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The Facts About Varicoceles

Varicoceles are the most commonly identified and correctable cause of male infertility.

A neon yellow outline of the male reproductive system highlights the testicles with a glowing, red spot.

There are more than 3 million cases of varicoceles each year in the United States, with about 15 out of 100 men having a varicocele.

A varicocele is an enlargement of the veins in the scrotum, much like varicose veins, which are twisted, swollen veins usually found in the leg. They can grow larger and may become more pronounced over time.

Varicoceles largely present no symptoms, and there's a strong chance you won't know you're afflicted unless a doctor notices the enlargement during a physical exam. The worst effects you may experience as a result of a varicocele are shrinkage of the affected testicle and, most notably, possible infertility. Data indicate 4 in 10 men tested for fertility problems were found to have a varicocele. The current prevailing theory is that the enlargement of veins in the testicle raises the localized temperature, which negatively impacts sperm health. Luckily, varicoceles are highly correctable.

When the veins in the scrotum become enlarged, it is more common to have a varicocele appear on the left side, where there's a greater volume of blood flow. While varicoceles can exist on both sides at the same time, it is rare.

The causes of varicoceles are mostly unknown. One explanation is that the valves in the spermatic cords, which carry blood to and from the testicles, stop working correctly. Why this happens is not entirely understood, but it is similar to what happens when varicose veins occur in the leg.

Causes and risk factors of varicoceles

A varicocele develops from veins that carry blood away from the testicles and toward the heart. Normally, valves in these veins help blood move in the right direction. If there is a problem with these valves, a backup of blood can occur, which causes the vein to dilate and swell, resulting in a varicocele.

They are most likely to develop during puberty and can grow larger with age. A varicocele may develop as a result of poorly functioning valves that are normally found in veins. In other cases, it may occur from compression of a vein by a nearby structure.

One-way valves in the veins should always allow blood to flow toward the heart. Faulty valves disrupt the blood flow, resulting in the blood pooling rather than moving on. This buildup of blood causes the vessels to dilate. As with any organ, a disruption in blood flow can eventually stop it from working correctly.

A person's genes affect how likely they are to develop a varicocele. Men are more likely to have a varicocele if their father or brother has had one.

Symptoms of varicoceles

Varicoceles often produce no symptoms that a man can feel but can cause low sperm production and decreased sperm quality, thus possibly contributing to male infertility. A major function of the veins surrounding the testicles is to draw heat away from the testicles. A varicocele can cause the testicles to overheat, which in turn negatively affects sperm production. This can result in decreased sperm quality and quantity, as well as lower testosterone levels. Larger varicoceles can cause a dull pain in the testicles and scrotum.

If a person does not have discomfort and fertility is not affected, treatment is usually unnecessary.

Diagnosis of varicoceles

Varicoceles are found through self-exam of the scrotum or during a routine doctor's exam.

Urologists often check for varicoceles with the patient standing. Patients may be asked to take a deep breath, hold it, and bear down while a urologist feels the scrotum above the testicles. This lets the doctor find any enlarged veins. They can feel something like a "bag of worms" next to the testicles when the patient is standing. One testicle may appear larger than the other, or the testicles may feel as if they disappear when the patient is lying down.

There are three grades for a varicocele. Grade 1 and grade 2 varicoceles are small and hard to detect without involving a healthcare professional. Grade 3 varicoceles can be felt easily and are often visible as lumps under the scrotal skin.

An ultrasound is not needed if problems are not felt during the physical exam. However, since an ultrasound can show the size of the testicles, it is useful in deciding how, or if, to treat a teenager because treatment is often indicated in cases of decreased testicular volume for a person's age, suggesting that the varicocele might be inhibiting appropriate growth.

Treatment and outlook for varicoceles

Treatment may not be necessary. Many men with varicoceles are able to father a child without any treatment. However, if the condition causes pain, atrophy or infertility, repair may be necessary.

The purpose of the surgery is to seal off the affected vein to redirect blood flow into normal veins. In the case of male infertility, treatment of a varicocele might improve or cure the issue. Even if traditional conception is still too challenging, treatment can improve the quality of sperm so techniques such as in vitro fertilization (IVF) can be used.

When warranted, treatment of varicoceles includes surgery, usually done on an outpatient basis with a general or local anesthetic. Options include open surgery (varicocelectomy); laparoscopic surgery, where a surgeon makes a small incision in the abdomen and uses cameras to see and repair the varicocele; embolization, or blocking the veins with coils; or a type of surgery called microsurgical subinguinal varicocele repair.

Risks of surgery include a buildup of fluid around the testicles, a recurrence of varicoceles, infection and/or damage to an artery.

For men whose primary concern is pain or discomfort, varicocelectomy is effective 80 to 90 percent of the time, according to the Journal of the American Medical Association. For men with fertility concerns, 70 percent of those treated have an improvement in sperm production in three to six months. In addition, success with assisted reproduction, such as intrauterine insemination (IUI) and IVF, may be improved after repair.

However, natural treatments and minimally invasive alternatives to surgery are also available. If you have a varicocele that causes minor discomfort but does not affect your fertility, over-the-counter pain relievers such as acetaminophen and ibuprofen may be sufficient. Supportive underwear can also relieve pressure and reduce pain.

A varicocele does not usually pose a risk, but if there is any change in shape, size or consistency in the genital region, it is important to see a doctor.