What Is a Varicocele?

Varicocele, pronounced "vari-co-seel," is when veins in your scrotum swell and get enlarged. It’s a lot like a varicose vein in your leg. It might feel like a bag of worms.

It usually shows up above one your testicles, most often the left one. You can usually see it when you stand up, but not when you lie down.

It should be harmless, but it can be uncomfortable or painful. And it might affect your fertility or cause your testicles to shrink.

This condition is fairly common and usually affects young men. About 10 to 15 of every 100 men have this problem.

If your varicocele causes problems, your doctor may send you to a specialist called a urologist.

Causes

Doctors aren’t sure what causes this condition. It could be a problem with blood flow in the spermatic cord, which carries blood to and from your testicles. If valves inside the veins in the cord don’t work like they should, the blood backs up and the veins get wider.

Symptoms

Varicoceles rarely hurt. You may not even know you have one until you or the doctor sees it.

If yours does cause pain, it might:

  • Switch from dull to sharp
  • Get worse when you stand or exert yourself, especially for a long time
  • Become more intense as the day goes on
  • Go away when you lie on your back

Diagnosis

You and the doctor may be able to feel the mass easily. If not, the doctor might ask you to stand, take a deep breath, and hold it while you bear down. He’ll call this the Valsalva maneuver. It helps him feel enlarged veins.

If the exam isn’t enough to be sure, he might take an ultrasound of your scrotum. This test uses sound waves to take pictures of the inside of your body.

Treatment

Not all varicoceles require treatment. It’s mostly done if:

  • You’re in pain
  • You have problems fathering a child
  • You’re a boy whose left testicle is growing smaller than the right

Continued

There are no meds to prevent varicoceles. If yours hurts, the doctor may tell you to take ibuprofen for the pain.

If you do need treatment, the goal will be to tie off or remove the veins that supply blood to your spermatic cord. You might have:

Open surgery: The doctor will make a 1-inch cut into your scrotum. He’ll use a magnifying glass or microscope to help hem see small veins better. You might get local anesthesia to numb the area, or you may need general anesthesia to help you sleep through the procedure.

Laparoscopic surgery: The doctor makes a much smaller cut and uses it to insert tubes that hold surgical tools and a special camera to help him see inside you. You’ll get general anesthesia so you can sleep while it’s done.

Results from both types are similar because the cuts are small. It’s rare, but some people notice:

  • The varicocele doesn’t go away or comes back
  • Fluid in the testicles (your doctor will call this hydrocele)
  • Your testicular artery gets injured

It’s less common, but there is a third type of treatment:

Percutaneous embolization. A doctor called a radiologist will cut into a vein in your groin or neck to insert a tube. He’ll use X-rays to guide him to the varicocele and insert a balloon or coil into it through the tube. This blocks the blood flow to the varicocele and shrinks it. You'll have this done with general anesthesia.

Problems that can follow this procedure include:

  • The varicocele doesn’t go away or comes back
  • The coil moves
  • An infection where the doctor made the cut

What to Expect After Treatment

You can probably go back to work a day or two after surgery. But you’ll need to take it easy -- no exercise -- for about 2 weeks.

Recovery after an embolization is a little quicker. You’ll still need a day or two off from work, but you can get back to the gym in a week to 10 days. Your varicocele may be more likely to come back after this treatment, but sometimes it’s the better choice.

If you had the procedure to help with fertility, the doctor will test you in 3-4 months. That’s how long it takes for new sperm to grow. You’ll probably see improvements in 6 months, but it could take a year. A little more than half of the infertile men who have the procedure benefit from it.

Surgery is also successful for most teens who have it to fix slow testicular growth.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on December 01, 2017

Sources

SOURCES:

Mayo Clinic: “Varicocele: Diagnosis & treatment,” “Varicocele: Symptoms & causes.”

Urology Care Foundation: “How Are Varicoceles Treated?” “More Information,” “What Are Signs of a Varicocele?” “What Are Varicoceles?” “What Can I Expect After Treatment?”

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