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Varicocele, what do you need to know? Symptoms, causes, and treatment.

Varicocele is a common condition that affects the veins in your testicles and scrotum. Here, we’ll review the basics of it. 

In this reading, you will find everything you need to know about varicocele. A certified doctor took the time to answer all of your frequently asked questions about this condition. Everything from what it is to its causes, diagnosis, and treatment. And the best part is that it’s answered in simple words, so you understand everything easily. So, we encourage you to keep reading to learn about this disease. 

How are the testicles constituted? 

The testicles, or testes, are paired male genital organs. They contain sperm, cells that produce and nourish sperm, and cells that produce testosterone (male hormone).

They are located in a sac called the scrotum. Inside the scrotum, there is also the epididymis, a small structure in which the sperm mature. There is a structure called the vas deferens, which carries sperm from the epididymis to the prostate. It’s part of a larger structure called the spermatic cord. This vital structure contains the vas deferens, blood vessels, nerves, and lymphatic channels. 

File:Human testicle - 4766.jpg
Human Testicle
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The veins of the spermatic cord form a structure known as pampiniform plexus. These veins conduct blood from the testes, epididymis, and vas deferens. The pampiniform plexus veins then become spermatic veins that drain into the main circulation of the kidneys. 

The pampiniform plexus can be affected and cause a condition we know as varicocele. 

What is a varicocele? 

Varicocele is the dilation of the veins in the pampiniform venous plexus in the scrotum. This happens when the venous plexus becomes twisted and enlarged. It’s almost like having a varicose vein in your leg, but it’s in the scrotum instead.

This is a widespread disease, with around 20% of the fertile male population develops varicocele. It’s more common in infertile men, affecting approximately 40% of them. This tells us that there is a link between having varicocele and being infertile. We’ll discuss this item later in the article. 

File:Varicocele.png
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The disease more commonly affects the left testicle rather than the right. In fact, around 90% of varicocele cases will affect the left testicle. This is due to anatomic reasons like: 

  • The entering angle of the left testicular vein into the left renal vein.
  • Impaired function of antireflux valves at the juncture of the testicular and renal vein. 
  • The increased pressure of the left renal vein between two arteries. 

Nevertheless, it is not uncommon that a left varicocele comes with a right varicocele as well. This usually occurs as subclinical varicocele, which is undetected. Around 40% of males with a left varicocele actually have a bilateral varicocele, discovered upon examination. Varicoceles may vary in size, and doctors classify them into three groups: 

  • Large: When it’s identified with inspection alone. 
  • Moderate: Identified with palpation only. 
  • Small: Identified only with Valsalva maneuver (bearing down). This happens because intrabdominal pressure increases and impedes blood drainage, increasing varicocele size. 

What causes a varicocele to develop? 

The leading cause why this disease occurs is due to defects of the valves in the veins. Usually, these valves close and don’t let blood back up in the vein. This helps regulate the blood flood to and from the testicles.

When these letter valves fail, it can cause enlarged veins or varicocele in the case of pampiniform veins. The blood will back up, causing dilation or swollen veins. 

This can happen commonly during puberty. During this period, the testicles are growing fast and need more blood. This increases the chance of poor circulation and the development of the disease.

Left varicocele is more common for reasons we mentioned before, like entering angle of the left testicular vein into the left renal vein and impaired function of vein valves in this juncture. 

There are other causes like masses within the testicles or the abdomen that can impair blood flow. This also can result in veins becoming swollen and developing the disease. 

How does varicocele affect the testis?

One of the most important things for the correct functioning of the testes is temperature. Testes need a specific temperature below our core body heat to correctly produce and mature sperm. This is why the testicles are located outside of the body, in their own sac. This ensures a temperature around five degrees less than the temperature of the abdomen or the pelvis.

One of the other mechanisms that keep the testes at the right temperature is the pampiniform plexus veins. They act as a countercurrent heat exchanger. They cool down the blood in the testicular artery before coming into the testicle.

When varicocele occurs, the blood flow is impaired, and the blood heats more than usual. This results in an increased temperature of the testicles, affecting the production and maturing of sperm. An untreated varicocele can impair the quality and quantity of the sperm, resulting in infertility. 

Who is likely to develop varicocele? 

Varicocele usually develops slowly, and the causes are rarely identified. Therefore, there are no specific risk factors that can increase your chance of getting varicocele.

This is a widespread condition, and any man can develop it. In fact, 1 out of 6 men will definitely develop the disease at some point in their life. Still, the appearance of varicocele is more common in teenage men. This is due to the fast growth of the testicles during this period. The more considerable demand for blood flow and larger testicles can result in the failure of venous valves. Like we already know, this is the primary cause of the disease. 

However, one factor that seems to contribute even more to this disease development is obesity. This makes sense because obese patients have increased intrabdominal pressure. This pressure can affect the blood flow in the renal vein. Therefore, it will end in increased backup pressure towards the testicular veins. With backup blood in the veins, then comes varicocele. 

Other conditions, like masses or tumors, can manifest in varicocele. The reason is basically the same. A mass that puts pressure on affected veins will cause increased backup pressure in other veins. This can happen with renal tumors since the renal vein will be blocked. This, of course, also depends on the side of the tumors. 

What symptoms might indicate you have varicocele?

Most of the time, varicocele won’t cause any symptoms. Usually, patients don’t know they have varicocele until they start having trouble conceiving. Yet, symptomatic varicocele occurs in around 10% of all varicocele cases. The most common varicocele symptoms include: 

  • Abnormal pain: Patients may describe it as dull, aching, or throbbing pain. Also, pain can be acute, stabbing, or sharp, but this is uncommon. The pain will usually increase with standing or physical exercise, especially during long periods. 
  • A lump or a mass in one of your testicles: This can also be a symptom of many other testicular conditions. However, having a lump in your testicle is a common symptom of varicocele. The lump is usually just your dilated veins.
  • Swelling in your scrotum: Increased blood pressure can result in an overall swelling of the scrotum. You can notice your scrotum increased in size. 
  • Visibly enlarged or twisted veins in your scrotum: Like any varicose veins, varicocele can be seen as enlarged veins in the scrotum. This can give your scrotum a look that’s described as a bag of worms. 

The fact that you don’t experience any symptoms doesn’t mean you don’t have varicocele. In fact, while being asymptomatic, you can still have fertility affectation. Remember the increased temperature will affect the quality or quantity of your sperm. 

When are varicoceles usually found? 

Varicocele usually occurs or develops slowly. It can be diagnosed at any moment of your life. However, it is most common during puberty and early adult years.

Around 15% of all varicocele cases will be diagnosed in men from 14-19 years old. During puberty, the testicles increase their size pretty quickly. This translates into increased blood flow to the testicles. If the venous valves don’t work correctly, this increased blood flow will become varicocele. 

Nevertheless, this doesn’t mean that older men won’t develop varicocele. In fact, the latest studies have found that your chances of getting varicocele will increase with age. The risk of developing varicocele increases around 10% with every decade that passes. For example, the chance of getting varicocele in your 30s is around 18%. On the other side, the chance of getting varicocele in your 80s increases up to 75%. 

What are the complications of varicocele? 

In the majority of the cases, the prognosis or possible outcomes of this disease are excellent. However, since it usually doesn’t cause any symptoms, it can go untreated for a long time. When varicocele is left untreated, it can result in complications such as: 

  • Testicular atrophy: This is shrinkage or a loss of testicular tissue. It’s not very well described how varicocele causes this. Doctors think this happens because of the compression of sperm-producing tubules. Increased pressure in the testicles due to varicocele can result in toxins accumulation that damages the tissue. Besides, the compression can impair oxygenated blood flow to testicles, and the tissue won’t receive nutrients. 
  • Infertility: As we mentioned before, testicles need a specific lower temperature. This is to ensure the production and maturing of sperm. When this disease occurs, the temperature of the testicle rises. This compromises the production and adequate motility of sperm. When you produce less or poorly functioning sperm, your fertility will be impaired. 

You may also want to see: Gonorrhea.

What is the link between varicocele and infertility? 

Like we mentioned before, infertility can be a common complication of varicocele. In fact, it can be the problem that makes you look for medical help before knowing you have varicocele.

As you know, the testes are in charge of producing sperm. Producing sperm includes producing and maturing the cells so they have all they need to be fertile. This includes adequate mobilization and enough number of cells. All the parts of this process need a specific temperature to develop. 

The average temperature of the human body is around 36-37 degrees Celsius. This temperature is way too high for your testis. This is why evolution has put your testicles outside of your body and inside the scrotum. This way, the temperature of the testes is maintained at around 5 degrees lowers than the rest of your body. 

When this disease occurs, normal veins of the scrotum become swollen and dilated. This results in the accumulation of blood in the veins of the scrotum, which increases the testis’s temperature.

A persistent high temperature of the testicles will directly affect sperm production. This will result in an impaired production and maturing of sperm. So, you’ll end up lowering your sperm count, but poorly functioning sperm too. This, obviously, will end up with you having decreased fertility and your capacity to conceive. 

How is a varicocele diagnosed?

If you think you have this disease, you should go to the doctor. There, your doctor will ask questions about your medical and family history. Then, they will ask about the symptoms you’ve been having. Once the interrogatory is done, they will perform a physical examination. This will include palpation of your testicles to see what’s wrong.

Depending on the size of the varicocele, your doctor can identify it right away. If your varicocele is smaller, then they probably ask you to stand up. They can also ask you to take a deep breath and hold it while you bear down. This is a Valsalva maneuver, and it increases intrabdominal pressure.

An imaging study can help look at the structures in your scrotum, like the scrotal varicocele. If your doctor doesn’t find anything, they can indicate that you get a scrotal ultrasound. This can also rule out other causes for your symptoms, like a tumor compressing the internal spermatic vein. 

When should a varicocele be treated?

Not every case should get varicocele treatment. Remember that most of the time, it won’t cause any symptoms. Doctors have agreed that there is a specific group of patients that need varicocele treatment. The indications for varicocele treatment include: 

  • Palpable varicocele in the physical examination.
  • Decreased sperm count means that you produce less sperm than usual.
  • Discomfort or abnormal pain that doesn’t respond to routine treatment.
  • Testicular atrophy means loss of shrinking of testicular tissue less than 20cc or 4cm.
  • Demonstrated infertility. 

What is the treatment?

Since this disease is the result of anatomic abnormality, there is no efficient medical treatment for it. The only medical treatment that doctors can recommend is over-the-counter pain relievers for varicocele pain.

The best form of treatment for this condition is varicocele surgery. Many different surgical treatments can treat varicocele. The main purpose of surgery is to redirect blood flow to normal veins that aren’t dilated. Nowadays, there are several methods available to cure varicocele, these include: 

  • Open surgery: The doctor opens an incision in your groin to access the vein. This includes procedures like microsurgical varicocelectomy, where doctors use a microscope and subinguinal approach. This method has the highest success rates of them all. 
  • Laparoscopic surgery: This procedure requires general anesthesia. Your doctor opens a small incision and passes instruments through them to repair the varicocele. Since the incision is smaller, there is a smaller risk of surgery-related complications like hematomas. 
  • Percutaneous embolization: In this procedure, interventional radiologists insert a tube into a vein in your groin or your neck. This is a catheter through which instruments can be passed. The doctor can see the enlarged veins in a monitor and inject a solution that scars them. This is what embolization means. This causes blockage of testicular veins and repairs the varicocele. The varicocele embolization is a convenient procedure, but it is not that common. 

Do you have symptoms of this disease?

This tool is a Varicocele Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will help anybody who uses it the likelihood of their symptoms because of Varicocele. Using the tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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Left testicular or scrotal pain? – Varicocele Symptoms Checker