Living with one: Mental health, body image and fertility concerns after orchiectomy for testicular torsion

Objective Testicular torsion in childhood and adolescence is a urological emergency that may necessitate orchiectomy. The long-term impact of orchiectomy on psychological well-being, body image, and fertility concerns remains poorly defined. This study aimed to evaluate the psychosocial and sexual consequences of orchiectomy following torsion, compared with patients who underwent orchiopexy alone. Methods A retrospective single-center study included 54 men, who underwent surgery for torsion between 2013 and 2023. Participants were healthy, with no prior psychiatric history. Validated questionnaires, DASS-21 (Depression, Anxiety, Stress Scale), IIEF-5 were administered. Subgroup analysis assessed the impact of testicular prosthesis placement. Results Twenty-seven patients had undergone orchiectomy and 27 orchiopexy. Mean (±S.D.) age at surgery was 16.8 ± 7.1 and 16.9 ± 4.2 years, respectively. Mean follow-up age was 27.6 ± 5.9 years. Orchiectomy was associated with significantly higher anxiety (11.9 ± 3.0, p < 0.001) and stress scores (18.4 ± 4.5, p < 0.001). All orchiopexy patients were within normal range on all DASS-21 subscales. Sexual function (IIEF-5) showed no significant difference (29.4 ± 2.2 vs. 30.0 ± 0.0, p = 0.15). Body image dissatisfaction was reported by 89% (24/27) of orchiectomy patients, all explicitly attributing it to testicular loss. The most frequent concern was fear of future infertility. Prosthesis implantation improved self-perceived body image but did not significantly mitigate anxiety or stress. Conclusions Orchiectomy for torsion exerts a measurable and enduring psychosocial burden, manifesting as moderate anxiety, mild stress, and high rates of body image dissatisfaction. Testicular prosthesis placement enhances appearance-related satisfaction but does not normalize emotional distress. Comprehensive post-torsion care should include psychological and fertility counselling to address the multidimensional impact of testicular loss.