Horizontal Placement of the Testicle: Causes, Symptoms, and Treatment

What is Horizontal Placement of the Testicle?

Horizontal placement of the testicle, also known as "horizontal testicular position" or "testicular torsion," occurs when the testicle rotates around the spermatic cord. This condition causes the testicle to be positioned abnormally within the scrotum, either horizontally or twisted, which can disrupt blood flow to the testicle and cause severe pain.

Causes of Horizontal Placement of the Testicle

• Congenital Abnormalities. Some individuals may have a congenital condition where the testicle is abnormally positioned from birth. The testicle may be horizontally oriented in the scrotum, which increases the risk of testicular torsion later in life.
• Testicular Torsion. The most common cause of horizontal testicular placement is testicular torsion, a condition in which the spermatic cord becomes twisted, cutting off blood flow to the testicle. This can lead to the testicle rotating horizontally in the scrotum.
• Trauma or Injury. Injury or trauma to the scrotum can lead to the twisting or rotation of the testicle, causing it to adopt a horizontal position. This is often accompanied by intense pain and swelling.
• Increased Testicular Mobility. In some cases, the testicle may be more mobile than usual due to a longer spermatic cord, which increases the likelihood of torsion and abnormal positioning.
• Rapid Growth During Puberty. During puberty, the testicles grow quickly, and if the spermatic cord is not adequately developed or supported, this can lead to testicular torsion and horizontal placement of the testicle.

Symptoms of Horizontal Placement of the Testicle

• Severe Testicular Pain. One of the most common symptoms is sudden, severe pain in the testicle, often described as sharp or intense. This pain can occur suddenly and may worsen with movement.
• Swelling of the Scrotum. The affected side of the scrotum may become swollen, red, or inflamed due to the lack of blood flow to the testicle.
• Testicular Tenderness. The testicle may be extremely tender to the touch, and any pressure on the scrotum can exacerbate the pain.
• Changes in Testicle Position. The affected testicle may appear higher or more horizontal in position within the scrotum, which can be noticeable during a physical examination.
• Nausea and Vomiting. Due to the intense pain and discomfort, some individuals may experience nausea and vomiting as a secondary symptom.
• Loss of Cremaisteric Reflex. The cremasteric reflex, which causes the scrotum to tighten when the inner thigh is stroked, may be absent on the affected side due to torsion.

Treatment for Horizontal Placement of the Testicle

• Immediate Medical Attention. Testicular torsion, which causes horizontal placement, requires immediate medical intervention. Without treatment, the blood flow to the testicle can be permanently damaged, leading to the loss of the testicle.
• Manual Detorsion. In some cases, a doctor may attempt to manually untwist the spermatic cord by rotating the testicle back to its normal position. This can restore blood flow and alleviate pain.
• Surgical Intervention. If manual detorsion is unsuccessful or the condition has persisted for too long, surgery may be required. During surgery, the testicle will be untwisted, and the spermatic cord will be secured to prevent further torsion.
• Orchiectomy. If the testicle is too damaged from a lack of blood flow, it may need to be surgically removed. This procedure, called orchiectomy, is usually a last resort when the testicle cannot be saved.
• Prevention. If one testicle has experienced torsion, the other testicle may also be at risk. During surgery, the unaffected testicle may be surgically fixed to prevent torsion in the future.