The varicocele is the enlargement of the veins which are in the loose bag of skin that holds the testicles (known as scrotum). The varicocele is similar to the varicose vein which you might see in your leg. A varicocele is a common cause of low sperm production and decreased sperm quality and this can affect infertility. But, not all varicoceles affect sperm production.
The varicocele can also cause testicles to fail to develop normally or shrink. In most cases, varicoceles develop over time. But, most varicoceles are easy to diagnose and many of them do not need treatment. If the varicocele causes symptoms, then it can be repaired surgically. Always consult with your doctor about varicocele before you use some treatment for varicocele.
Varicocele: Symptoms
Often, the varicocele is producing no signs or symptoms. In rare cases, varicocele can cause pain [1]. The pain can:
- Be relieved when you lie on your back
- Worsen the course of a day
- Vary from sharp to dull discomfort
- Impaired fertility
- An increase with standing or physical exertion, especially over long periods
As time passes, the varicocele might enlarge and it can become more noticeable. The varicocele is described to look like a bag of worms. This condition can cause a swollen testicle and usually, this is happening on the left side. Usually, the varicocele has no symptoms, so it often does not require treatment. The varicocele can be discovered through a routine physical exam or during a fertility evaluation. But, if you experience swelling or pain in your scrotum or you discover a mass on your scrotum, then talk with your doctor.
Also, you should talk with your doctor if you notice that your testicles are different in size, you developed a varicocele in your youth or you have problems with fertility. There are many different conditions that can cause a scrotal mass or testicular pain and some of them need immediate treatment. Your doctor will make a physical exam, which might reveal a nontender mass above your testicles which feels like a bag of worms. If it is large enough, then your doctor will be able to feel it. If you have a smaller varicocele, then your doctor may ask you to stand, take a deep breath and hold it while you bear down.
This can help your doctor to detect abnormal enlargement of the veins. If the physical exam is inconclusive, then your doctor can order a scrotal ultrasound. This test is using high – frequency sound waves to create precise images of structures inside your body and it might be used to ensure there is not another reason for your symptoms. In some cases, further imaging can be recommended to rule out other causes for the varicocele, such as a tumor compressing the spermatic vein.
Causes
The spermatic cord is carrying blood to and from your testicles. But, it is not known what causes varicoceles. But, many experts believe that a varicocele is forming when the valves inside the veins in the cord prevent your blood from flowing properly [2]. The resulting backup is causing the veins to widen (or dilate). This can cause damage to the testicles and it can result in worsened fertility [2,3]. Often, the varicocele is forming during puberty. Usually, varicocele happens on the left side, most likely of the position of the left testicular vein.
Risk factors
There are no risk factors that can increase your chance of developing varicocele.
Complications
The varicocele can lead to some complications, like:
- Infertility: The varicocele can keep the local temperature in or around the testicles too high and this is affecting sperm formation, function, and movement (also known as motility). [2,3]
- Shrinkage of the affected testicle (atrophy): The bulk of the testicle comprises the sperm-producing tubules. When it is damaged, as from varicocele, then the testicle shrinks and softens. It is not known what is causing the testicle to shrink, but the malfunctioning valves can allow the blood to pool in the veins and this can result in increased pressure in the veins, and exposure to toxins in the blood can cause testicular damage. [4,5]
References:
[1] Paick S, Choi WS. Varicocele and testicular pain: A review. The World Journal of Men’s Health. 2019;37(1):4–11. doi:10.5534/wjmh.170010
[2] Kantartzi PD, Goulis CD, Goulis GD, Papadimas I. Male infertility and varicocele: myths and reality. Hippokratia. 2007;11(3):99–104.
[3] Lundy SD, Sabanegh ES. Varicocele management for infertility and pain: A systematic review. Arab Journal of Urology. 2018;16(1):157-70.
[4] Pinto KJ, Kroovand L, Jarow JP. Varicocele related testicular atrophy and its predictive effect upon fertility. The Journal of Urology. 1994;152(2):788-90.
[5] Akbay E, Cayan S, Doruk E, et al. The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents. BJU International. 2000;86(4):490-3.
