A testicular varicocele is an abnormally enlarged vein within the sac that holds the testicles (the scrotum). Complications of this condition can range from a mild aching sensation in the scrotum to testicular shrinkage and infertility.
Varicoceles most commonly form during adolescence when the testicles are growing rapidly and require an immediate increase in blood supply. However, they also regularly occur in adult men with no history of symptoms.
Despite being a common condition, many men have a fundamental misunderstanding of both what causes varicoceles and the treatment options that exist.
What Causes A Testicular Varicocele?
Varicoceles are caused by malfunctioning vein valves in the scrotal veins (the pampiniform plexus).
The left side of the scrotum is affected in approximately 90% of cases of varicoceles. This is because the left spermatic vein joins with the left renal vein, which is three times longer than the right renal vein and transverses more organs in the abdomen.
When the valves in the veins malfunction, it causes blood to backflow and pool in the scrotal area. This leads to vein engorgement.
Are Varicoceles Painful?
Most patients with varicoceles experience no painful symptoms. However, some patients do report mild aching or discomfort in the affected testicle. Rarely, varicoceles cause intense testicular pain that interferes with the individual’s life.
Pain from a varicocele is more common when standing or being active for long periods of time.
How Common Are Varicoceles?
Varicoceles occur in approximately 10% – 15% of adult men and in up to 20% of adolescent boys. Up to 30% of men who undergo fertility evaluations are found to have one or more varicoceles.
How is a Varicocele Diagnosed?
The most common method for diagnosing a varicocele is a physical exam.
During this exam, your doctor will carefully palpate the scrotal sac and spermatic cord to search for varicose veins in the scrotum. Typically, affected veins will cause the scrotum to feel like a “bag of worms”.
Your doctor may also take note of physical symptoms, such as the affected testicle being smaller, noticeable varicose veins in the scrotum or scrotal lumps.
Your doctor may also request an ultrasound to confirm your diagnosis.
Risk Factors for Developing a Varicocele
There are no universally accepted risk factors for varicoceles. Rare risk factors include deep vein thrombosis, renal arteriovenous malformations and thrombosis in the pampiniform plexus.
Additionally, some studies show that men who are tall and men who smoke are at greater risk of developing varicoceles.
Complications of Varicoceles
Varicoceles are the most common cause of reversible male infertility.
The testicles require a fairly cool temperature for optimal sperm production (around 95 degrees Fahrenheit). Varicoceles cause a higher temperature in the scrotum, leading to decreased sperm count, decreased sperm motility and sperm malformation.
Fortunately, the majority of individuals with this condition don’t experience symptoms and are able to conceive normally.
Treatment of Varicoceles
For men experiencing varicocele-related infertility or scrotal pain, there are cutting edge, minimally invasive treatments available through interventional radiology.
Georgia Vascular Institute specializes in varicocele embolization at all of our Georgia vein clinics.
Varicocele embolization is a minimally invasive procedure that is less painful and requires less downtime than the more invasive varicocelectomy. Among infertile men who undergo varicocele embolization, sixty percent went on to conceive a child normally. Over 80 percent saw an increase in sperm concentration following the embolization procedure.