Testicular Torsion in Newborns
Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist
Content reviewed against published AAP, NIH guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect testicular torsion in newborns, here is what the evidence says.
The short answer
Testicular torsion (twisting of the testicle) in a newborn is rare but is a surgical emergency. It may present as a hard, swollen, discolored (dark or blue) scrotum. Neonatal testicular torsion is different from torsion in older children and often occurs before or during birth. Any hard, discolored, or swollen testicle in a newborn should be evaluated urgently.
Key takeaways
- Testicular torsion (twisting of the testicle) in a newborn is rare but is a surgical emergency. It may present as a hard, swollen, discolored (dark or blue) scrotum. Neonatal testicular torsion is different from torsion in older children and often occurs before or during birth. Any hard, discolored, or swollen testicle in a newborn should be evaluated urgently.
- Usually normal when: A soft, non-tender scrotum with both testicles palpable
- Call your doctor if: A hard, swollen, discolored (dark, blue, or red) scrotum requires immediate emergency evaluation
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to AAP, NIH guidelines, testicular torsion (twisting of the testicle) in a newborn is rare but is a surgical emergency. It may present as a hard, swollen, discolored (dark or blue) scrotum. Neonatal testicular torsion is different from torsion in older children and often occurs before or during birth. Any hard, discolored, or swollen testicle in a newborn should be evaluated urgently. At 0-1 month, neonatal testicular torsion can occur prenatally (before birth) or perinatally (around the time of birth). It may be noticed at birth or in the first days of life. Signs include a hard, non-tender (because the tissue may already be damaged), discolored scrotum on one side. The affected side may appear dark, blue, or red. Unlike torsion in older children, neonatal torsion is often extravaginal (the entire cord and testicle twist together). The prognosis for saving the affected testicle in prenatal torsion is poor because the damage usually occurred before birth. However, emergency evaluation is still needed to protect the opposite testicle and rule out other conditions. It is generally considered normal when a soft, non-tender scrotum with both testicles palpable. However, you should contact your pediatrician promptly if a hard, swollen, discolored (dark, blue, or red) scrotum requires immediate emergency evaluation.
Normal vs. Concerning
By Age
What to expect by age
0-1 month
Neonatal testicular torsion can occur prenatally (before birth) or perinatally (around the time of birth). It may be noticed at birth or in the first days of life. Signs include a hard, non-tender (because the tissue may already be damaged), discolored scrotum on one side. The affected side may appear dark, blue, or red. Unlike torsion in older children, neonatal torsion is often extravaginal (the entire cord and testicle twist together). The prognosis for saving the affected testicle in prenatal torsion is poor because the damage usually occurred before birth. However, emergency evaluation is still needed to protect the opposite testicle and rule out other conditions.
1-3 months
Testicular torsion can occur at any age. Any sudden onset of scrotal swelling, hardness, or discoloration requires emergency evaluation. A normal scrotal examination at well-child visits helps establish baseline.
3-6 months
Continue to be aware of scrotal appearance during diaper changes. Sudden changes should be evaluated promptly.
6-12 months
Testicular torsion is possible at any age. Sudden scrotal pain, swelling, or color change requires emergency evaluation within hours for the best chance of saving the testicle.
What to Tell Your Pediatrician
- Describe when you first noticed testicular torsion in newborns and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if you notice asymmetric scrotal size or the scrotum looks different on one side.
- Mention if a hydrocele that does not seem to be decreasing over time.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- A soft, non-tender scrotum with both testicles palpable
- Mild scrotal swelling from a hydrocele that transilluminates (glows with light) and is soft
- Normal scrotal skin color
- You notice asymmetric scrotal size or the scrotum looks different on one side
- A hydrocele that does not seem to be decreasing over time
- You cannot feel one testicle in the scrotum (possible undescended testicle)
- A hard, swollen, discolored (dark, blue, or red) scrotum requires immediate emergency evaluation
- Sudden onset of scrotal swelling or apparent pain in an infant of any age is a surgical emergency until proven otherwise
What You Can Do at Home
- Keep track of when you notice testicular torsion in newborns — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that a soft, non-tender scrotum with both testicles palpable — this is generally within the range of normal.
- At 0-1 month, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
- While monitoring at home, seek immediate care if a hard, swollen, discolored (dark, blue, or red) scrotum requires immediate emergency evaluation.
Related Conditions
Baby Undescended Testicle (Cryptorchidism)
Undescended testicle (cryptorchidism) is one of the most common conditions in baby boys, occurring in about 3-5% of full-term and up to 30% of premature newborns. Many undescended testicles come down on their own within the first 3-6 months. If a testicle has not descended by 6 months, surgery (orchiopexy) is recommended before 12-18 months to protect future fertility and reduce other risks.
My Baby Has a Swollen Scrotum
A hydrocele is a collection of fluid around the testicle that causes the scrotum to swell. It's common in newborn boys and usually harmless. Most hydroceles disappear on their own by age 1. Your pediatrician will examine your baby to distinguish it from an inguinal hernia, which requires surgery. If the hydrocele persists or is very large, surgery may be recommended.
Swollen Genitals in Newborns
Swollen genitals in newborns are very common and normal for both boys and girls. The swelling is caused by maternal hormones that crossed the placenta and by fluid retention during delivery. The swelling is temporary and typically resolves within the first few days to weeks of life without any treatment.
Related Resources
Frequently asked questions
Is testicular torsion in newborns normal?
When should I call the doctor about testicular torsion in newborns?
When is testicular torsion in newborns normal?
What causes testicular torsion in newborns?
What should I mention to my pediatrician about testicular torsion in newborns?
Is testicular torsion in newborns normal at 0-1 month?
Is testicular torsion in newborns normal at 1-3 months?
Should I go to the ER for testicular torsion in newborns?
Does testicular torsion in newborns go away on its own?
References
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Testicular Torsion in Newborns.
Things to mention
- Describe when you first noticed testicular torsion in newborns and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if you notice asymmetric scrotal size or the scrotum looks different on one side.
- Mention if a hydrocele that does not seem to be decreasing over time.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- You notice asymmetric scrotal size or the scrotum looks different on one side
- A hydrocele that does not seem to be decreasing over time
- You cannot feel one testicle in the scrotum (possible undescended testicle)
Urgent signs to report immediately
- A hard, swollen, discolored (dark, blue, or red) scrotum requires immediate emergency evaluation
- Sudden onset of scrotal swelling or apparent pain in an infant of any age is a surgical emergency until proven otherwise
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of testicular torsion in newborns are normal. Talk to your pediatrician if a hard, swollen, discolored (dark, blue, or red) scrotum requires immediate emergency evaluation.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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Related Medical Concerns
Baby Undescended Testicle (Cryptorchidism)
Undescended testicle (cryptorchidism) is one of the most common conditions in baby boys, occurring in about 3-5% of full-term and up to 30% of premature newborns. Many undescended testicles come down on their own within the first 3-6 months. If a testicle has not descended by 6 months, surgery (orchiopexy) is recommended before 12-18 months to protect future fertility and reduce other risks.
My Baby Has a Swollen Scrotum
A hydrocele is a collection of fluid around the testicle that causes the scrotum to swell. It's common in newborn boys and usually harmless. Most hydroceles disappear on their own by age 1. Your pediatrician will examine your baby to distinguish it from an inguinal hernia, which requires surgery. If the hydrocele persists or is very large, surgery may be recommended.
Swollen Genitals in Newborns
Swollen genitals in newborns are very common and normal for both boys and girls. The swelling is caused by maternal hormones that crossed the placenta and by fluid retention during delivery. The swelling is temporary and typically resolves within the first few days to weeks of life without any treatment.
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