Testicular Torsion & Self-Exams: What You Need to Know

At CHKD, we believe in empowering youth and families with the knowledge to take charge of their health. One important area that's often overlooked is testicular health — and understanding testicular torsion and how to perform a testicular self-exam (TSE) can make a real difference.

What is Testicular Torsion?

Testicular torsion happens when the spermatic cord, which provides blood flow to the testicle, becomes twisted. This can cut off blood supply to the testicle, and it’s a surgical emergency.

Signs of testicular torsion may include:

• Sudden, severe pain in one testicle
• Swelling and redness of the scrotum
• Nausea or vomiting
• Testicle sitting higher than usual or at an unusual angle
• Pain that may come and go, especially in younger children

If your child or teen has any of these symptoms, go to the emergency department right away. The sooner you seek treatment, the better the chance the testicle can be saved.

Understanding the TWIST and TWISTER Scores

To help doctors identify testicular torsion, a clinical tool called the TWIST Score (Testicular Workup for Ischemia and Suspected Torsion) is used.

It can help determine if a child needs to be transferred to a hospital with pediatric urology care.

TWIST Score includes:

• Testicular swelling
• Wooden/hard testicle
• Inactive cremasteric reflex*
• *The cremasteric reflex is when the testicle pulls upward after touching the inner thigh. If this does not happen, it is a red flag!
• Sky high/high-riding testicle
• Throwing up/nausea

Use the TWIST online calculator to see if your pain needs immediate evaluation by a doctor: Testicular Workup for Ischemia and Suspected Torsion score | QxMD

In younger children or those with communication challenges, CHKD may use an adapted version called the TWISTER score. This score is helpful when a parent or doctor can examine the child:

• Testicular swelling
• Wooden/hard testicle
• Inactive cremasteric reflex*
• Shuffling gait/abnormal walk
• Throwing up/nausea
• Elevated testicle
• Red testicle

Why This Matters

Using the TWIST and TWISTER scores, CHKD providers can:

• Rapidly identify high-risk cases
• Ensure treatment at an appropriate hospital
• Reduce time to treatment and time in pain
• Limit unnecessary imaging or delays
• Improve outcomes for children of all ages and abilities

These tools are just one of the many ways CHKD provides safe, evidence-based, child-centered care.

How and Why to Do a Testicular Self-Exam (TSE)

Regular self-exams are one of the best things you can do for your health. Testicular self-exams (TSEs) are simple, quick, and can help teens catch changes early—whether it's swelling, a lump, or something that just doesn’t feel right.

Doing a TSE once a month—starting in the teen years—can help spot serious conditions like testicular torsion or testicular cancer, which is rare but most common in young men ages 15–35. Step-by-Step: How to Do a Self-Exam

Let’s Talk About It

We know it can be awkward to talk about these topics — but they’re important. We’re here to support you in staying healthy and informed.

If you have questions or concerns about testicular torsion, self-exams, or anything else, don’t hesitate to contact our Urology team.