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Varicoceles at a glance

  • A varicocele is a varicose vein (an enlarged vein) in the scrotum, which is the bag of skin that holds the testicles.
  • Varicoceles are common in men, and even more common among men experiencing problems with infertility related to sperm production.
  • Varicoceles do not always need to be corrected, but for men with infertility or other issues that might be related to varicoceles, they can be corrected with an outpatient surgical procedure.

What are varicoceles?

Varicoceles (VAR-ih-koe-seels) are enlarged varicose veins in the scrotum, which is the loose bag of skin that holds the testicles. They are similar to varicose veins of the leg.

Varicoceles are common and form in 10 to 15 percent of boys during puberty. As many as 15 percent of men have varicoceles. An estimated 40 percent of men with known infertility issues have varicoceles.

Most varicoceles develop over time, most often presenting in puberty. Fortunately, most of these enlarged veins are easy to diagnose. Many varicoceles don’t need treatment, but a varicocele that causes symptoms can be repaired surgically.

Varicoceles commonly cause low sperm production and decreased sperm quality. Many physicians suspect that varicoceles increase the temperature of the testicles, and this can be one factor that damages or kills sperm, impairing fertility. Still, most men who have varicoceles have adequate sperm quality and quantity to achieve pregnancy.

Varicoceles can also cause shrinkage, or atrophy, of the testicle. Varicoceles can damage the main element of the testicles, which are tubules that produce sperm. The affected testicle becomes softer and shrinks.

Usually, varicoceles occur on the left side. Doctors believe this is because of the way the left testicular vein enters the scrotum. If a man has a varicocele in either testicle, however, it can affect the production of sperm in both testicles.

Causes of varicoceles

Doctors aren’t sure what causes varicoceles, but some theories suggest that for various reasons, blood pools in the veins of the region due to sluggish flow or even backflow. In rare cases, enlarged lymph nodes or other masses in the space behind the abdominal cavity could block blood flow. Either process may cause the scrotal veins to get bigger.

Symptoms of varicoceles

Most varicoceles don’t cause any symptoms or signs, other than that a man may notice the vein or veins. Varicoceles are frequently diagnosed in men who are seeking medical help with fertility issues. Routine physical exam can also detect varicoceles. Varicoceles sometimes enlarge over time and this usually makes them more noticeable.

In some men, varicoceles cause pain. This pain can vary from sharp to dull. Usually, it gets worse over the course of a day. People who stand for long periods may be more likely to notice stronger pain from varicoceles. The pain usually feels better if a man lies on his back, and good scrotal support can also be helpful.

In young men, varicoceles can cause testicles to fail to develop normally. In men of any age, they can cause testicles to shrink.

A man should see a physician if he experiences:

  • Swelling or pain in the scrotum.
  • A mass or lump in or on the scrotum.
  • Testicles that seem to be different sizes.
  • Notable varicoceles at a young age or varicoceles that are changing or growing.
  • Problems with fertility.

While varicoceles can cause these symptoms, several other conditions can cause the same symptoms. Some of these conditions need immediate treatment. A physician can evaluate any mass and advise a man on the next steps to take.

Diagnosis of varicoceles

To identify varicoceles, during a physical examination a physician will palpate (feel) the scrotum and testicles. Some people describe varicoceles as feeling like a “bag of worms.” If the doctor is uncertain whether the veins are enlarged, he or she might ask a patient to try the Valsalva maneuver. This is where a man stands, takes a deep breath, and holds his breath while bearing down. The maneuver allows the doctor to identify any unusual vein enlargement.

If the physician needs additional information, he or she might order ultrasound imaging of the scrotum. Ultrasound uses high-frequency sound waves to make a picture of the structures within the scrotum. It can help physicians determine whether any other reason might be causing symptoms.

Treatments for varicoceles

Once a physician confirms a diagnosis of varicoceles, two paths of action are common. If a man is not experiencing fertility issues, shrinkage of the testicles or pain, the physician may recommend observing the condition without taking action (watchful waiting).

For young men who are experiencing low growth of the testicles due to a varicocele, or men who are considering assisted reproductive techniques (infertility treatments), doctors may recommend varicocele repair.

Doctors use several methods to repair a varicocele:

  • Open surgery. A small incision is made in the lower abdomen and the surgeon uses a microscope to identify the veins that produce the varicocele. These veins are cut to eliminate blood flow, stopping the varicocele’s growth. This procedure uses local or general anesthetic.
  • Laparoscopic surgery. The surgeon makes a small incision in the abdomen. He or she then uses a tiny instrument (the laparoscope) to locate and repair the varicocele, in the same way as above. This procedure must be done under general anesthesia.
  • Percutaneous embolization. In this procedure, a doctor uses a monitor to view the enlarged veins that are causing the varicocele. Meanwhile, a radiologist guides a tube through a vein in the groin or neck. The doctor then can release into the vein coils or a solution that causes scarring. The scarring blocks the veins to stop the blood flow in the area and stop the growth of the varicocele. This procedure, which is done with local anesthesia, is not used as frequently as surgery.

Typically, all of these procedures are done on an outpatient basis. Doctors prescribe pain medication for a few days. Most men can return to light work within a few days, and return to all activities within one or two weeks. Many physicians suggest men avoid sex for about six weeks after the procedure. Men experiencing infertility may not see improved sperm production for about three months.