Varicocele
Varicocele is a condition which occurs when veins in your scrotum get swollen and eventually get larger. It resembles a varicose vein which you can get in your leg, and it can feel like a bag of worms. This condition generally shows up above one of the testicles, most often the left one.
It is generally seen when you stand up, but not when you are lying down. Though in most cases, it is harmless, it can sometimes be uncomfortable, or painful. It might also affect your fertility or may lead to the shrinking of your testicles.
Varicoceles are known to be found in around fifteen percent of the adult male population, as well as around twenty percent of the adolescent male population.
Symptoms
A varicocele might often show no signs or symptoms. In rare cases, it may cause pain, which might lead to sharp or dull discomfort. The pay may also increase with physical exertion, or worsen over a day, but may get relieved when you lie down.
Varicoceles might get enlarged and become more noticeable over time. The condition might cause a swollen testicle, generally on the left side.
As a varicocele generally doesn’t cause any symptoms, it may often not require any treatment. They might be discovered during a fertility evaluation or during a routine physical exam.
However, if you are experiencing pain or swelling in your scrotum, or if you discover a mass on your scrotum, or if you are having problems with fertility then you might be in need of immediate treatment, and therefore you should contact your doctor.
Causes & risk factors
Each testicle is held up by a spermatic cord, which also contains the veins, arteries, and nerves supporting these glands. In healthy veins inside your scrotum, the blood is moved by one-way valves, from the testicles to the scrotum, after which it is sent back to the heart.
Sometimes, the blood is unable to move through the veins as it should, and therefore it begins to pool in the vein, which causes it to enlarge. A varicocele generally develops slowly over time.
There are generally no established risk factors for a varicocele, and the exact cause is also unclear.
Diagnosis
Physical exam
Your doctor will first conduct a physical exam, and if you have this condition, then your doctor will find a nontender mass above your testicle feeling like a bag of worms. If it is large enough, your doctor should be able to feel it. However, if it is smaller, your doctor may ask you to stand and take a deep breath, and hold it while you bear down. This can help your doctor to detect any abnormal enlargement of the veins.
Ultrasound
If the physical exam is inconclusive, then your doctor might order a scrotal ultrasound, which makes the use of high-frequency sound waves to create a precise image of the structures inside your body, and this can be used to ensure that there isn’t another cause of your symptoms. In some cases, your doctor might also recommend further imaging so that he/she is able to rule out other causes for the condition, such as a tumor compressing the spermatic vein.
Treatment
It is not always required to treat a varicocele. Some men with this condition are even able to father a child. However, treatment can be considered if the varicocele is causing pain, causing testicular atrophy, or leading to infertility.
If you are thinking about assisted reproductive techniques, then you can consider treatment as well.
Since this condition can also cause problems with testicular functioning in some people, the earlier you begin your treatment, the better your chances are of improving sperm production.
Sometimes, wearing tight underwear or a jockstrap can also provide you with the support that can alleviate pain or discomfort. Sometimes, additional treatment, such as varicocelectomy and varicocele embolization, might also be necessary, if your symptoms get worse.
Varicocelectomy
Varicocelectomy is a same-day surgery that is done in a hospital. A urologist will first go in through your abdomen, or pelvis and clamp and tie off the abnormal veins. Blood may then flow around the abnormal veins to the normal ones. You can talk with your doctor about preparing for the surgery, and what to expect after the operation.
Varicocele embolization
Varicocele Embolization is a lesser invasive and same-day procedure. In this procedure, a small catheter is inserted into a groin or neck vein. After, this a coil is placed into the catheter and into the varicocele, which blocks blood from getting to the abnormal veins.
It is noteworthy that surgery becomes necessary only if you are experiencing pain from the varicocele, or if you are trying to have a child. You can discuss with your doctor which treatment is the best option for you.
Complications
A varicocele can have an effect on your fertility. This condition is known to be present in 35 to 44 percent of men with primary infertility and in 45 to 81 percent of men with secondary infertility.