Varicoceles are swollen veins in the scrotum. They usually cause mild symptoms, including swelling of the scrotum or severe testicular pain and may not cause any symptoms at all. However, they are a common cause of infertility.
What is varicocele?
Varicocele is a common disorder that dilates the veins in the scrotum as the scrotum is the skin sac behind the penis that usually contains the testicles.
Varicoceles are usually painless but can sometimes cause testicular pain, which may not be continuously.
In some people, varicocele may cause infertility. If you don’t feel pain due to varicocele, you may not need treatment.
The effect of varicocele on fertility
Varicocele can affect fertility in some people and varicocele can also contribute to about 40% of all cases of male infertility. However, many people with varicocele have no problems having children.
Research and studies have not confirmed the role that varicocele plays in infertility, as it is possible that the temperature inside the scrotum increases due to the accumulation of blood in the veins.
The high temperature may therefore affect the testicles and the number or production of sperm. As a result, fertility concerns are the main reason people receive varicocele treatment.
How common varicocele is?
Varicocele affects 15% to 20% of the proportion of all men varicocele is more likely to occur on the left side of the scrotum due to differences in how the blood drains from the left testicle back into the main veins of the body. It can also affect the right side or both sides.
Symptoms of varicocele:
A person with varicocele usually does not show any severe symptoms. However, you may feel the following:
- Dull pain in the testicle or pain in the scrotum, which often improves when lying down.
- Swelling of the testicles or scrotum.
- Shrinkage of the testicles (testicular atrophy).
- Inability to achieve pregnancy after at least a year of trying (infertility).
- A small lump above the affected testicle.
Varicocele may cause mild discomfort or pain and the varicocele may be too small to be seen or felt.
The main cause of varicocele:
Doctors are not sure about the reasons for the development of varicocele, but some believe that the wrong “switching” (valve) inside certain veins in the spermatic cord may cause it.
The spermatic cord is a collection of tissues that holds the testicles in place. These veins return blood from the testicles back to your body.
The valve acts as a kind of “On / Off” switch as the testicle is made up of two flap-like structures that help the blood move back towards your heart.
When the valve does not work the way it should, blood may accumulate inside the veins in the testicles. And over time the veins swell.
People affected by varicocele:
Varicocele can affect anyone who has testicles at any age. Several studies have made it clear that varicocele is present at birth (congenital).
Often people notice varicocele during the teenage years. Doctors believe that this may have something to do with puberty when blood flow to the genitals increases. In some cases, varicocele can prevent it from developing properly.
Does varicocele cause erectile dysfunction:
There is not enough research to say definitively that varicocele causes erectile dysfunction, but there may be a link. Some studies show that people receiving varicocele treatment may sometimes fail to achieve an erection, but not significantly.
Complications caused by varicocele
A large varicocele may increase the risk of other complications, including:
- Low testosterone (male hypogonadism): testosterone is a hormone that begins to appear clearly in males during puberty, enhances libido (sex drive) and helps strengthen bones and muscles. And low testosterone can shrink the size of the testicles, reduce sex drive, reduce muscle mass and cause depression.
- Azoospermia: azoospermia is when you don’t have any sperm in your semen. Sperm cells are reproductive cells that fertilize an egg. Which later develops into an embryo. Azoospermia is one of the causes of male infertility.
Diagnosis of varicocele
So varicocele is diagnosed. The specialist will review your medical history, ask questions about symptoms, and conduct a physical examination.
During the physical examination, the doctor may ask you to stand up, take a deep breath, close your nose and mouth, strain to push the air out. This way the doctor will feel your scrotum and enlarged veins while you hold your breath and strain.
In addition, the specialist performs the following tests to confirm the diagnosis:
- Pelvic ultrasound: pelvic ultrasound is a non-invasive imaging test that gives your doctor a detailed view of the veins in the testicles. It is the most common imaging test that doctors order to help diagnose varicose veins.
- Semen analysis: the semen sample is sent to the laboratory, where specialists will look for the presence of sperm and their general health. The doctor will order a semen analysis if there are concerns that varicose veins affects your fertility.
- Blood test: during the blood test, the doctor will use a small needle to draw a small blood sample. They will send your blood sample to the laboratory, where the specialist will check the levels of hormones, including follicle-stimulating hormone (FSH) and testosterone.
Degrees of varicocele
Specialist doctors use such grades for the classification of varicocele as:
- Grade 0: this is the smallest type of varicocele in which the doctor cannot feel it during a physical examination, but can see it through ultrasound.
- First degree: your doctor cannot see varicose veins, they can only feel it when you perform Valsalva voltage breathing.
- The second degree: the doctor can feel the varicose veins even when you are not straining Valsalva breathing, but it is still not visible.
- Third degree: this is the largest size that varicocele can reach, as the doctor can clearly see and feel the varicose veins.
Varicocele treatment
Treatment of varicocele depends on the severity and degree of varicocele. For low-grade varicocele, the doctor may recommend treatment options at home , including:
- Changes to your daily routine: you may need to avoid certain activities that cause discomfort. Wearing tight underwear or a sports belt while exercising or standing for long periods of time can alleviate the symptoms.
- Ice: applying ice or cold compresses to the scrotum may help relieve pain and feel comfortable. Do not apply ice directly to your skin. Wrap ice or cold compresses with a towel. Apply ice for no more than 15 minutes at a time.
- Medications: non-steroidal anti-inflammatory drugs such as naproxen and ibuprofen can help relieve any pain in the scrotum or testicles. Not everyone can take NSAIDs, however.
Varicocele surgery
Varicocele resection is a surgical procedure that treats varicoceles that are very painful or that affect fertility.
A surgeon specializing in conditions affecting the urinary and reproductive systems will cut the affected veins and close the limbs.
Which redirects blood flow to other healthy veins in the scrotum. Most people recover completely after varicocele removal within six weeks.
Laser varicocele removal
Varicocele laser treatment is a medical procedure that uses laser technology to treat and remove varicose veins in the testicle.
This procedure is an alternative to traditional treatments such as conventional surgery or endoscopic therapy, and it is increasingly being used due to its effectiveness and the lack of surgical interventions.
Laser technology directs a high-frequency and high-energy laser light beam towards varicose veins in the testicle. This laser beam helps to get rid of the blood collected in varicose veins and close the dilated blood vessels without the need for conventional surgery.
Some of the benefits of varicocele laser treatment are:
- Non-surgical: the operation is largely non-invasive, which reduces the risks and the time required for recovery.
- Less interference: laser treatment does not require large cuts or major surgical interventions, which reduces pain and speeds up the recovery process.
- Fast recovery time: the recovery time after laser treatment is often shorter compared to conventional surgeries.
- Permanent results: laser therapy can provide permanent results and effectiveness in the treatment of varicocele
What happens if varicocele is left untreated
It depends on the degree of varicocele. The doctor may not recommend treatment if you have a small varicocele that does not bother you or causes fertility problems.
If you have high-grade varicocele and don’t get treatment, it can permanently damage your testicles.
