In most males, the testicles are attached to the inner lining of the scrotum. Males whose attachment is higher up are at risk of testicular torsion. This condition is known as a bell clapper deformity (as in the central piece of a bell) and is a major cause of testicular torsion. A male who notices the ability of either or both testicles to freely rotate within the scrotum should be aware that he is at risk of testicular torsion. Testicles that are in a much lower position and/or in a slightly rotated position in the scrotal sack are a visual indicator of this risk.

Torsions are sometimes called “winter syndrome”. This is because they often happen in winter, when it is cold outside. The scrotum of a man who has been lying in a warm bed is relaxed. When he arises, his scrotum is exposed to the colder room air. If the spermatic cord is twisted while the scrotum is loose, the sudden contraction that results from the abrupt temperature change can trap the testicle in that position. The result is a testicular torsion.