Varicocele: Causes, Symptoms, and Treatment

Varicocele refers to the dilatation of veins of the scrotum that may cause discomfort, heaviness, pain, and testicular atrophy. In extreme cases, it may cause infertility. It may be an asymptomatic condition in some males and usually affects the left testicle than the right. This is because the affected veins of the scrotum are generally located on the left side. Sometimes, it may affect both testicles. These veins are similar to the varicose veins of the legs. 

While some may be visible, others can be felt. Other symptoms of varicocele of testis may be accompanied by feelings of heaviness. The size of the varicocele varies between individuals. The varicocele of testis may disappear while lying down and may reappear after standing up.

Varicocele is a condition of abnormally dilated veins of either or both the testis of the scrotum.

Symptoms of Varicocele

The symptoms of the health condition vary amongst patients. Not all of them appear amongst every individual with the condition. Most importantly, it may be asymptomatic. This implies that there are no external manifestations of the condition. In case symptoms appear, it is generally after standing or sitting for a long time, post-heavy workout sessions, or during hot weather.

The possible symptoms are as below:

• Constant ache in the testicle(s)
• Discomfort in the affected testicle(s) and the adjoining areas
• Dilated veins in the scrotum that feel like worms upon touch
• Smaller size of the affected testicle due to disrupted blood flow
• A heavy feeling in the scrotum

Causes

Blood vessels carrying blood become enlarged because of the inability of the valves of the scrotum’s small veins to function well. These valves, situated at intervals, open to enable blood flow towards the heart. However, these valves close when the blood flow is slower than expected to prevent the blood from flowing back owing to gravity. This blood gets collected in the lower parts of the veins to develop a varicocele. The reason why the valves do not function efficiently is still under debate. 

In rare conditions, blockage in the larger veins of the abdomen may exert pressure on the smaller veins of the scrotum. This dilates the veins of the scrotum, leading to a condition of varicocele testis. Blockage of the veins can affect the temperature of the testis. This may affect the production of sperms and testosterone.

Risk and Diagnosis

Teenagers and younger men are usually more susceptible to varicocele of testis. 

The diagnostic procedure of varicocele usually follows a combination of medical tests. The following process is usually followed:

Physical examination

The doctor may check the testis and the surrounding areas while the patient is standing, so that the scrotum is in the suspended position. The examination is based on the symptoms that have been explained. This can be done through a physical checkup or through a testicular examination.

The weight, size, and position of the testicle(s) are checked for the presence of inflammation or lumps. The epididymis, the tube through which sperms travel to the testicles, may also be checked for symptoms of tenderness. The spermatic cord may also be evaluated for the presence of inflammation.

Medical tests

The doctor may advise the patient to undertake an ultrasound test to analyze the flow of blood in each of the veins of the scrotum.

Treatment

Varicocele testis generally does not require treatment as it is usually harmless, unless it is in the advanced stages where it can affect fertility. If required, varicocele treatment options are as follows:

Anti-inflammatory medications: In case of discomfort, heaviness, pain, and other symptoms, medications may be prescribed to relieve the pain and heal the inflammation. 

Surgery: Minimally invasive surgery like microsurgical varicocelectomy may be recommended on an outpatient basis. This involves making a minute incision in the lower groin and performing the surgery under the administration of general or local anesthesia. There is no risk of losing the testicle(s).

Lifestyle changes and home remedies

The doctor may advise the patient to wear a scrotal support post-surgery. For patients who do not require treatment, no lifestyle changes need to be undertaken to keep the condition under control.

Cold compress or ice pack may be recommended by the doctor post-surgery. For varicocele testis that does not cause discomfort, irritation, or pain, there are no home remedies required.

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