A varicocele is when the group of veins inside your scrotum (the sac that holds your testicles) get bigger because of poor blood flow. These veins are called the pampiniform plexus. When they grow larger, they may look like a "bag of worms".
Varicoceles are more common on the left side. Ten to fifteen men out of one hundred have this. It is like getting a varicose vein in your leg.
Most of the time, varicoceles cause no problems and are harmless. They may cause pain, problems with fertility, or slow testicle growth in young boys.
What Happens Normally?
The scrotum holds the testicles (testes) of the male reproductive system. Sperm and the hormone testosterone are made in the testicles. The spermatic cord supports the testicles. It includes nerves, a tube to carry sperm called the vas deferens, the testicular artery, and the pampiniform plexus.
This grouping of small veins drains the blood from the testicles to cool them to support good quality sperm. If these veins become enlarged (varicocele), the testes can overheat and lead to poor sperm quality.
Varicocele Symptoms & Diagnosis
Most men with a varicocele have no symptoms. But this condition can cause infertility (problems fathering a child) or it can slow growth for the left testicle during puberty. Men tend to find varicoceles during a self-exam. Doctors can diagnose it during a routine exam. Your urologist may order a scrotal ultrasound test to see inside the scrotum.
The Causes of Varicocele
Varicocele could happen for a few reasons. The valves in the veins may not work well (or may be missing). Blood may pool in the veins if blood flow is sluggish. If blood pressure is weak, blood can flow backwards and cause the veins to swell. In rare cases, swollen lymph nodes or other masses behind the belly can block blood flow and make the scrotal veins swell.
Treatments for Varicocele
Most of the time varicoceles are not treated. However, treatment is offered for men who have fertility problems or abnormal semen, or if a boy's testicle grows slowly. There are no drugs to treat or prevent varicoceles.
Over-thecounter pain medicine may help. If needed, surgery is the main form of treatment. With surgery, the veins are ligated (tied or removed) to stop blood from pooling.
This surgery can be done microscopically or laparoscopically with a small cut. Embolization (placing a tiny coil and/or fluid in the blood vessel to move blood away from a varicocele) is one more choice. Healing after surgery is fast and pain is often mild. Other fertility treatments may be needed.
Urology Care Podcast
For more information, listen to our recent podcast called Varicocele 101 with Dr. Sarah Vij. Dr. Vij is a urologist with the Cleveland Clinic in Cleveland, Ohio. You can listen to the podcast, here: