What is a Varicocele?

Varicocele is a very common, abnormal enlargement of the veins within the loose bag of skin that holds the testicles (scrotum) and is similar to a varicose vein that can occur in the legs. Most men do not experience any pain or discomfort; however, when pain does occur it can range from a sharp to dull discomfort that increases with standing or physical exertion, especially over long periods. The pain often worsen over the course of a day requiring patients to lie on their back for relief. With time, varicoceles may enlarge and become more noticeable. In young men, the presence of a varicocele impairs sperm production and can often be improved with treatment.

Varicocele is categorized by size which helps to guide treatment recommendations:

  • Grade O: Seen on ultrasound, but not physically detectable (also called subclinical varicocele)
  • Grade I: Palpable (felt on exam) when the patient is performing the valsalva maneuver (bearing down)
  • Grade II: Palpable even without valsalva
  • Grade III: Varicocele causing visible deformity of the scrotum

Impaired Fertility and Low Sperm Count

Varicoceles can cause infertility and is generally found during a routine physical examination. One third of men being examined have some form of varicoceles on one or both sides of the scrotum. It is important to know that varicoceles of all sizes may affect fertility. In addition, new evidence shows that sperm function may also be affected by varicoceles in ways that are not detected by semen analysis. A varicocele on one side of the scrotum has an effect on both testes in regards to function and temperature. Varicoceles that cannot be felt by a physician but are diagnosed by ultrasound or other imaging studies are not considered clinically significant. 80% of men with varicoceles are able to conceive with their partners without any medical intervention.

Decreased Testosterone

Male infertility (the inability to reproduce), can be caused by a number of factors including varicoceles, or swollen veins in the scrotum. Now, it seems varicoceles may lead to problems even more severe than infertility. Varicoceles disrupts a man’s ability to produce testosterone – a hormone that is extremely important for keeping men in good health. Besides causing low energy, decreased muscle strength and sexual problems, it is a major risk factor for osteopenia/osteoporosis and can also cause changes in cognitive and psychological function, in particular, depression.

Scrotal Discomfort

However, if you experience pain or swelling in your scrotum, discover a mass on your scrotum, notice that your testicles are different sizes, or develop a varicocele in your youth, or you’re having problems with fertility, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment. If a varicocele causes symptoms, it can often be repaired endovascularly.
Shrinkage of the affected testicle (atrophy). The bulk of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It’s not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.
Infertility. Varicoceles may keep the local temperature in or around the testicle too high, affecting sperm formation, movement (motility) and function.

What Causes Varicoceles?

The spermatic cord carries blood to and from a man’s testicles. It’s not certain what causes varicoceles; however, many experts believe a varicocele forms when the valves inside the veins in the cord prevent blood from flowing properly. The resulting backup causes the veins to widen (dilate) resulting in damage to the testicle and worsened fertility. Varicoceles often form during puberty. Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles.