Urology/Right testicle and scrotal discomfort
QUESTION: About 2 weeeks from the time I am writing this, I started to experience the following problem. I got out of a warm bath that night and went to bed. The following day, I started to experience discomfort in the right testicle. It was a sort of stinging, pinching, and a pulling sensation. It feels twisted. Additionally I noticed that when the muscles retract the testicles upwards the right testicle gets pulls up and outward so that it points out at an unusual angle. Also I have been frequently palpating the location of the epididymis and it seems the testicle sometimes hangs in a rotated way, 90 to 180 degrees. Sometimes turning it about 90 degrees seems to relieve any discomfort fairly quickly which seems odd.
I went to the doctor and was given a brief examination but nothing was found. The examination happened while I was experiencing this discomfort. (It has been intermittent and not constant)
Both my testicles appear to hang at a '45 degree angle inwards'. Not completely horizontal or vertical. The other day I woke up and noticed that when I stood up, the right testicle was positioned more horizontally and this alarmed me.
I have a few questions.
Is it possible to know where my testicles are attached to the scrotum and whether it is adequate to prevent torsion?
Do my symptoms sound like torsion? What could be going on? Some of the symptoms suggest torsion, yet I have never felt any severe or even moderate pain at any time.
Is there such a thing as 90 degree torsion? Or if it was a partial torsion could this explain the lack of pain?
I remember that 4 years ago I had a similar type of pain but more in the inguinal area. This eventually went away.
I am 29 years old. It seems odd that all of a sudden my testicles would start becoming torsioned and detortioned.
It is not possible to identify the exat connections between the testicle and scrotum. They do not show up on imaging and cannot be felt on examination.
Your symptoms do suggest the possibility of an intermittent torsion.
Yes, the testicle can twist to 90 degrees, but this rarely, if ever, causes any pain or discomfort. To compromise blood flow, the twisting generally has to be 360 degrees or more.
29 years old would be a little old for a torsion, but not unheard of. Discuss this with a local urology specialist. It may be worth having the testicles surgically fixed in the scrotum to prevent any twisting. This may or may not help your pain, but it may be worth a try.
---------- FOLLOW-UP ----------
QUESTION: i dont think it is torsion anymore. this has been ongoing for almost 3 weeks. i felt an improvement but now it seems to be getting bad again. I also dont feel well generally. My body feels weak and tired as if its trying to fight an infection. could it be an infection of some sort? what else could be causing this discomfort in my right testicle?
3 weeks seems quite a long time. Im worried whether it will ever go away and what is actually wrong?
You should contact a physician and have it checked. Feeling weak and tired could be due to some kind of infection but may be unrelated. The cause of your testicular pain is unclear from the available information. You should consider a urology consultation.
---------- FOLLOW-UP ----------
QUESTION: Actually I have changed my mind again and i think it could be torsion. Can you tell me:
what is the normal range of rotation in degrees for a testicle?
how does the testicle rotate? does it twist around on the cord? or can it twist along the other axis?
how will the doctors be able to determine it is torsion if it is an intermittent torsion i am having?
sometimes the epidydimis on the right side cannot be felt on the bottom but is on top. this suggests it has rotated 180 degrees. is this normal?
if the testicle is attached to the scrotum even if its loose, how can torsion happen? i can only imagine it happening
if there was no attachment at all.
There is no set "range of rotation" for a torsion, but either a testicle is fixed in place or it isn't. In general, 360 degrees or more is considered absolute proof of a torsion.
The testicle twists around the cord. It cannot twist otherwise, but it may lie at an unusual angle depending on the exact situation and anatomy.
If they can do an ultrasound during a "torsion" event, then they can easily see the diminished blood flow. If not, they may have to just fix it an hope that fixing it helps the pain.
What you describe about the epididymis is not normal but is probably due to inexperience in examination. The epididymis extends from the top (head) to the bottom (tail) of the testis so you should be able to identify it at both locations although the head or top part is usually easier to feel.
The testicle is either attached or it isn't. the attachments may be missing, but are rarely "loose". Obviously, a torsion cannot happen if sufficient attachments are present, but it can easily spin around 1 or even 2 if they are not spread out enough.
Please follow my earlier advice and consult a local urologist.