QUESTION: When I wake up in the morning, I am finding very often that the epididymis of the right testicle is facing up towards my abdomen as opposed to the normal position which is underneath. If I check later in the day, I find that it has turned itself around again.
If I hadn't been checking, I would have never known about this because there is no pain or any other sign.
I do not necessarily think I am at a greater risk of torsion just because the testicle seems to have a greater degree of movement. and I would only have surgery if the p value was sufficiently low to nullify the null hypothesis.
How can it be determined whether the symptom I have described is in itself causing harm to my testicles?
Since you are not having any pain or any other obvious problem with the testicle, it does not appear that this minor twisting is having any bad or permanent effect on the testicle.
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QUESTION: When I say I haven't been having pain what I mean is I don't think the twisting is related to the pain I have felt in the same testicle for a few months now, because that pain started quite suddenly. And I think I remember feeling the epididymis the wrong way around from many years ago. In other words I do not think I have suddenly started to have a minor torsion. What is your opinion?
Why would my testicle not twist for more than 20 years, and then suddenly start twisting half way and then back to normal again? My view is that the minor twisting has been going on since I was young.
The only reason I can think of for a sudden change is if the skin holding the testicle in its normal position has torn. What is your view on that?
This minor and intermittent twisting is a bit different from the normal type of torsion that doctors talk about.
What evidence is there that such minor on and off twisting causes damage?
The pain in the testicle could be from the twisting or not. If it seems to be related, a small surgery can be done to prevent any twisting. If this eliminates the pain, then you have your answer.
Torsions happen by themselves but can be related to trauma and other conditions. There is no known reason why it might happen on any given day.
There are attachments of the testicle to the inside of the scrotal skin. If these attachments are too close together, a torsion or twisting is possible.
Your problem does not sound like a standard torsion which usually has severe pain which remains until the torsion is fixed. You could possibly have an intermittent type torsion but this cannot be confirmed from the limited data presented.
The twisting causes damage by limiting the blood supply. This decrased blood flow, called ischemia, can cause severe pain and if allowed to proceed will result in some damage to the testicle.
You should have a urologist check it out for you.
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QUESTION: but is the intensity of the pain related to ischemia proportional to the decrease in blood flow in a continuous way or is it discrete (on/off)?
and can we reliably say that the degree of damage due to torsion is a function of the degree of torsion even in cases where the torsion is less than a full 360 degrees? could it not be for example that some men due to individual variation can tolerate 180 degrees torsion whereas others might suffer much more damage?
what do you mean by if the attachments are too close? and can these attachments tear and come off due to say a trauma?
if i experience discomfort even while the testicle is not rotated, doesnt this suggest that the rotation has nothing to do with my discomfort? because usually, the pain is relieved immediately once the testicle has been untwisted no?
The degree of damage depends on the severity of the torsion, the degree of ischemia and the duration. The more severe the blood flow restriction, the greater the pain and the damage. Eventually, the pain would go away but the testicle would be destroyed.
While there is some individual variation, very few men could tolerate the severe pain from a significant acute torsion.
If the attachments are spread out, then twisting is unlikely. When they are too close together, they can twist around the clumped attachments.
These attachments can tear, but this is unlikely except in severe trauma like from a auto accident.
While pain without any obvious twisting does suggest another source, it does not totally rule it out either. And the pain is not necessarily relieved when the twisting is untwisted as any damage done will still cause pain. Sorry, it's just not that simple and it can be difficult to say for sure what is causing your pain. It may or may not be the twisting.