A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum). A varicocele is similar to a varicose vein that can occur in your leg.
Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to fail to develop normally or shrink.
Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and many don’t need treatment. If a varicocele causes symptoms, it often can be repaired surgically.
A varicocele forms when valves inside the veins that run along the spermatic cord prevent blood from flowing properly. Blood to backups leading to swelling and widening of the veins. (This is similar to varicose veins in the legs.)
Varicoceles develop slowly most of the time. They are more common in men ages 15 – 25 and are most often seen on the left side of the scrotum.
A varicocele in an older man that appears suddenly may be caused by a kidney tumor, which can block blood flow to a vein. The problem is more common on the left side than the right.
Several theories have been proposed to explain the harmful effect of varicoceles on sperm quality, including the possible effects of pressure, oxygen deprivation, heat injury, and toxins.
Despite considerable research, none of the theories has been proved unquestionably, although an elevated heat effect caused by impaired circulation appears to be the most reproducible defect. Supporting this hypothesis is the fact that a varicocele created in an experimental animal led to poor sperm function with elevated intratesticular temperature. Regardless of the mechanism of action, a varicocele is indisputably a significant factor in decreasing testicular function and in reducing semen quality in a large percentage of men who seek infertility treatment.
An unproven hypothesis holds that a varicocele may represent a progressive lesion that can have detrimental effects on testicular function. An untreated varicocele, especially when large, may cause long-term deterioration in sperm production and even testosterone production. If an infertile male has bilateral varicoceles, both are repaired to improve sperm quality.
A varicocele often produces no signs or symptoms. Rarely, it may cause pain. The pain may:
- Vary from sharp to dull discomfort
- Increase with standing or physical exertion, especially over long periods
- Worsen over the course of a day
- Be relieved when you lie on your back
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.
You will have an exam of your groin area, including the scrotum and testicles. The health care provider may feel a twisted growth along the spermatic cord.
Sometimes the growth may not be able to be seen or felt, especially when you are lying down.
The testicle on the side of the varicocele may be smaller than the one on the other side.
Varicocele treatment may not be necessary. However, if your varicocele causes pain, testicular atrophy or infertility or if you are considering assisted reproductive techniques, you may want to undergo varicocele repair.
The purpose of surgery is to seal off the affected vein to redirect the blood flow into normal veins. In cases of male infertility, treatment of a varicocele may improve or cure the infertility or improve the quality of sperm if techniques such as in vitro fertilization (IVF) are to be used.
Varicoceles typically develop in adolescence and likely result in worsened sperm production. Despite the decreased sperm quality overall, many men with varicoceles continue to have sufficient sperm quality to achieve a pregnancy later in life.
Clear indications to repair a varicocele in adolescence include progressive testicular atrophy, pain or abnormal semen analysis results. Although treatment of a varicocele generally improves sperm characteristics, it is not clear if an untreated varicocele leads to progressive worsening of sperm quality over time.
Varicocele repair presents relatively few risks, which may include:
- Buildup of fluid around the testicles (hydrocele)
- Recurrence of varicoceles
- Testicular atrophy
- Damage to an artery
Repair methods include:
- Open surgery. This treatment usually is done on an outpatient basis, during a general or local anesthetic. Commonly, your surgeon will approach the vein through your groin (inguinal or subinguinal), but it’s also possible to make an incision in your abdomen or below your groin.
Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.
You may be able to return to normal, nonstrenuous activities after two days. As long as you’re not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.
Pain from this surgery generally is mild but may continue for several days or weeks. Your doctor may prescribe pain medication for a limited period after surgery. After that, your doctor may advise you to take over-the-counter (OTC) painkillers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve discomfort.
Your doctor may advise you not to have sex for a period of time. Most often, it will take several months after surgery before improvements in sperm quality can be seen with a semen analysis. This is because it takes approximately three months for new sperm to develop.
Open surgery using a microscope and subinguinal approach has the highest success rates when compared with other surgical methods.
- Laparoscopic surgery. Your surgeon makes a small incision in your abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.
- Percutaneous embolization. This procedure is done during local anesthesia on an outpatient basis. A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele.
This procedure isn’t as widely used as surgery.