Overview
Varicocele is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum). These veins transport oxygen-depleted blood from the testicles. A varicocele occurs when blood pools in the veins rather than circulating efficiently out of the scrotum. It usually forms during puberty and develops over time. Varicoceles may cause discomfort or pain, but they often result in no symptoms or complications. However, they may cause poor development of a testicle, low sperm production, or other problems that may lead to infertility. Surgery may be recommended to treat varicoceles and address related complications.
Understanding the disease
Symptoms
The symptoms of a varicocele may include pain, discomfort, or a mass in the scrotum. A varicocele usually occurs on the left side of the scrotum and may produce no signs or symptoms. Other symptoms could be dull, aching pain or discomfort that is more likely when standing or late in the day. Lying down often relieves pain. If there is a large varicocele, it may be visible as a "bag of worms" above the testicle. It is important to see a healthcare provider if you experience any pain, swelling, or a mass in the scrotum.
Development
The exact cause of a varicocele is unknown, but one contributing factor may be the malfunction of valves inside the veins that are intended to keep blood moving in the right direction. A varicocele develops when blood pools in the veins rather than circulating efficiently out of the scrotum. This results in the enlargement of the pampiniform plexus, which is a network of small veins that transport oxygen-depleted blood from the testicle to the main testicular vein. The malfunctioning valves cause the veins to widen (dilate), creating the varicocele.
Assessment and Diagnosis
Triage
You should see a doctor if varicocele is suspected, especially if you experience symptoms such as pain, swelling, or a mass in the scrotum. While varicoceles may not always cause symptoms, they can lead to complications like poor testicle development, low sperm production, and infertility. If you have been diagnosed with liver disease or cirrhosis, consult your healthcare provider about your risk of esophageal varices and discuss any necessary procedures to check for their presence. Remember to schedule annual wellness visits for boys to monitor the development and health of their testicles.
Diagnosis
Your health care provider can diagnose a varicocele by visual inspection of the scrotum and by touch. During the examination, you'll likely be asked to lie down and stand up, with the health care provider performing the Valsalva maneuver to make the varicocele easier to examine. In some cases, an imaging test, such as an ultrasound exam, may be recommended to confirm the diagnosis or eliminate other conditions as potential causes of symptoms.
Management and Treatment
Complications
Potential complications of varicocele include poor testicular health, infertility, and difficulty fathering a child. Varicoceles can make it difficult for the body to regulate the temperature of the testicles, leading to oxidative stress and the buildup of toxins. However, not all varicoceles cause infertility, and the exact percentage of men experiencing complications is not specified.
Treatment
The treatments for varicocele may include surgery to address complications such as poor development of a testicle, low sperm production, or other problems leading to infertility. Surgery is generally recommended if the varicocele causes discomfort or pain, or if it affects fertility. The procedure is called varicocelectomy, and it involves tying off or removing the affected veins. Non-surgical options may include watching and waiting for potential complications, wearing support stockings, and making lifestyle changes to improve blood flow and muscle tone.