What is a Varicocele? – Causes, Symptoms & Treatment

A testicular varicocele is an enlargement of the veins within the scrotum. In most cases, it appears unilaterally, that is, in one of the testicles, but there are cases of bilateral varicocele in which both the right and left testis are affected.

Generally, varicocele does not produce serious symptoms, although it may cause pain or be a cause of infertility. For this reason, when the patient wishes to have children, the appropriate treatment must be applied.

In the most severe cases, surgery may be necessary to cure varicocele and reduce its consequences on male fertility.

What are the causes of varicocele?

About 15 percent of men with a varicocele do not have infertility issues, whilst 35 percent have primary infertility, and the remaining 81 percent have secondary infertility.

In the vast majority of the cases (about 87%), it affects the left testis. In 7% of the cases, it is bilateral, and only 3% of the patients have a varicocele in the right testis.

Normal testis vs. varicocele

The main cause why the veins within the scrotum become enlarged is an alteration in the blood flow of testicular veins. The veins are filled with blood due to the backflow of blood (i.e. regurgitation) from the renal vein to the testis, causing enlargement and affecting the testicular function.

Symptoms of varicocele in men

As we have discussed, the only noticeable symptom arising from varicocele is pain and it does not occur in all cases. There are many patients with varicocele who are asymptomatic.
Other possible clinical manifestations of varicocele in the male include the following:

• Enlargement of the scrotal veins.
• Differences in testicular size since the testicle affected by varicocele would be smaller.
• Appearance of a tumor in the scrotum without pain.

Signs and symptoms of varicocele

In addition, men with varicocele may have problems having a baby and their sperm count may be decreased.

Diagnosis: physical examination and ultrasound

To render a correct diagnosis of varicocele, your doctor will carry out a rigorous physical exploration of the scrotal and inguinal content, preferably while you are lying flat. Afterward, you will be asked to get up and increase pressure in the abdomen. This allows the urologist to examine blood flow from upwards and see how it fills the inguinal canal and the testicular vein.

Based on how challenging the diagnosis process becomes, the urologist classify it into one of the following grades of severity

Grade 1

Diagnosis is complicated. It requires extra pressure on the abdomen. Your doctor might ask you to cough or forcibly blow out.

Grade 2

By touching the testicle, an urologist can confirm whether the volume of the veins is greater than normal.

Grade 3

The enlarged veins are visible to the naked eye.

When varicocele cannot be diagnosed with a physical exploration, performing an ultrasound scan to detect the presence of enlarged veins is advisable. To check the speed of blood flow, a Doppler ultrasound is used.

Consequences: can it cause infertility?

The blood vessels that nurture the testis start in the abdomen. When they descend, they become part of the spermatic cord. The flow of blood vessels is controlled by a set of valves that prevent the backflow of blood. Alterations of these blood vessels are the physiopathological basis of varicocele.

In the case of varicocele, regurgitation increases intratesticular temperature, affecting spermatogenesis (sperm production and maturation process). This is the reason why the testes are outside the rest of the body since spermatogenesis must occur at a temperature that is 2 °C lower.

Due to all these consequences, between 50 and 70% of the patients are diagnosed with one of the following sperm disorders after a semen analysis:

Oligozoospermia

Low sperm concentration.

Asthenozoospermia

Sperm motility issues.

Teratozoospermia

Abnormal sperm morphology.

Varicocele affects spermatogenesis

In the most severe cases, it can even lead to azoospermia, that is, the total absence of sperm in the semen ejaculated.

On the other hand, a varicocele can cause alterations in the hormone system that regulates spermatogenesis, with the subsequent decrease of testosterone levels.

Finally, another effect derived from varicocele is oxidative stress, which can have a highly severe effect on male fertility and can lead to sperm DNA fragmentation.

Alterations in the testicular function can affect both testes, irrespective of whether the varicocele is unilateral or bilateral since an increase in temperature affects both sides.

Microsurgical treatment and complications

Varicocele requires treatment when the pain it causes is unbearable for the patient, and it cannot be relieved with medication. Also, when the patient wishes to have a baby and the varicocele is causing trouble.

According to experts, men who do not wish to conceive, are diagnosed with a varicocele, and have a normal semen analysis (normozoospermia), should be offered treatment as well. In the case of young males with varicocele and a normal semen analysis, their progress will be tracked with a semen analysis every two years.

Surgery is the most effective treatment option for varicocele. The procedure is called varicocelectomy.

Surgery

Different surgical procedures can be used to treat a varicocele. Today, the technique of choice is microsurgery. Based on the size of the varicocele, inguinal or inguinal microsurgery can be used. The risks associated with this procedure are minimal.

The technique of choice depends on the grade of severity, as well as on the expertise and skills of the surgeon. It can be performed with laparoscopic surgery as well. In any case, it does not take longer than 15-30 minutes, and it is carried out using epidural anesthesia, although sometimes general anesthesia is used.

After the procedure, the patient is recommended to rest for 1 or 2 days, apply ice on the genitalia and, in particular cases, use scrotal support. Normal daily routines can be resumed within a week or 10 days, which means that the recovery process is rather fast.

Tips after varicocele surgery

There is another treatment known as percutaneous embolization that can be done to repair the varicocele in those blood vessels that present reflux.

It involves the insertion of a small catheter into a large vein in the groin area. The catheter is advanced to the varicocele, which is then blocked by physical means. Embolization is an effective treatment for varicoceles that have previously been operated on, when the alteration is repeated (2% of cases treated with microsurgery), it may be the definitive solution.

Results and risks

Thanks to these treatments, the normal temperature of the testicle are recovered, thereby recovering normal testicular function. By reestablishing it, spermatogenesis will occur with normality.

In 90% of the cases, the treatment of varicocele is successful. In fact, most studies show an improvement of sperm quality of between 40 to 60%. Also, pregnancy rates experience an increase of 20-60%. So, as one shall see, treating a varicocele with surgery improves fertility.

The most common complications of microsurgery are hydrocele and discomfort in the epididymis.

Post-operative follow-up

Several tests should be run after surgery to treat varicocele in order to make sure the results have been optimal.

A spermatic venography is typically the method used to identify potential areas where backflow of blood persists. If it were identified, treating it again would be required. Post-op semen analysis should be performed every three months during a year or until pregnancy is achieved.

For some experts, surgery is ineffective to eliminate infertility caused by varicocele. If pregnancy is not achieved naturally after surgery for varicocele, Assisted Reproductive Technology (ART) offers a wide range of options to achieve so, including sperm donation.

FAQs from users

Is it normal for the testicles to swell after surgery for varicocele?

Varicocele in the male refers to dilatation of the spermatic vein and surgical correction consists of sealing the vein. This correction can be approached locally or by translaparoscopic surgery.

It is common that after varicocele surgery a transient inflammatory process is generated and fluid accumulates in the scrotum (hydrocele). For this reason, the man may have the sensation that the testicles have swollen.

Can a varicocele be cured without surgery?

It depends on the grade of severity. Males with a mild-to-moderate varicocele are more likely to being able to conceive naturally. On the other hand, severe cases of varicocele affect male fertility significantly and surgery may be the only solution.

Is a varicocele the same as having varicose veins in the testis?

Yes, a varicocele is defined as having varicose veins or enlarged veins in the testis.

Can a varicocele have a negative impact on libido?

Yes, there exist cases of varicocele where the man has experienced a decrease of libido, probably due to abnormal testosterone levels. Nonetheless, although it is possible, it is uncommon.

Also, this diminished libido as a result of varicocele can lead to sexual impotence, but only in very severe or extreme cases.

Can a varicocele cause cancer?

No, a varicocele is unlikely to turn into a cancerous tumor.

Can a varicocele be prevented?

Unfortunately, contrary to what happens to varicose veins in the legs, there is no possible way for a varicocele to be prevented.

What is the difference between a varicocele and a hydrocele?

A varicocele is an enlargement of the veins in the testicles due to an abnormal blood flow. Conversely, a hydrocele is the presence of fluid in the scrotum, which function is to allow testicular mobility and to absorb the shocks. A hydrocele is commonly caused by inflammation of the testes.

Learn more: What Is a Hydrocele? – Symptoms, Causes & Treatment.

Can I have sex relations if I have a varicocele?

Yes, as long as it is not painful for you. Occasionally, some males with varicocele have difficulty during sexual intercourse because they feel pain and/or discomfort in the scrotum.

Can a varicocele cause erectile dysfunction?

No, in principle a varicocele does not affect erection. Only if testosterone levels drop dramatically, the man may experience erectile dysfunction, but it is uncommon.

Can a varicocele cause premature ejaculation?

No, a varicocele cannot cause premature ejaculation.

For the erectile function of a male with varicocele to be affected, it would be necessary for the varicocele to severely damage both testicles, causing a decrease in testosterone levels and thus causing erectile dysfunction. However, this does not happen in men with varicocele.

Recommended readings

As one shall see, a varicocele can affect male fertility to a large extent. To learn more about how to become a father in spite of having a varicocele, continue reading here: Achieving Pregnancy with a Varicocele.

Also, if you wish to get more info on the whole set of causes that can lead to male infertility, read: What Causes Male Infertility? – Symptoms & Treatment.