Ovarian torsion is a gynecologic medical emergency where the ovary, and often the fallopian tube, twists completely around its supporting ligaments. This rotation pinches the blood vessels supplying the organ, compromising blood flow and lymphatic drainage. Deprived of oxygen, the ovary suffers ischemia, leading to potential tissue death. Rapid diagnosis and treatment are required to prevent the loss of the affected ovary.
Describing the Pain of Ovarian Torsion
The pain associated with ovarian torsion is typically severe and sudden in onset, differentiating it from many other types of pelvic discomfort. Patients often describe the pain as a sharp, stabbing sensation, sometimes reaching a debilitating intensity. The discomfort is generally located in the lower abdomen or pelvis and is almost always isolated to one side.
This intense, localized pain results from the sudden obstruction of blood flow and subsequent ovarian swelling. While the classic presentation is abrupt, the pain may also begin as intermittent or colicky, coming in waves as the ovary twists and spontaneously untwists. Even if the pain subsides, an intermittent presentation requires urgent evaluation.
The pain commonly radiates from the lower pelvic region to the flank, lower back, or inner thigh. This radiating pattern is due to shared nerve pathways in the pelvic cavity. The overwhelming severity of the discomfort compels most individuals to seek emergency care.
As the condition progresses, a dull, constant ache may replace the initial sharp pain due to venous congestion and swelling. However, sudden, sharp, one-sided pain remains the primary warning sign. The intensity of this pain often separates ovarian torsion from less serious pelvic conditions.
Related Physical Symptoms
The severe pain is frequently accompanied by systemic symptoms reflecting the body’s reaction to acute trauma and lack of blood flow. Nausea and vomiting are highly prevalent, occurring in up to 70% of cases alongside lower abdominal pain. These gastrointestinal symptoms are thought to be caused by nerve stimulation from the severe visceral pain.
The extreme discomfort can also cause lightheadedness or faintness due to the body’s stress response. A low-grade fever may develop if the lack of blood supply has been prolonged, leading to necrosis (tissue death) in the affected ovary. Fever combined with the characteristic pain suggests a potentially advanced stage of the condition.
Some patients may experience abnormal vaginal bleeding or spotting, though this is less common. The presence of these systemic symptoms alongside intense, one-sided pelvic pain raises immediate suspicion for a gynecologic emergency. These accompanying symptoms help distinguish torsion from other causes of acute abdominal pain, such as appendicitis or kidney stones.
Understanding Why Torsion Occurs
Ovarian torsion occurs when the ovary rotates around its supporting structures, including the infundibulopelvic and utero-ovarian ligaments. These ligaments form the vascular pedicle containing the blood vessels. When twisting occurs, the thin-walled veins and lymphatic vessels are compressed first, leading to congestion and swelling of the ovary.
The primary risk factor is the presence of an ovarian mass or cyst, which destabilizes the ovary. Masses measuring five centimeters or larger significantly increase the risk because the increased weight and size make the ovary prone to spinning on its axis. The mass acts like a weight, allowing the ovary to twist more easily.
Hormonal changes during pregnancy also increase the risk, particularly in the first trimester, often due to an enlarged corpus luteum cyst. Additionally, fertility treatments involving ovarian stimulation can enlarge the ovaries with multiple cysts, increasing the potential for rotation.
The ovary’s natural instability, especially on the right side, is compounded by these masses or enlargements. Any factor changing the ovary’s normal weight, size, or position makes the organ vulnerable to torsion. While spontaneous torsion can occur in a normal-sized ovary, it is far more common when an underlying mass is present.
When to Seek Emergency Care
Ovarian torsion is a time-sensitive surgical emergency. Anyone experiencing sudden, severe, one-sided pelvic pain accompanied by nausea or vomiting must seek immediate medical attention. Delaying care dramatically increases the risk of losing the affected ovary due to prolonged ischemia. The goal of emergency treatment is to quickly untwist the ovary to restore blood flow and save the organ.
Diagnosis often begins with a physical exam and a pelvic ultrasound, usually performed with Doppler flow imaging. The Doppler study checks blood flow within the ovary, though flow presence does not rule out torsion due to the ovary having a dual blood supply. Definitive diagnosis and treatment are achieved through laparoscopic surgery.
During the procedure, the surgeon confirms the twist and untwists the ovary, a process called detorsion. Even if the ovary appears discolored from lack of oxygen, it is generally untwisted, as the organ often retains the ability to recover function. Saving the ovary is directly related to how quickly blood supply can be re-established after symptom onset.
If the ovary cannot be salvaged, the surgeon may need to remove it completely. Patients should not wait for the pain to resolve or try home remedies, as this condition will not resolve safely on its own. Immediate consultation is the only way to confirm the diagnosis and prevent irreversible tissue damage.