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diagram of male scrotum

Varicocele is a common medical condition in people born male where one or more of the veins in your scrotum become enlarged and sometimes twisted.

Think about when you have a varicose vein that bulges out of your leg and then imagine that this same condition is happening to one of the veins that feeds your testicles. About 15% of men can get varicocele which they first notice because of a pain in their testes or the area behind their scrotum.

Today, I’ll share with you how a urologist can diagnosis and treat an inflamed vein in your scrotum. I always prefer to meet my patients face to face to discuss the options with you, so feel free to schedule your appointment using our online form.

Varicocele can occur on either side of the scrotum, but it is much more common on the left side. This is because the left testicular vein follows a slightly different path of blood flow than the right vein, making it more susceptible to the condition. Varicocele can also vary in severity, with some cases causing few or no symptoms, while others can lead to significant discomfort and fertility problems. Treatment options for varicocele include surgery, embolization, active observation, and lifestyle adjustments.

Varicocele Surgery

Varicocele surgery is a treatment option for those with more advanced cases of varicocele, especially those men who wish to conceive a child. There are two main types of varicocele surgery: embolization and microsurgical subinguinal varicocele ligation.

Varicocele Embolization

Varicocele embolization is a minimally invasive procedure performed by a board certified urologist that involves inserting a catheter through a small incision in the groin and threading it up to the affected vein. Once the catheter is in place, a small coil is inserted to block blood flow to the varicocele. This causes the vein to shrink and eventually disappear, which allow the blood flow to increase in other veins in the testes which can enhance your sperm production. In short, the blood is spread more evenly around the testes to maintain a more even temperature throughout which can enhance your fertility.

This procedure is generally less invasive than microsurgical subinguinal varicocele ligation, but it may not be as effective in treating larger varicoceles. Patients typically experience minimal discomfort and can return to normal activities within a few days after varicocele embolization.

Microsurgical Subinguinal Varicocele Ligation

Microsurgical subinguinal varicocele ligation is a more invasive surgical procedure performed by a board certified urologist that involves making a small incision in the groin and tying off the affected vein. This procedure is typically performed under general anesthesia and requires a longer recovery time than embolization.

However, microsurgical subinguinal varicocele ligation is generally more effective in treating larger varicoceles and there is a lower risk of recurrence. It may also be a better option for patients who have previously undergone unsuccessful embolization procedures.

Varicocele Symptoms

Varicoceles affect every man differently. Early on, they don’t always present symptoms, but as swelling increases, you might experience:

What Does a Varicocele Feel Like?

When you touch your scrotum, a more advanced grade of varicocele may feel like a bag of worms, with a mass that is visible or palpable above the testicle. The veins may also feel swollen or enlarged, and the scrotum may appear to be lopsided or asymmetrical. However, in the early stages of development, you may not be able to feel anything when you palpate the scrotum, however there can still be a pain in the area. The lowest grades of varicoceles can only be seen on a Doppler ultrasound.

How Common Are Varicoceles?

Varicoceles are a relatively common condition, affecting up to 15% of all men and can occur at any age. However, up to 17% of teenage boys are diagnosed with varicoceles so this condition can happen as a boy enters puberty.

Does a Varicocele Cause Erectile Dysfunction?

While varicoceles are not typically associated with erectile dysfunction, they may cause discomfort or pain during sexual activity. In some cases, the pain may be severe enough to interfere with sexual function.

What Problems are Associated with Varicoceles?

Varicoceles can cause a variety of problems, including impaired fertility, decreased testosterone production, and scrotal discomfort. In some cases, varicoceles may also cause azoospermia, or the complete lack of sperm in the ejaculate.

Do Varicoceles Cause Male Infertility Issues?

Varicoceles are a common cause of male infertility, as they can interfere with sperm production and function. In some cases, varicoceles may also cause abnormal sperm morphology, motility, and concentration.

Is It Okay to Live with Varicocele?

While many men with varicoceles may not experience any symptoms or complications, those who do may benefit from treatment. Treatment options may include surgery, embolization, active observation, and certain lifestyle changes such as only sitting for shorter periods of time.

What Can I Do to Ease Varicocele Pain?

In some cases, varicocele pain may be relieved by wearing supportive underwear or applying ice to the affected area. Over-the-counter pain relievers may also be helpful.

How Long Will I Have to Wait to See if My Semen Quality Gets Better After Varicocele Surgery?

It may take several months to see an improvement in semen quality following varicocele surgery. However, most men will experience an improvement in their semen quality within 6-12 months.

What Are the Complications of Varicocele Embolization?

Complications of varicocele embolization may include infection, bleeding, or damage to surrounding tissues. In rare cases, embolization may also lead to a recurrence of the varicocele.

Does Varicocele Ligation Affect Testosterone Production?

Varicocele can contribute to low testosterone in the long term because the blood stagnates and the testes can be starved of oxygen. However because varicocele ligation temporarily decreases blood flow in one area of the testes, ligation may cause a temporary decrease in testosterone production, but this is typically not a long-term concern. In most cases, testosterone levels will return to normal within a few months following surgery and some may experience an increase as the other veins receive more blood flow.

Varicocele Grading

Varicocele grading is used to classify the severity of varicocele based on the size and extent of the enlarged veins as follows:

Grade 0 – The enlarged vein can be seen on a Doppler ultrasound, but it can’t be felt on a Physical exam

Grade I – The enlarged vein can’t be felt when palpated but it can be see on a Doppler Ultrasound and be felt when the patient is performing the Valsalva maneuver which is like mimicking the strain of a bowel movement while the doctor palpates the scrotum.

Grade II – The enlarged vein can be felt without using the Valsalva maneuver and will show up as being larger on a Doppler Ultrasound.

Grade III – The most advanced grade of varicocele is physically visible as a deformity of the scrotum in addition to being palpable without the Valsalva maneuver and will show up as a very enlarged vein on a Doppler ultrasound.

Varicocele Ultrasound

Varicocele grading is typically done through ultrasound imaging, which can show the size and location of the dilated veins. During the ultrasound, the patient may be asked to perform a Valsalva maneuver, which involves holding their breath and bearing down almost like mimicking a bowel movement, in order to increase the pressure in the abdomen and help visualize the varicocele. A color ultrasound will be able to highlight the enlarged vein in the Doppler images.

Varicocele vs Hydrocele

It is important to distinguish between varicocele and hydrocele, as they are two different conditions that can affect the scrotum. A hydrocele is a buildup of fluid around the testicle, while varicocele is a dilation of the veins in the scrotum.

Varicocele grading is not used to classify hydrocele, as it is a separate condition that requires different diagnostic and treatment approaches. Hydrocele can be diagnosed through physical examination or ultrasound imaging, and may be treated with medication or surgery depending on the severity of the condition.

Once you a diagnosis of varicocele, our team at Comprehensive Urology can recommend the best treatment option for you. We also offer other scrotal treatments such as Scrotox and Scrotoplasty for those who wish to use this opportunity to enhance the appearance of their scrotum.

Frequently Asked Questions

Is varicocele dangerous?

Varicocele is generally considered a benign condition and does not pose a significant risk to a person’s health. However, in rare cases, it can cause pain or lead to fertility problems.

What should I do if I have varicocele?

If you have varicocele and are experiencing pain or discomfort, it is recommended that you seek medical attention. Your doctor may recommend treatment options such as surgery or embolization to alleviate symptoms or prevent further complications.

Is it okay to live with varicocele?

Many men with varicocele do not experience any symptoms and are able to live with the condition without any issues. However, if you are experiencing pain or infertility, it is recommended that you seek medical attention to discuss treatment options.

What causes a varicocele to form?

Experts aren’t entirely sure what causes varicoceles. However, faulty vein valves inside of your spermatic cord may play a role. This is the tube that carries blood to and from your testicles. It plays a vital role in keeping the reproductive system functional.

If your vein valves fail, blood can’t flow properly, causing a backup. Over time, this leads to a backup of blood which can heat up the testes and harm sperm production as sperm are sensitive to hot temperatures. This is why the scrotum hands outside of the body to keep the sperm cooler than the rest of the body. If it progresses far enough, this backup may damage one or both testicles. In turn, this leads to damaging your fertility.

What lifestyle causes varicocele?

There are no specific lifestyle factors that are known to cause varicocele. However, certain activities that increase pressure in the abdomen, such as heavy lifting or straining during bowel movements, may contribute to the development of varicocele. Sitting for long periods of time and wearing tight fitting clothing in hot weather may aggravate the condition. Cardiovascular exercise and pelvic floor therapy exercises may be recommended to normalize blood flood in the area and to reduce stress.

Can varicocele cause infertility?

Varicocele has been associated with male infertility, although the exact mechanism is not fully understood. It is believed that the stagnating blood in the enlarged varicocele may heat up the area and degrade sperm quality or quantity, leading to reduced fertility. Treatment of varicocele may improve fertility in some cases. We can help optimize your changes of conceiving a child. Contact us today.

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