The lay term “fat testicles” is a common, though medically inaccurate, description for an enlarged scrotum or testicle, properly referred to as scrotal swelling or testicular enlargement. This condition is a physical sign that the scrotum is larger than its normal size, often due to a buildup of fluid, inflammation, or an abnormal mass. The enlargement can affect one or both testicles and may develop suddenly or gradually over time. Because the underlying causes range from benign fluid collections to serious medical emergencies and malignancy, any noticeable change in size or shape requires immediate medical evaluation to determine the specific cause and prevent potential complications.
Identifying Associated Symptoms
The presentation of testicular enlargement varies widely, providing important clues about the underlying problem. Swelling that occurs acutely and is accompanied by sudden, severe pain is a red flag for an immediate medical emergency. This intense pain may also include nausea, vomiting, or a testicle positioned higher than normal within the scrotum.
In contrast, gradual enlargement may be painless or present only as a dull ache or a sensation of heaviness. The skin over the enlarged area might show discoloration, such as redness or bruising, or feel warm to the touch, suggesting an inflammatory or infectious process. Other symptoms might include a discharge from the penis, blood in the urine or semen, or a palpable lump or mass within the scrotum.
Underlying Causes of Testicular Enlargement
Testicular enlargement stems from several distinct medical conditions. A frequent cause is a hydrocele, a collection of clear fluid that accumulates within the thin sac surrounding the testicle. This fluid buildup causes the scrotum to swell and can result in discomfort or a heavy pulling sensation, though it is often painless.
Another common vascular cause is a varicocele, which involves the abnormal enlargement of the veins inside the spermatic cord. This condition is often described as feeling like a “bag of worms” and typically develops gradually on the left side due to pooled blood. Swelling can also result from inflammation or infection, such as epididymitis (inflammation of the sperm storage tube) or orchitis (inflammation of the testicle itself). Both are often caused by bacterial infections, including sexually transmitted infections.
A serious, time-sensitive cause is testicular torsion, which involves the twisting of the spermatic cord, cutting off the testicle’s blood supply. This sudden obstruction leads to rapid, severe swelling and intense pain, requiring immediate surgical intervention to prevent tissue death. Finally, a mass or growth can cause enlargement, including an inguinal hernia or testicular cancer. Testicular cancer typically presents as a firm, painless lump or a noticeable change in the size or shape of one testicle.
Clinical Assessment and Diagnosis
A medical professional begins diagnosis with a thorough physical examination and detailed patient history. The physician examines the scrotum, noting the size, location, and consistency of the enlargement, and asks about the onset and nature of any pain. A technique called transillumination may be performed, where a light is shined through the scrotum to see if the mass is fluid-filled, which would suggest a hydrocele.
To rule out infection, blood and urine tests are frequently ordered to detect markers of inflammation or the presence of bacteria. The primary tool for visualizing the scrotal contents is ultrasound imaging, which is considered the gold standard for diagnosis. This non-invasive test uses sound waves to create detailed images, allowing the doctor to determine if the enlargement is due to fluid, a solid mass, or enlarged veins. Doppler ultrasound is useful for assessing blood flow to the testicle, which is necessary for diagnosing testicular torsion.
Condition-Specific Treatment Strategies
Treatment for testicular enlargement depends entirely on the underlying cause identified through diagnosis. For infections like epididymitis or orchitis, the primary treatment involves a course of antibiotics to eliminate the bacterial pathogen. Pain management with anti-inflammatory medications and supportive measures, such as scrotal elevation, are also used to reduce discomfort and swelling.
Conditions involving fluid accumulation or structural defects, such as a hydrocele, varicocele, or inguinal hernia, often require surgical correction if they cause significant symptoms or pose a risk to the testicle. A hydrocelectomy involves draining the excess fluid, while a varicocele may be treated by blocking or tying off the enlarged veins. Testicular torsion is a surgical emergency that demands immediate intervention to untwist the spermatic cord and restore blood flow within a window of hours. If the diagnosis reveals testicular cancer, treatment typically involves surgical removal of the affected testicle, followed by potential chemotherapy or radiation therapy.