The most common etiology for intravaginal testicular torsion is the "bell clapper deformity." Normally, the tunica vaginalis attaches to the posterior surface of the testicle; however, some patients have an inappropriately high attachment of the tunica vaginalis, the bell clapper deformity, which allows the testicle to rotate freely on the spermatic cord within the tunica vaginalis (intravaginal testicular torsion).
The only known anatomic risk factor for intravaginal testicular torsion is the bell clapper deformity (Caesar & Kaplan, 1994; DaJusta et al., 2013).