will continue to  produce sperm. Explaining this fact to them can console teen boys if they are concerned. 

It is very important for adolescent males to know that they can come to their parents or other trusted, caring adult if they are experiencing genital pain. Boys may often be uncomfortable to discuss such a subject, but keeping the discomfort a secret is very dangerous. Parents should be vigilant to signs that their son is in pain and should take immediate measures to get him medical care. Even if the pain decreases or goes away, it is still a good idea to get the child evaluated, as torsion may happen again (ibid). 

Overall, testicular injuries in teens can be prevented by wearing protective cups and jock straps. Cups shield the groin and protect the testicles from harm during contact sports, while jock straps secure the testicles during bicycling or heavy exercise (ibid).  With these measures in place, boys will be able to protect themselves while engaging in the physical activities they enjoy! 

References

American Academy of Pediatrics. (2015). Testicle pain and testicular torsion. AAP. Retrieved Nov. 1, 2020 from https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Testicular-Torsion.aspx   

Nemours Foundation. (2016). Testicular injuries (for teens). TeensHealth. Retrieved Nov. 1, 2020 from https://kidshealth.org/en/teens/testicular-injuries.html?ref=search

Nemours Foundation. (2017). Testicular torsion (for parents). TeensHealth. Retrieved Nov. 1, 2020 from https://kidshealth.org/en/parents/torsion.html?ref=search

Parenting Healthy Babies. (2018). Testicular torsion in children: causes, symptoms, treatment. Parenting Healthy Babies. Retrieved Nov. 1, 2020 from https://parentinghealthybabies.com/testicular-torsion-symptoms-treatment/

WebMD. (2020). Testicular injuries. WebMD. Retrieved Nov. 1, 2020 from https://www.webmd.com/men/guide/testicle-injuries#1