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Key points
Key points- A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins in the legs.
- About 15% of men have some degree of varicocele, most often on the left side.
- It can cause pain or heaviness in the testicle, testicular atrophy when it appears in adolescence, and poor semen quality.
- Diagnosis is based on your medical history and a physical exam, and may be complemented with ultrasound, semen analysis, and FSH levels.
- Treatment aims to relieve pain and improve semen quality, and is decided with your specialist according to each case.
What is a varicocele?
A varicocele is an enlargement of the veins within the scrotum, very similar to varicose veins in the legs. It is a frequent cause of infertility in men because it affects sperm production.
About 15% of men have some degree of varicocele. The side most often affected is the left.
Causes and risk factors of varicocele
Varicoceles arise from the absence or incompetence of the venous valves in the pampiniform plexus of the scrotum. They usually appear in adolescence and young adulthood.
Family history
Having close relatives with varicocele.
Rapid testicular growth
As occurs in adolescence.
Body build
A tall, slim build.
Varicose disease
In other parts of the body, such as hemorrhoids or varicose veins in the legs.
Secondary varicocele
Sometimes a varicocele is due to compression of the spermatic vein in the inguinal or abdominal region. It may be secondary to:
- Inguinal hernia repair.
- Spermatic vein thrombosis.
- External compression of the spermatic vein by the superior mesenteric artery.
- An abdominal tumor, in rare cases.
Symptoms of varicocele
A varicocele can cause the following findings.
Testicular pain
Moderate to severe; it may radiate to the leg on the affected side.
Heaviness
A feeling of heaviness in the affected testicle.
Testicular atrophy
When it appears in adolescence.
Poor semen quality
Low count, poor motility, and excess abnormal sperm.
Diagnosis of varicocele
First
Medical history and physical exam
The diagnosis is based on a complete medical history and a physical exam.
To complement
Recommended studies
Testicular and inguinal ultrasound (to look for hernias), semen analysis, and FSH blood levels; CT scan or MRI of the abdomen if an abdominal or retroperitoneal tumor is suspected as the cause.
Varicocele treatment
The goal of treatment is to relieve pain and improve semen quality.
Anti-inflammatory pain relievers
Always as directed by your doctor.
Scrotal elevation and local ice
The choice of treatment is made with your specialist, according to each patient.
Surgical repair (varicocelectomy)
Indicated for a varicocele that causes symptoms, such as pain; infertility due to varicocele; and a desire to preserve fertility in adolescents.
Possible benefits of varicocelectomy
The purpose of surgically removing a varicocele is to relieve testicular pain, prevent testicular atrophy, and improve semen quality.
Testicular temperature
With a varicocele, it is slightly above normal. Correcting it may allow the temperature to return to normal, which supports testicular function.
Fertility
In some cases, a varicocelectomy may help recover fertility and achieve a pregnancy. Results depend on each patient.
Minimally invasive
It is considered a minimally invasive surgery. Recovery and discomfort after the operation vary from patient to patient.
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