A varicocele is a condition that affects many men, often silently until they experience symptoms or complications. It is important to understand what a varicocele is, how it can affect your health – particularly your fertility – and what treatment options exist for you. This is a comprehensive summary of everything you need to know about varicoceles, from the causes and symptoms, diagnosis, treatment and prevention.
Understanding Varicocele
What is Varicocele?
In short, varicocele occurs when the valves inside the veins of the scrotum are dysfunctional which leads to pooling of blood in the veins causing them to swell. A varicocele most often occurs on the left side due to the anatomical arrangement of the male reproductive tract and sometimes on the right side as well.
Also, the other way, varicocele is an enlargement of the veins composed of a network (plexus) located in the scrotum, similar to what can happen with varicose veins that occur in the legs. The veins in question are the pampiniform plexus and they assist in cooling blood before it reaches the testicles. When they expand (enlarge), it may interfere with blood flow, causing possible discomfort and potential to cause testicular damage and fertility problems.
Key Facts:
- Impacts 15% of men overall
- Occurs in 40% of men with infertility
- Usually develops during puberty
Effects on Fertility
The greatest concern with varicoceles is their effects on male fertility. The pooling of warm blood around the testicles can cause elevated temperatures that can impact the production and quality of sperm. Research shows that varicoceles can result in:
- Low sperm count
- Poor sperm motility
- Abnormal sperm morphology
This does not suggest that every man with a varicocele will have infertility, but you should be aware of the elevated risk.
Signs and Causes
Though the specified cause is not always known, varicoceles are commonly associated with faulty valves in the testicular veins. When valves are faulty, blood collects and causes enlargements of the veins.Associated
Risk Factors:
- Genetic (family history)
- Tall height
- High level of physical exertion
- Hormonal imbalance
Symptoms of Varicocele
Most varicoceles are asymptomatic (has no overt signs), although once symptomatic some may complain of:
- A dull ache or discomfort in the scrotum
- Heaviness or dragging sensation
- Noticeable enlarged veins (anyone can feel it- to the patient it feels like a “bag of worms”)
- Atrophy of a testicle
- Pain that worsens with standing or physical activity
Main Cause of Varicocele
The main cause of varicocele is a defect in the one-way valves in the veins of the spermatic cord. These valves are supposed to keep blood flowing from the testicles to the heart and when the valves malfunction, blood collects there and results in dilation of the veins
Who It Affects
The condition is most common in males aged 15 to 25 years. It is rare in boys who have not reached puberty and in older men. While the majority of men with varicoceles are completely asymptomatic, some may present with fertility issues while others may develop chronic pain.
Does the Varicocele Cause Erectile Dysfunction?
While a varicocele primarily affects fertility, chronic pain caused by the varicocele and hormonal changes due to the condition can theoretically contribute to erectile dysfunction. However, it is uncommon and typically not the primary complaint.
Other Complications
If not treated, varicoceles can cause several complications:
- Decreased testosterone production
- Testicular shrinkage (atrophy)
- Decreased fertility
- Chronic pain
- Emotional stress or self-esteem concerns
Diagnosis
How Your Provider Will Diagnose It?
Diagnosis generally starts with a physical exam when the docctor will feel for the englarged veins while your are standing and bearing down (Valsalva maneuver). Other diagnostic studies consist of:
- Scrotal Ultrasound: measure the size of the veins and evaluate blood flow.
- Doppler Testing: evaluate the direction and speed of blood flow.
Grades of Varicocele
Varicoceles are graded according to size and appearance:
- Grade I – Small and only felt when bearing down.
- Grade II – Medium and felt without bearing down.
- Grade III – Large visible veins.
Prevention
Is it possible to prevent a varicocele?
There aren’t any guarantees for preventing a varicocele because the defining characteristics which contribute to the development of a varicocele typically relate to genetics or anatomical defects. However, you can preserve overall scrotal health by:
- Avoid prolonged standing
- Wearing supportive underwear
- Avoiding heavy lifting
- Drinking plenty of fluids
Methods for Treatment of Varicocele
Treatment depends upon the severity of the symptoms and an evaluation of a couple’s fertility. Most men do not need treatment unless discomfort occurs or infertility develops.
Observation
If the varicocele is not causing symptoms or interfering with fertility, observation may be all that may be needed. Routine check ups and self-assessments are also part of observation to monitor for any progression of symptoms.
Medications
Pain control from the varicocele may be managed with over-the-counter pain medications including:
Ibuprofen
Acetaminophen – these may relieve discomfort, but there is no cure for the condition
Surgery (Varicoclectomy)
For men that are experiencing infertility or have significant symptoms, surgery is usually the best option. Surgical options for the varicocele include:
Open surgery (microsurgical varicocelectomy), which is performed through a small incision, in which the vein is tied off
Laparoscopic surgery, in which a camera is utilized in a less invasive manner to aid in the procedure
Percutaneous embolization, a procedure performed by a radiologist in which a small catheter is used to block the affected vein
Benefits of Surgery
- Improved semen quality
- Less scrotal pain
- Improved testosterone production
Recovery
- For most men, activities will resume in 1-2 weeks
- Avoid heavy lifting for 4-6 weeks.
- Most experience pain relief within days
Untreated Varicocele
Not treating a varicocele can lead to:
- Progressive damage to the testicle.
- Chronic pain.
- Increase chance of infertility.
- Hormone imbalance.
If you suspect you have a varicocele, plan to have children or don’t experience relief from pain, you should be seen.
What questions should I ask my medical provider?
- How do I know if I have a varicocele?
- Is it on one side or the other or is it bilateral?
- What type or grade of varicocele do I have?
- Could this be caused by something specific, like a sport or an injury?
- Can a varicocele recur and not always be present?
- Will this remain the same or worsen over time or activity?
- Is the aching I am feeling, specifically from the varicocele?
- How come pain worsens often after work or after standing and being active?
- Could this relate to other testicular or scrotal conditions?
- If the testicular pain bothers me more often, what can I do?
- Are there non-surgical things I can do at home to treat the condition?
- Would supportive underwear help relieve some of the symptoms?
- Should I limit activities, for example, heavy lifting or long runs?
- Would I benefit from ice packs or anti-inflammatories?
- How often do I need to be revisited for evaluation of grade or size of the varicocele?
- Is there a way I could keep some record of whether the varicocele is getting worse in size or grade?
- Will it be permanent or will it change over time?
- Will this affect my ability to have children either now or in the future?
- Should I get a semen analysis to see if there is any kind of issue?
- Can a varicocele affect testosterone or hormonal issues?
- What are the odds that fertility will become better after treatment?
- Is it okay to wait since I am not actively trying to have children?
- In my case, do you think surgery or non-surgical would be best?
- What are the risks or side effects of surgery and embolization?
- What is the recovery time if I decide to have the varicocele fixed?
- Does a varicocele come back again after treatment?
- Are there any natural or alternative treatments worth trying?
- Will I require imaging or lab work after treatment?
- Is this something to be worried about if it is left alone?
- Does a varicocele increase my chances of getting more testicular stuff later in life?
- If I fix it now will it prevent any more issues with fertility or pain in the future?
