About 4.5 in every 100,000 males under 25 gets testicular torsion every year, but what causes it?(1) The cause of torsion is often unknown, but there are some situations that may make it more likely.
Bell-Clapper: Most cases of testicular torsion are caused by a "bell-clapper deformity." This is an abnormality of the testicle that allow it to rotate more freely, and may cause it to lie horizontally in the scrotum.(2) You likely won't know if you have this, and most cases of bell-clapper do not result in testicular torsion, but the risk is higher if you do.
Trauma: Some cases of torsion have been linked to trauma (like getting kicked really hard in the balls) (3). Although this is rare, its still a good idea to minimize trauma as much as possible!
Vigorous physical activity: Sometimes, torsion can occur during or after strenuous exercise, such as sports. (4) This is also rare, but its a good idea to pay attention to any pain you may have afterwards.
Sleep: While the sleep itself doesn't cause torsion, many cases do happen spontaneously during your sleep!
No matter the cause, be sure to check your testicles regularly so that you know what normal is, and pay attention to any changes! It is most important that you seek medical attention for any pain lasting more than 2 hours!
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Sources
(1) Mansbach J, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Journal of Adolescent Health. 2004;2(34):143-4.
(2) Greear GM, Romano MF, Katz MH, Munarriz R, Rague JT. Testicular torsion: epidemiological risk factors for orchiectomy in pediatric and adult patients. International Journal of Impotence Research. 2021 Mar;33(2):184-90.
(3) Seng YJ, Moissinac K. Trauma induced testicular torsion: a reminder for the unwary. Emergency Medicine Journal. 2000 Sep 1;17(5):381-2.
(4) Hazeltine M, Panza A. Testicular Torsion: Current Evaluation and Management. Urologic nursing. 2017 Mar 1;37(2).
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