VARICOCELE OVERVIEW
A varicocele is the abnormal enlargement of veins around the testicles. This is similar to having enlargement of veins in the legs, called varicose veins. This is essentially varicose veins of the testicles.
Varicocele can affect 1 in 6 men and can appear in younger males ageing between 15-25 years. 1 This can develop during puberty and it usually shows up on the left testicle and appears like a “bag of worms.” Usually, it is harmless, but sometimes it can result in pain. Varicocele can also cause infertility in men by causing low sperm production. In fact, this is found in 40% of infertile males, compared to 15% to 20% overall.1 Men with varicocele can also have lower androgen levels resulting in sexual dysfunction, reduced strength and low energy levels.2
A varicocele is usually present on the left side of the scrotum as the anatomy of the vein is different than the right as it has to join the kidney first.3 the blood flow on the left side is greater as compared to the right side, as it comes off the renal vein. The right side has a more direct path and less likely to be affected.
Varicocele Symptoms
Most men do not have any symptoms, and the varicocele is an incidental finding discovered on physical examination. For other men this can pose more of an issue. Symptoms can include:
- Dull pain or discomfort in the testicle(s)
- Feeling of heaviness in the scrotum
- Enlarged testicle with a feeling of a “bag of worms”
- Smaller testicular or “atrophy” due to the abnormal blood flow
- Aching or dull scrotal pain with exercise or prolonged physical activities
- Sexual dysfunction, reduced strength and low energy
Causes of a Varicocele
Varicocele occurs because there are abnormal valves in the testicular vein that runs from the scrotum to the abdomen. The testicles are attached to a spermatic cord that contain its arteries, veins and nerves that support its function. The testicular vein exits the cord in the pelvis and carries the blood from the testicle back to the heart. When the valves don’t work properly, the blood pools down in the testicle causing them to sag and enlarge. This does not appear overnight, but gradually over time worsening the condition. It is uncertain why these valve stop working properly, possibly genetic or issues during rapid growth during puberty.
Long Term Risks of a Varicocele
Without treatment, the varicocele can have a long-term impact on the production of testosterone and infertility due to abnormal temperature regulation. Abnormal blood flow through the testicle in the long term can result in shrinkage of the affected testicle(s), also known as testicular atrophy. This mean one or both testicles can appear smaller than they should be. There is also increased exposure to toxins as there is pooling of used deoxygenated blood that has not been cleaned, thus damaging the testicles.
Fertility and Varicocele
In order to achieve successful fertilization of an egg, a man needs to have both a sufficient number of sperm and healthy sperm. If there is disruption in the normal process of sperm production, both the sperm count, and the health of the individual sperm can be affected. This can then result in male infertility.
Low sperm count are found in males with infertility and a varicocele.4 A study conducted by World Health Organization (WHO) on 9,034 men stated that the occurrence of varicocele in males with abnormal sperm production was twice that of males with normal sperm production and that having a varicocele is also associated with a smaller testicular volume. Physicians believe that the main reason behind male infertility is a varicocele.5
Research studies have found a link between infertility and a varicocele because it affects the ability of the body to regulate the scrotal temperature. This increased temperature affects the level of hormone production as well as the structure of the sperm. Thus, this lowers not only the number of sperm produced but also the quality. Abnormal sperm may be unable to swim properly or can have an abnormal outer skeleton, causing the sperm to be rejected by the egg.
Diagnosis
The simplest test to a diagnosis is a physical examination. The doctor will examine the testicle to see if there are enlarged veins along the testicle(s). The definite way to diagnose a varicocele is using an ultrasound, which can demonstrate these large veins running along the testicle.2 Sometimes your doctor will order a CT scan before treatment to evaluate if there may be another internal problem that may be pushing on the veins causing abnormal flow.
Treatment
Conservative treatments include the use of analgesics and scrotal support. However, this does not treat the root of the problem and only assists with the symptoms.
The least invasive treatment option is embolization. In this method, the interventional radiologist uses microtools to go into the primary abnormal vein and close it down. This method is similar to how varicose veins in the legs are treated. That is, the veins are closed down from the inside without major incisions. This way, the blood only flows through the healthier blood vein.1
Surgical methods include incisions in the groin or open surgery to burn or suture the veins closed. This method involves closing the veins from the outside.
How Is Non-Surgical Embolization Performed?
- You will receive twilight sedation to help you relax
- Our specialist numbs the skin on the neck or groin
- A tiny catheter is placed
- Foam and small coil plugs placed into the vein
- The catheter is removed
- Band-Aid is applied
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We are Here to Help
Request an Appointment to meet with our varicocele specialist who will review your imaging, labs and history to determine if you are candidate for the procedure, and the outcomes you can expect. Each person is an individual and should discuss the potential risks and benefits of embolization and other treatments with our doctor to decide which option is best.
Appointments are available via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego. Why should you choose us? Read here
- Leslie, S. W., Sajjad, H., & Siref, L. E. (2020). Varicocele. PubMed; StatPearls Publishing. ncbi.nlm.nih.gov/books/NBK448113/
- Healthline, “Varicocele: Causes, Symptoms, and Diagnosis,” Healthline, Aug. 15, 2012.
- Cimador, M, Di Pace, M., Peritore, M., Sergio, M., Castagnetti, M., De Grazia, E. “The role of Doppler ultrasonography in determining the proper surgical approach to the management of varicocele in children and adolescents.” (2006). BJU Int. 97(6):p. 1291-1297.
- Gorelick, J. I., & Goldstein, M. (1993). Loss of fertility in men with varicocele. Fertility and Sterility, 59(3), 613–616.
- World Health Organization. (1992). The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization. Fertility and Sterility, 57(6), 1289–1293.
The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor but can act as a starting point for such a discussion.
