Independent Predictors of Ovarian Torsion Laterality: Nulliparity (Virgo) and Cyst Presence

<b>Objective</b>: This retrospective cohort study aimed to identify independent clinical predictors specifically associated with the laterality of ovarian torsion, rather than examining potential associations with patient age or serum hormonal profiles. The analysis sought to improve diagnostic accuracy and preoperative risk stratification in ovarian torsion, a gynecologic emergency where fertility preservation is a priority. <b>Materials and Methods</b>: Data from 64 patients with surgically confirmed ovarian torsion between January 2018 and June 2025 were retrospectively reviewed at Harran University Faculty of Medicine. Demographic, clinical, ultrasonographic, and hormonal data were collected. Hormonal assays were performed using electrochemiluminescence immunoassays (Roche Diagnostics). Univariate and multivariate logistic regression analyses were employed to identify factors independently associated with torsion laterality. <b>Results</b>: The median age of the 64 patients included in the study was 22 years (IQR: 20-33). Right ovarian torsion was detected in 65.6% of the cases. In the final multivariate logistic regression model, nulliparity (VIRGO) (OR: 0.22; 95% CI: 0.07-0.75; <i>p</i> = 0.015) and the presence of a cyst (OR: 0.10; 95% CI: 0.02-0.53; <i>p</i> = 0.007) were found to be independent and significant predictors of torsion laterality. Both variables demonstrated an effect that reduced the probability of left ovarian torsion. No significant association was found between patient age, parity, other clinical features, and hormonal profiles (progesterone, E2, FSH, LH). The main reason for the lack of backing for the hormonal hypothesis was that hormone measurements in 95.3% of the patients were conducted during the follicular phase, a time at which progesterone and estrogen levels are typically low compared to the luteal phase. <b>Conclusions</b>: This study demonstrates that, in addition to the anatomical predisposition for right ovarian torsion, nulliparity (VIRGO) and cyst presence are independent clinical indicators of ovarian torsion laterality. The absence of these features (VIRGO and cyst presence) increases the risk of right-sided torsion. The findings offer valuable information to enhance the index of clinical suspicion in the differential diagnosis of patients presenting with ovarian torsion symptoms. The importance of prompt detorsion and a conservative surgical approach to preserve ovarian viability and secure long-term reproductive health is emphasized.