Of the many different causes of male infertility, a varicocele is one of the most common. A varicocele is very simply a varicose vein that develops in the venous system of the testicles. This varicose vein develops in much the same way that others do. This means that the one-way valves that control the blood flow in the veins are damaged and allow the blood to pool. This pooling results from poor circulation. This increases the temperature inside the scrotum and decreases sperm production because of the heat. (1)
Urologists estimate that between 10 and 20% of all men will experience a varicocele at some point in their lives. And only 40% who have a varicose vein in the testicle will have any discernible symptoms. Most men can feel the swelling or lump that surrounds the testicle inside of the scrotum. Interestingly 96% of all cases this will be on the left side. There is a physiological reason for this. The spermatic cord on the left side is longer and requires a more circuitous route to the heart. It also connects to the left kidney vein which has a higher blood pressure than the right one. A higher pressure on the side increases the likelihood of swelling in this vein which may be weakened. (2)
Many times the swelling will be present when standing but will disappear when the man lies down. The degree of pain, discomfort or swelling will vary from person to person. In fact, some may not have any discomfort at all while others may have significant pain. Men may first notice a varicocele directly after puberty and before the age of 35. Any man can be affected, although it seems to be more frequent in individuals who are tall and thin or who live in very hot climates.
When a man presents to his primary care physician with these complaints most diagnoses can be made with medical history and a thorough physical examination. Sometimes an ultrasound is ordered if there is any doubt about the diagnosis or in order to confirm that there are no other growths present at the time. The varicocele can be large or small. Prominent ones can be easily seen with the naked eye. Small varicoceles may require the use of a Doppler in order to visualize the internal organs. A thermogram is a procedure which detects pockets of heat that may be used in order to diagnose a varicose vein in the scrotum. (3)
If the urologist requests this examination because of suspected infertility, several sperm samples may be requested for comparative anaylsis. This is because infertility that is brought on by a varicocele will have an inconsistent pattern of development.
In some cases, the decrease in circulation to the testicle will cause it to shrink in size. Those who develop the condition gradually will assume that this shrinkage or discomfort is in some way associated with aging. Others can attribute the onset of pain to some type of muscular strain following heavy lifting. Any man should be aware that any recurrent or constant discomfort in the genital region is abnormal and they should seek the care of the urologist or primary care physician as soon as possible.
If a varicocele is not causing the man any discomfort there is no treatment required. For individuals who suffer from mild discomfort or swelling a jock strap or firm fitting underwear can help to keep the swelling down as well as the discomfort. Surgery may be recommended if a varicocele is causing significant discomfort or if it is associated with a reduced size of the testicle. Although the operation is straight forward it is a delicate procedure which must be done by a skilled and experienced surgeon.
(1) PubMedHealth: Varicocele
(2) PG Blazer: Varicocele is More Common in Left Side: Mechanism
(3) MetroUrology: FAQ About Varicocele