The mere thought of a twisted testicle makes the toughest of men turn white as a sheet – even women who don’t quite understand that sort of pain wince when you say the words. But no matter how squeamish it makes you, if you have a son, this is one article you can’t afford to stop reading.
Incredible pain. Loss of a testicle. Fertility issues later in life. These are all possible upshots of testicular torsion. It’s more common than you think, and it’s always an emergency situation. It happens when the spermatic cord, which provides blood flow to the testicle, rotates and twists. Just a few hours can be the difference between going through life with one testicle or two.
No mother in the world wants to see her young son writhing in pain because of an out-of-place private part, but that’s just what happened to my boy. I found myself at NUH, flashing to the scene from Terms of Endearment when the mother starts screaming, “Give my daughter the shot!” I felt that same desperation watching my son, feeling helpless to make things better. A few days earlier, I’d come home from work to find my seven-year-old standing on the stairs, bent over in pain.
“Mommy, I got hurt on the playground.” He looked absolutely miserable. He said he was running and he suddenly had a pain. Nobody kicked him. He didn’t fall. No ball landed between his legs. He just started hurting.
My son is a pretty tough cookie and quite athletic. I’ve seen him injured in all sorts of ways only to pop back up and keep going, so I knew it was something big; I just didn’t realise how big. The pain was in the bend of his leg, up near his hip bone so we decided he’d pulled a muscle of some sort. Never in my wildest dreams would I think a pain in his hip would be because of a retracted, twisted testicle.
The next day, he had a field trip to the Botanic Gardens. God bless that kid, he insisted on going and walked around for four hours without complaining, but I could tell he was in pain. By dinner, he had a slight fever. The next morning, I took him to the GP.
And here’s where I learned my lesson: when a child is in that much pain, make sure the doctor does a physical examination. Instead, the doctor took a urine sample and gave him antibiotics for the fever. Home we went without the doctor ever looking at him. If he had, he would have noticed the out-of-place testicle. To be fair, I also hadn’t looked because it never occurred to me to look between his legs for a pain in his hip. I just didn’t know better – but the doctor should have.
After three doses of antibiotics, his fever was going up instead of down and he was in more pain than ever. Saturday night, we rushed to one hospital that then sent us to the paediatric department of National University Hospital (NUH). The admitting doctor immediately realised his testicle wasn’t in place and sent him for testing and they had to give him Fentanyl just to do the ultrasound. There was blood flow – lots of blood flow – so they weren’t convinced it was a twisted testicle, but they thought instead it might be an infection of some sort as blood flow increases around infection and a twisted testicle would have none. Plus, the fact that he had been able to go to his field trip and keep moving made them think it couldn’t possibly be testicular torsion. “No boy his age could endure that kind of pain.” I told you he was a tough cookie.
After a full day in the hospital on IV antibiotics, with the symptoms only getting worse, the doctors decided to do surgery. Sure enough, the testicle was partially twisted. The surgeon cut open his scrotum, pulled the testicle back into place and made sure that neither testicle would ever retract or twist again. The next day, we were home with stitches to rival Frankenstein. Within two weeks, he was back to playing soccer. My son was incredibly lucky as he remained intact, especially after having been twisted for more than 100 hours!
Why does it happen? Well, it’s not always clear. According to the Mayo Clinic in the US, most males (but not all) who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles, but not every male with the trait will have testicular torsion. Turns out, my father-in-law had an undescended testicle that was fixed by surgery as a boy, only none of us ever knew. Frankly, how many in-laws chat about testicles over a holiday dinner?
As a parent, you need to be in tune with your son. If he’s complaining about pain or swelling in his scrotum or in the bend of his leg or up near his hip, pay attention. He also might be nauseous, vomiting or have fever. Often, the boy will wake up with pain in his scrotum. Don’t wait for it to get better. Be safe and take him immediately to an emergency room and don’t let him eat in case he needs surgery. In Singapore, the best hospital to visit for this condition in young boys is NUH.
How is my son now? Well, there’s something to be said for this happening at the age of seven. He’s a bit of a hero now at school. The girls all want to know what a testicle is. The boys? Well, one said to his mother, “Did you hear about my friend? His ball exploded.”
And he told me it was okay for me to write this article. “Mom, if telling my story can help another boy, then you should tell it.” Love that kid.
• One in 4,000 boys are affected. Most are between the ages of 12 and 18, but it is also common in infants.
• The amount of twisting can be anywhere from 180 to 720 degrees. The degree of twisting affects how quickly a testicle gets damaged.
• According to kidshealth.org, as a general rule, within about four to six hours, the testicle can be saved 90 percent of the time. After 12 hours, this drops to 50 percent; after 24 hours, the testicle can be saved only 10 percent of the time.
• Testicular torsion often occurs several hours after vigorous activity, a minor injury to the testicles or even sleep. Cold temperature or rapid growth of the testicle during puberty also might play a role.
• Symptoms include pain, nausea, vomiting or fever.
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This article first appeared in the March 2018 edition of Expat Living. You can purchase a copy or subscribe so you never miss an issue!