Varicocele is the engorgement of veins within the scrotum. Untreated, it may cause low sperm production and decreased sperm quality, which may lead to infertility.
The gold standard to manage a large symptomatic varicocele is surgery, but it is associated with potential complications and even recurrences. There are no drugs to prevent or specifically treat this condition. Treatment is offered for men who have the following issues:
- Abnormal semen report
- The left testicle developing slower than the right
- Fertility issues
- Mass on your scrotum
The physician may prescribe painkillers to relieve pain. Other options are scrotal supports, antioxidant therapy and other treatments.
The treatment of varicocele usually enhances sperm quality, but there is no evidence that untreated varicocele leads to deterioration of sperm quality.
What is a varicocele?
Varicocele is the engorgement of veins within the scrotum. It may be first noticed as a minor swelling in the underwear area or a painful area. Some varicoceles may cause low sperm production and decreased sperm quality. As a result, the person may suffer from infertility. Yet, not all varicoceles may affect sperm quality.
Varicoceles form during puberty and about 10 to 15 boys out of 100 have this condition. They most commonly occur on the left side of the scrotum, although varicoceles may exist on both sides at the same time.
How does the male reproductive system function?
The male reproductive system produces, stores and mobilizes sperms. The scrotum is a loose pouch of skin that holds the testicles (testes). Testicles are involved in the production of sperm and the hormone, testosterone. In the next stage of sperm development:
- They mature while traveling through the epididymis (a coiled tube) behind each testicle.
- Then they travel into the prostate from each epididymis via a tube called the vas deferens.
- Finally, the sperm mixes with seminal fluid to form semen which is released during ejaculation.
- Semen travels through the urethra and comes out of the end of your penis.
The spermatic cord brings blood to the testicles. It also comprises pampiniform plexus veins that drain the blood from the testicles. Testes require a body temperature that is lower than the core body temperature. This temperature is ideal for good sperm production, development and functioning. The body heat in the scrotum is about five degrees lower than that of the abdomen or pelvis. The lower temperature may be attributed to the presence of pampiniform plexus, which acts as a heat exchanger, cooling blood in the testicular artery before it enters the testicles.
Varicocele occurs when the pampiniform plexus veins enlarge. Further, it may lead to lower sperm production and function, leading to lower fertility potential.
What are the causes of varicoceles?
Some of the most common causes of varicoceles are as follows:
- The valves in the vein are not functioning or are missing.
- Blood flow is slow, leading to the pooling of blood in the veins.
- The position of the left testicular vein may sometimes lead to the pooling of blood.
- Infections such as epididymitis may sometimes cause pain in the scrotum and a small varicocele.
What kind of pain does a varicocele cause?
Varicoceles are generally symptomless. However, they can sometimes contribute to mild or severe scrotal pain. The pain may
- Change from dull to sharp
- Worsen as you stand or exert yourself for a long time
- Get worse as the day progresses
- Be relieved once you lie on your back
What is the “grading” system for varicocele size?
The varicocele grading system can be a useful tool for diagnosing and treating varicocele.
|Seen on ultrasound, but not physically detectable (also called “subclinical varicocele”)
|Palpable (felt on an exam) when the patient is performing the Valsalva maneuver (“bearing down”)
|Palpable even without the Valsalva maneuver
Varicocele, causing visible deformity of the scrotum
Medically Reviewed on 3/5/2021
Urology Care Foundation
Johns Hopkins Medicine