A Varicocele is a formation of varicose veins in the scrotum. The scrotum is the sac that holds the testicles outside the male body. A Varicocele refers to an enlargement of veins inside the scrotum.
Varicocele
Introduction
The testicles are a pair of sperm-producing reproductive organs. A Varicocele causes enlargement of the veins around the testicles, causing a decreased sperm production or the production of low-quality sperm.
A Varicocele may cause the testicles to shrink or interfere with their normal growth. This might even cause infertility. Mostly a Varicocele is easily diagnosed and might not even require treatment. If severe, it can be treated with surgery.
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What Causes Varicocele?
Blood is carried to and from the testicles with the spermatic cord. However, what causes a Varicocele to form is not yet clear. Experts believe the cause could be a defect in the valve function. Valves inside the cord or veins regulate blood flow in a single direction. When the blood flows in a reverse direction, which is not a free flow, it causes the elastic vessel wall to expand. Pressure on the testicles interferes with healthy sperm production, causing infertility in the long run.
The most common appearance of a Varicocele is on the left side. It is mostly due to the anatomical position of the left testicular vein.
What are the Symptoms of Varicocele?
A person with Varicocele will rarely develop any signs or symptoms, even pain. If pain occurs, it may be a sharp or dull pain or might be a discomfort. Usually, the pain noticeably increases on prolonged standing or after any form of physical exertion.
You might notice that the pain worsens during the day, while you experience relief when you lie down on your back.
Sometimes, it is associated with reduced fertility. It usually looks like a “bag of worms”, as described in studies. If not visible immediately, you might notice an eventual increase in the vein size, forming a bulk usually over the left testicle.
How is Varicocele Diagnosed?
Commonly, a Varicocele is diagnosed during a physical examination for infertility or general physical. On suspicion of a Varicocele, your doctor will ask you to stand and hold your breath. This is known as the Valsalva maneuver. This process will allow your doctor to detect any enlarged vessels more effectively.
Sometimes, an ultrasound of the scrotum helps when the physical examination is inconclusive. It also helps identify certain tumours suppressing the spermatic vein.
Lifestyle modifications that help
You can use painkillers available over the counter if you experience pain. Generally, Tylenol, Motrin IB, Advil, etc., help with the pain. You can also make it a habit to wear athletic support wear to reduce pressure.
How is Varicocele Treated?
Varicocele is usually treated when you opt for any assisted reproductive techniques. Otherwise, it is not required as there are no symptoms of the condition. If there is pain associated, a Varicocele repair is performed.
In the surgery, the defective blood vessel is bypassed to allow blood to flow freely through the normal veins. In case you have infertility due to Varicocele , surgery is the right treatment for it. It has been observed that the sperm count gradually increases after surgery.
Your doctor might choose to perform the traditional open surgery or may go in for the laparoscopic option. The latter has a lower risk of infection and complications.
Percutaneous embolization is also an option for Varicocele repair. Here, a tube is inserted into the vein of the groin or the neck to access the affected vein. Doctors view the enlarged vein and insert a coil or chemical solution that causes scarring inside the vein. This blocks the testicular vein, thus repairing the Varicocele.
What are the Risk Associated with Varicocele Treatment?
A Varicocele repair poses certain risks, such as infection due to improper hygiene in the area after surgery. Sometimes, fluid might build up around the testicles, known as a hydrocele. Rarely, damage to the artery might occur due to its approximation with the gonads.
However, even after surgery, there are chances that the Varicocele might recur.
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When should I see a Doctor?
Usually, a Varicocele does not cause any signs or symptoms like pain. Therefore, in most cases, it is examined during a fertility evaluation or a general physical examination. If you feel pain in the area or notice a bulk or change in the size of your testicles, you should consult a doctor. Usually, treatment is not needed; however, it is best to follow what your doctor says. It is important to consult your doctor because certain other conditions that cause testicular mass or pain, if diagnosed need immediate treatment.
Why does Varicocele Cause Infertility?
A Varicocele increases the pressure on the testicles, causing a mobility disorder. It also increases the temperature of the testicles, causing a decreased quality and quantity of sperm production.
What Happens to Testes with Varicocele?
The testicles tend to shrink in size and become atrophic. It is not clear why this happens. The load of the pool of blood in the vessels surrounding the testicles causes damage. It is also likely that the toxins in the rather stagnant pool of blood adversely affect the testicles.
What is the Most Conservative Form of Varicocele Surgery?
A laparoscopic repair is the most conservative. The process is done under general anesthesia. Your doctor will make a small incision in your abdomen to pass the instrument to see and repair.
How Long does it Take to Get a Normal Sperm Count after Varicocele Repair?
It might take a few months after the surgery if the healing is normal and no complications occur. For this, your doctor might ask you to refrain from sex for a while. Usually, it takes three months for new sperms to develop completely.