A varicocele is dilatation of small veins next to one testis or both testes. It usually causes no symptoms. It may cause discomfort in a small number of cases. Though varicocele is thought to increase the chance of being infertile, but most men with a varicocele are not infertile. Treatment is not usually needed, as most men do not have any symptoms or problems caused by the varicocele.

What do you understand by varicocele?

A varicocele is due to dilatation of enlarged veins (blood vessels) in the scrotum. It could occur next to and above one testis or both of the testes (testicles).

The spermatic cord is like a tube that goes from each testis up towards the lower abdomen. The affected veins travel in the spermatic cord. You might feel the spermatic cord above each testis in the upper part of the scrotum. The spermatic cord contains the vas deferens (the tube that carries sperm from the testes to the penis), blood vessels, lymphatic vessels, and nerves.

Normally, you cannot see or feel the veins in the spermatic cord that carry the blood from the testes. If you have a varicocele, the veins become bigger (they enlarge or dilate) and this makes them more prominent. It is similar to varicose veins of the legs. The size of a varicocele can vary. A large varicocele is sometimes said to look and feel like a bag of worms in the scrotum.

Who are prone to get varicocele?

Varicocele affects age group between the ages of 15 and 25. In about half of cases the varicocele is on the left-hand side. In just under half of cases there is one on both sides. In a small number of cases it is just on the right side. The reason why most occur on the left side is because of the different route the left veins take out of the scrotum compared with the right.

How does varicocele present? 

They are generally painless and cause no symptoms. A small number might have a dragging feeling or slight discomfort from their varicocele. This may only occur at the end of a day, especially if you are on your feet all day. If you lie down, the blood from the veins drains away and the varicocele may seem to disappear. On standing, gravity will cause the blood to pool again and the varicocele reappears.

What is the reason for developing varicoceles?

Varicoceles develop because the valves of the small veins in the scrotum do not function well.  As these valves function to prevent the back flow of blood, there incompetence would result in pooling of blood in the lower parts of the vein to form a varicocele. (This is similar to how varicose veins form in legs. The main reason why the valves do not work well is not clear.

Rarely, some blockage of larger veins higher in the abdomen , might  put back-pressure on the smaller veins in the scrotum which then enlarge. This is only likely to occur in men older than 40. For example, if a varicocele suddenly develops in an older man, it may indicate a tumour of the kidney has developed which is pressing on veins.

But it must be stressed; the vast majorities of varicoceles develop in teenagers and young men and are not due to a serious condition.

What are the complications of varicoceles?

Varicoceles are usually harmless. Causes of concern include the following:

  • Possible cause of infertility associated with varicocele is a big concern among men. Studies have shown that there is a higher rate of infertility in men with a varicocele compared with those who do not have a varicocele. The reason for this is not clear. One theory is that the pooled blood causes a slightly higher temperature in the scrotum than normal. This may reduce the number and quality of sperm made by the testis, which can reduce fertility. Even if you have a varicocele only on one side, both testes can be warmed by the increased amount of blood pooled in the enlarged veins. However, on the contrary, most men with varicoceles are not infertile. It is just that the chance of being infertile is increased if you have a varicocele.
  • Small testes develop on the side where varicocele may developthis might contribute to infertility too.
  • Sudden onset of a varicocele in an older man is a cause of concern as abdominal tumor is suspected.

What tests are required?

As varicocele affects young healthy men, and  is associated with some cases of infertility, a semen test may be asked for if you are part of a couple being investigated for infertility. In the rare situation of a varicocele first developing in a man over 40, then tests to check out a possible underlying cause may be advised. Also, a solitary right-sided varicocele is unusual. If this occurs, you may need some tests to rule out any unusual cause.

How is it treated?

If a varicocele is causing no symptoms or problems, then it is best left alone. If there is just mild discomfort then supportive underpants (rather than boxer shorts) may help to ease or prevent discomfort. If a varicocele develops in a teenager, then your doctor may wish to monitor the growth of the testes. For example, an annual measurement of the testes may be advised. This may help to clarify if a testis is not growing to its full size. Treatment may be advised in certain situations, if there is persistent discomfort. Also, treatment may be advised if a testis is not growing properly in a teenager with a varicocele.

Treatment involves tying off the veins that are enlarged. Another method of treatment is to use a special substance injected into the veins to block them. Both methods are usually successful. Your surgeon will advise on the pros and cons of the different techniques.

However, after successful treatment, some men have a recurrence of a varicocele months or years later. This is because the veins left behind to do the job of taking the blood from the testes may themselves enlarge or dilate with the extra blood they will now have to carry. A recurrence can be treated in the same way as the first time.

Can male infertility be treated by treating varicocele?

Probably not - but there is debate about this. For many years it was thought that treating a varicocele in an infertile man would increase his chance of becoming fertile again. Studies have shown that, after treatment, the sperm count often improves. This was assumed to increase the chance of fertility. Some studies did indicate that fertility may be increased with treatment.

However, a recent large analysis of studies looked at this issue. The review found that there was no good evidence to say that fertility is increased by treatment. But, some experts are critical of this analysis and maintain that more research is needed to clarify whether treating a varicocele improves fertility. So, it is a controversial issue. If you are infertile, your specialist will advise on current research and thinking related to this issue.And remember, most men with a varicocele are not infertile.

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