Varicocele refers to the enlargement and varicosity of the veins within the scrotum (the skin covering the testicles). It is one of the most common conditions in men after puberty. Varicocele is the leading cause of reduced sperm production, poor sperm quality, and infertility in men. It may also lead to testicular shrinkage. Fortunately, most varicoceles are easily diagnosed, but if symptomatic, surgical treatment is required.
Since varicocele usually has no symptoms, it is often discovered during infertility evaluations or routine examinations. Varicocele is rarely painful, but the pain may:
Over time, varicocele may enlarge and become more noticeable. However, if you experience pain, swelling, or a lump in your scrotum, contact your doctor.
The veins and arteries regulate the blood flow to and from the testicles. The exact cause of varicocele is not entirely clear, but many experts believe it occurs when the valves inside the veins fail to function properly, leading to poor blood flow in the testicles. This malfunction results in vein dilation. Varicocele often develops during puberty, usually on the left side, due to the position of the left testicular vein. Additionally, the presence of varicocele on one side can affect sperm production in both testicles.
Varicocele is most commonly observed in men aged 15 to 25 years.
Testicular Shrinkage (Atrophy):
Testicles are primarily composed of sperm-producing tubes. When varicocele occurs, the testicle may soften and shrink. Although the exact cause of testicular shrinkage is unclear, it may be due to tissue damage or the presence of certain toxins in the blood. This damage is associated with the malfunction of the vein valves and increased pressure within the testicular veins.
Infertility:
The exact mechanism by which varicocele affects fertility is not fully understood. The testicular blood vessels help maintain an optimal temperature for sperm production. Varicocele causes blood flow stagnation, leading to increased local testicular temperature, which negatively impacts sperm production and motility.
If varicocele does not cause issues, treatment may not be necessary. Treatment is required in cases of pain, infertility, or testicular shrinkage. Surgical intervention involves removing the problematic vein from the testicular blood flow system and redirecting the blood flow through healthy veins. However, the impact of surgery on infertility remains uncertain.
Surgery is recommended in the following cases:
Surgical complications are minimal and may include:
Surgery is performed under general or local anesthesia. Patients typically return to normal conditions after two days and can resume light activities. Regular activities can usually be resumed after two weeks. Pain from surgery is mild, and prescribed painkillers can be used for the first two days. Sexual activity should be avoided for one week post-surgery.