Can I get an erection if both testicles were removed?

Dear Reader,

Testicular torsion is a painful condition that occurs when the spermatic cord — which includes the vas deferens, arteries, veins, lymphatics, and nerves — twists and cuts off blood supply to the testicle (where sperm and testosterone are produced). It happens when a small ligament that normally attaches a testicle's base to the scrotum becomes loose, allowing the testicle to twist and turn. A man could be born with a loose ligament, and so have some predisposition for this, but testicular torsion can also be the result of trauma to the scrotum or really strenuous physical activity.

Most often occurring in males under the age of 30 years, testicular torsion is more common during infancy or adolescence. It is estimated that the condition affects about 1 in 4,000 males under 25 years of age in the United States.

Symptoms of testicular torsion include:

• Onset of sudden pain in a testicle
• Swelling or tenderness of the scrotum
• Nausea, vomiting, and/or fever
• Abdominal pain
• Fainting and light-headedness
• Elevation of the testicle on the affected side

Testicular torsion requires surgery. In most cases, surgery needs to be performed as soon as possible after the onset of symptoms — preferably within six hours — in order to save the testicle. A restriction of blood flow due to testicular torsion could, over time, lead to the atrophying (shrinking) of the testicle, or even infection.

Having one testicle removed need not diminish or reduce sex drive or erections. But because the testicles produce male hormones, men who have lost both of their testes may experience a reduction in sex drive and difficulty in getting and/or maintaining an erection. When both testicles have been removed, the next step is usually testosterone replacement therapy, which can be discussed with one's primary health care provider or urologist.

Because the testicles produce sperm, losing both also means that a man can no longer have biological children. Your friend may want to talk with someone about how he feels about the surgery and its impact on his sex life and fertility.

Kudos to you for wanting to learn more about your friend's situation — he's lucky to have your support.