Boxer Karlos Balderas punching Rene Tellez Giron in the groin

If Your Testicles Twist Around One Another, Your Pain Will Be Unreal

Our favorite Internet doc explains why testicular torsion is as painful as a heart attack.

The thought of your testicles twisting inside your scrotum is something out of a horror film—but testicular torsion is very real. And it’s very painful.

In his latest Instagram post, Dr. Karan Raj, a surgeon with the UK’s National Health Service, dives into testicular torsion as his trauma topic of the day.

Gentlemen, it isn’t a light watch.

What is Testicular Torsion?

In short, your worst nightmare. Testicular torsion is when your spermatic cord—a reproductive cord with nerves, blood, and your vas deferens, which carries sperm from your testicle—twists, cutting off blood supply. This usually happens after physical trauma to the groin, like a kick, but it can also just happen while you’re sleeping. (Yes, we’re sadly serious.)

As any below-the-belt injury, testicular torsion is far from painless.

“That brief loss of blood supply leads to ischemia, one of the most painful biological processes a human can experience,” Raj says.

Ischemia is a condition where blood flow—and with that oxygen—is restricted to an area of your body. Raj says ischemia is often found in childbirth and heart attacks.

“A loss of blood supply over several hours can lead to the death of the ball and tissues within,” says Raj. “This is necrosis, cell death.”

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Saving a Twisted Testicle

Once testicular torsion happens, you have about six hours to save your balls, Raj says.

Your doctor may try manual detorsion—pushing on your scrotum to untwist the testicle—which sounds 100 times worse than the actual injury.

If that doesn’t work, surgery is required to untwist your spermatic cord and stitch your testicles to the inside of your scrotum to avoid future twisting.

The bulk of testicular torsion problems occur in males aged 12 to 18, so older guys have much less to worry about.

Dr. Raj is no stranger to posting about testicular trauma. Maybe his most gruesome yet was testicular degloving, where your skin around your testicles are completely removed. Doctors will take skin from other parts of your body to recover your testicle.