Varicocele: an overview for informational purposes. Treatment is by a Urologist, not a vein specialist.
A varicocele (VAR-ih-koe-seel) is a medical condition that affects the scrotum. It can lead to low sperm production and decreased sperm quality, potentially causing infertility. The majority of varicoceles develop over time and are easy to diagnose. A varicocele occurs in approximately 1 in 8 men and it is usually first noticed between the ages of 12 to 28.
A varicocele is an enlargement of the veins in the open area above the testicles. These veins are called the pampiniform plexus. A varicocele is similar to a varicose vein you might see in your leg except that is develops in the loose sack of skin than houses the testicals.
While not all varicoceles will affect sperm production, they can cause testicles to shrink or to fail to develop normally. Physicians are very good at diagnosing varicoceles and devising effective treatment plans. If you are experiencing pain or any other symptoms, seek medical attention immediately. Often the condition can be repaired surgically.
Symptoms of Varicoceles
An enlarged vein in the scrotum will often produce no signs or symptoms. In rare instances, it might cause pain. The pain can:
- feel sharp and stabbing or be a dull discomfort
- feel worse when standing or during physical activities, especially when done over long periods of time
- get worse over the length of the day
- get better when lying on your back
- impair fertility
Over time, varicoceles may become even more enlarged, making them more noticeable. Some in the field compare the feeling of a varicocele to a bag of worms. The swollen veins lead to the swelling of the testical, nearly always on the left.
When should I see a doctor?
Since a varicocele usually does not cause any symptoms, it rarely requires. Varicoceles may be revealed during a routine physical exam or fertility evaluation.
However, in some instances, men experience symptoms such as pain or swelling in the scrotum. If this is the situation in your case you should contact a healthcare provider right away. Don’t wait. You should also arrange a consultation if you discover that your testicles are different sizes, notice a mass on your scrotum or if you are having problems with fertility. There are a number of conditions that can cause testicular pain or a scrotal mass. Some of them require immediate treatment. If you developed a varicocele in your youth, you should keep a close eye out for any potential changes to the condition of your testicals.
Causes of Varicocele
Inside of your scrotum, the spermatic cord carries blood to and from your testicles. A varicocele forms when the veins in the spermatic cord become enlarged, possibly leading to other health problems. While still not completely understood, many experts believe that a varicocele forms when the valves inside the veins become damaged for one reason or another. The valves are designed to keep the blood flowing in the proper direction. When not working properly, they can stop the blood from flowing correctly and cause a backup or blood pooling. The additional pressure on the veins will cause them to widen (dilate), potentially causing damage to your testicles and possibly resulting in infertility.
Varicoceles are more likely to occur during puberty. Due to the position of the left testicular vein, varicoceles usually occur on the left side
What are the risk factors?
Studies have not revealed any significant risk factors for developing a varicocele.
What are the Potential Complications?
A varicocele can lead to potentially serious complications:
- Testicular Atrophy: The affected testicle may shrink. The vast majority of the testicle’s mass is made up of sperm-producing tubules. A varicocele has the potential to damage the testicle, causing it to shrink and soften. It is not fully understood why the testicles shrink. Many experts believe that malfunctioning valves in the veins allow blood to build up, resulting in increased pressure on the vein walls. This can squeeze the surrounding tissue or expose the testicals to toxins found in the blood, causing testicular damage.
- Infertility: Varicoceles may elevate the the local temperature in or around the testicle, affecting the formation of sperm, its ability to move, and function.
Diagnosing a Varicocele
What should you expect when you go to your doctor with symptoms of a varicocele? Your healthcare provider will likely conduct a physical exam. He or she will examine the area. The inspection may turn up a mass above your testicle. If it is a varicocele, it will not be tender and feel like a bag of worms. If it’s size is large enough, your healthcare provider will likely be able to feel it.
If he or she can not find it easily, your healthcare provider may ask you to stand up, hold in a deep breath and bear down (also called the Valsalva maneuver). This will help your doctor to detect any abnormal enlargement of the veins.
If your doctor’s exam is not conclusive, he or she might order an imaging test, most likely a scrotal ultrasound. This imaging technique uses high-frequency sound waves to create a precise picture of tissue within your body. This should help narrow down the possible causes of your condition and hopefully rule out any more serious reasons for your symptoms. Depending on the results, some further imaging testing might be recommended to eliminate the possibility of other causes for the varicocele, such as a dangerous tumor pressing on the spermatic vein. The treating physician is usually a Urologist.
Treating a Varicocele
Not all varicoceles need treatment. Many men live with varicoceles without any symptoms. They are able to father a children and do not feel any discomfort. However, if your varicocele is causing you pain or any of the other following conditions you should consider treatment. You may want to undergo varicocele repair by a Urologist if you are experiencing:
- testicular atrophy (shrinking testical),
- infertility (inability to father a child) or
- if you are considering assisted reproductive techniques
The purpose of treatment, usually surgery (in dramatic cases) is used to isolate the affected vein and redirect the blood flow into normal veins.