Varicocele

Written by Jaime Herndon | Published on August 15, 2012
Medically Reviewed by George Krucik, MD

What is a Varicocele?

The scrotum is the sac covered with skin that holds the testicles, and it also contains the arteries and veins that deliver blood to these reproductive glands. An abnormality of the veins servicing the testicles may result in a varicocele. A varicocele can result in a decrease sperm production and quality. It can also shrink the testicles.

There are no established risk factors for developing a varicocele. However, being overweight may increase your risk, according to the Mayo Clinic (Mayo).

A spermatic cord holds up each testicle. It also contains the veins, arteries and nerves that support these glands. The veins can widen when the valves in the veins do not function properly—this is called a “varicocele.”

According to the Cornell University Center for Male Reproductive Medicine and Microsurgery, varicoceles are common. They can be found in 15 percent of the general male population. In the adolescent population, it affects around 15 percent of males (Cornell).

The condition can have an effect on fertility. Vericocele is present in 35 percent of men with primary infertility, and in 75 to 81 percent of males with secondary infertility (Cornell). Primary infertility is generally used to refer to a couple that has not conceived a child after at least one year of trying. Secondary infertility describes those who have conceived at least once but are not able to again.

What Causes a Varicocele to Develop?

Similar to the process of varicose veins, a varicocele develops over time. The majority of males are diagnosed between the ages of 15 and 25, according to the National Institutes of Health (NIH).

The exact cause of varicoceles is unclear. However, there are several theories. A varicocele usually occurs on the left side, and the last two of these theories support this statistic:

Improper Vein Functioning

The valves in the veins that are not functioning properly in turn cause blood to back up.

Anatomic Asymmetries

There may be anatomic differences between the left and right internal spermatic veins. The left vein is longer, which means more pressure is needed to move blood through this vein.

3The “Nutcracker Effect”

The left renal vein, which begins near the left kidney, gets compressed. This causes pressure to build up in the left internal spermatic vein as it tries to move blood toward the heart via the renal vein.

Recognizing the Symptoms of a Varicocele

You may have no symptoms associated with a varicocele; however, you might experience a lump in one of your testicles or swelling in your scrotum. You may also have visibly enlarged or twisted veins in the scrotum. The varicocele is often described as looking like a “bag of worms”.

How Is a Varicocele Diagnosed?

The condition is usually diagnosed after a physical exam by your doctor. You will be examined both lying down and standing up. This is because the varicocele may not be able to be felt or seen when you lie down.

Sometimes a scrotal ultrasound is performed. This helps measure the spermatic veins and allows the doctor to get a detailed, accurate picture of the condition.

A varicocele is typically classified into three clinical grades. They are labeled Grades I through III, according to the size of the lump in your testicle (Grade I being the smallest and III the largest).

Methods of Treatment for Varicoceles

It is not always necessary to treat a varicocele. However, the condition causes progressive worsening of testicular functioning in some males. If treatment is needed, earlier treatment can have a better effect on sperm production, states Cornell University.

Sometimes wearing tight underwear or a jock strap can provide you with support that alleviates pain or discomfort. If symptoms get worse, further treatment such as varicocelectomy and varicocele embolization might be necessary.

Varicocelectomy

A varicocelectomy is a same-day surgery that is done in a hospital. A urologist will go in through your abdomen and clamp the abnormal veins. Blood can then flow around the abnormal veins to the normal ones. Talk with your doctor about any preparations you may need to do prior to surgery and what to expect after the operation.

Varicocele Embolization

Varicocele embolization is a less invasive, same-day procedure. A small catheter is inserted into a groin or neck vein. A coil is then placed into the catheter and into the varicocele. This blocks blood from getting to the abnormal veins.

Living with Varicocele

Some men become infertile as a result of a varicocele. If you and your partner are having trouble becoming pregnant, your doctor may recommend an appointment with a reproductive specialist.

Treatments also carry possible side effects, including infection, atrophy of the testicles (they become smaller and function poorly), and blood clots. Talk with your doctor about the severity of your condition and whether treatment is best for you.

If you have minor discomfort, over-the-counter pain medications may provide relief. Ask your doctor if this is appropriate before taking any drugs.

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Article Sources:

  • Sheynkin, Yefim R. (2000). Varicocele and Its Treatment. Male Infertility and Microsurgery Program: State University of New York Stony Brook School of Medicine. Retrieved June 21, 2012, from http://www.uhmc.sunysb.edu/urology/male_infertility/VARICOCELE_AND_ITS_TREATMENT.html
  • Varicocele. (1999). Cornell University Center for Male Reproductive Medicine and Microsurgery. Retrieved June 11, 2012, from http://www.maleinfertility.org/new-varicocele.html
  • Varicocele. (n.d.). PubMed Health. Retrieved June 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002263/
  • Varicocele: Risk Factors. (2012). Mayo Clinic. Retrieved June 11, 2012, from http://www.mayoclinic.com/health/Varicocele/DS00618/DSECTION=risk%2Dfactors
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