Varicocele is a condition characterized by the enlargement of the veins within the scrotum. It is similar to varicose veins that occur in the legs. I learned about varicocele when my symptoms became bad and I was required to have surgery. Here is an excellent video depicting how the veins getting enlarged and one form of treatment (ligation is the most common surgical treatment for this condition) – I had the same treatment done. It is a trip to think I have numerous tiny clips inside my scrotum.
Cause of Varicocele
Varicocele occurs when the veins inside the scrotum (the pouch of skin that holds the testicles) become enlarged. The exact cause of varicocele is not entirely understood, but it is believed to be related to the malfunction of the valves within the veins that regulate blood flow. Normally, these valves prevent blood from flowing backward, but when they fail to function properly, blood can pool in the veins, causing them to enlarge.
Several factors may contribute to the development of varicocele, including:
- Faulty valves: The most common cause of varicocele is thought to be dysfunctional valves in the spermatic cord veins, which hinder normal blood flow and cause the blood to pool.
- Genetics: Some studies suggest a genetic predisposition to varicocele, indicating that it may run in families.
- Obstruction: A blockage or obstruction in the spermatic cord can also lead to varicocele by impeding the normal flow of blood.
- Blood flow issues: Conditions that affect blood flow, such as an increase in abdominal pressure (like from heavy lifting or straining during bowel movements), can contribute to the development of varicocele. However, according to this interesting study there was no difference in varicocele found among bodybuilders and aerobic athletes. However, the study revealed a higher rate of varicocele among athletes who exercised more than three times per week
How Common is Varicocele
Varicocele is a relatively common condition, particularly among men in their reproductive years. It is estimated that about 10% – 15% of men overall have varicocele. However, the prevalence can vary depending on factors such as age and whether the individual is being evaluated for infertility or other medical reasons. The good news is that while varicocele is a common condition, not all men with varicocele will experience symptoms or require treatment.
Varicocele is most commonly diagnosed in adolescents and young adults, typically between the ages of 15 and 25. The condition can persist into adulthood, but the prevalence tends to decrease with age. Varicocele is also more commonly found in men who are being evaluated for infertility, with studies suggesting that it may be present in up to 40% of men seeking treatment for infertility.
Main Issues Associated with Varicocele
There are several primary issues associated with Varicocele:
- Impaired fertility – I likely experienced this. My wife and I were struggling to get pregnant for over a year. Within 2 months of me having the ligation surgery, we got pregnant.
- Decreased testosterone production by the testis.
- Scrotal discomfort. I experienced this. Also, in some cases, varicocele can cause azoospermia, or the complete lack of sperm in the ejaculate.
Treatment
Treatment for varicocele is usually not necessary unless it causes discomfort or affects fertility. If surgery is required, it is done under general anesthesia. The two most common surgeries are:
- Microscopic varicocelectomy: With this technique, the surgeon makes a 1 cm cut above the scrotum. Using the microscope, the surgeon ties off all small veins but avoids the vas deferens, testicular artery, and lymphatic drainage. The procedure takes 2 to 3 hours, and the patient goes home on the same day. This is what I had done. I was back to working out after 10 days.
- Laparoscopic varicocelectomy: With this technique, the surgeon inserts thin tubes into the abdomen and performs vein ligation. This procedure is shorter and takes about 30-40 minutes. The patient returns home on the same day.
My Experience
Based on my experience, I believe my case of varicocele was quite unique and caused by damage or aggravation to my spermatic cord. In 2015, I had left inguinal hernia surgery. While the surgery went smoothly, I had complications post-surgery. I developed pain and swelling in the surgery area – likely due to the implanted mesh – and my spermatic cord became extremely sensitive. Anytime I sneezed or stood for too long, it felt like someone was pulling on my spermatic cord. I felt constant pressure and pain on my spermatic cord going from my testicle to my left inguinal area. As time went on, the symptoms went on.
Two years after my hernia surgery, I felt a lot of pressure inside my left testicle and it was getting worse. Additionally, I could feel tiny lumps in my testicle – it felt like a bag of worms when I squeezed it with my fingers. My left testicle was very tender to the touch. To make matters worse, I was not getting a proper diagnosis. I made 7 visits to the urologist and had an ultrasound done. The ultrasound report did show some varicocele, but at no time did anyone mention I should have varicocele surgery. It was very frustrating and I felt hopeless.
I then went overseas for a family vacation. While on vacation, I paid $50 to see a urologist in his office. He asked me to drop my pants. He felt my testicle and said you need surgery. That was it. This does say a lot about medical care in the US. I think at time providers are scared to give a diagnosis. I came back to the US and informed my urologist I wanted surgery. And that did it.
In fairness to my urologist, I think he was so focused on the complication issues from the hernia surgery, that he was less focused on the varicocele issue. I had the hernia surgery done at the same hospital my urologist worked at. I will never know for sure, but the urologist may have been concerned about giving advice that would implicate the hernia surgeon or hospital in any type of wrongdoing. This should serve as a reminder that you need to be your own proponent when it comes to getting medical care.
I am now 6 years post-varicocele surgery and feel good. If you are experiencing pain or the symptoms mentioned in this article get checked for varicocele. Also, if you are having trouble getting pregnant, varicocele is one culprit that should be checked.