5 signs of a varicocele

varicocele
Here are the 5 signs of a varicocele, which include a scrotal mass, heavy sensation, enlarged veins, dull or sharp pain, and infertility issues.

Varicocele is typically asymptomatic, but it may become more visible over time. When a varicocele reaches a certain size, men may begin to experience symptoms.

The top 5 signs of a varicocele include:

  1. Scrotal mass: Lumps in one of the testicles.
  2. Heavy sensation: Swelling in the scrotum that is aggravated by lifting weights.
  3. Veins: Enlarged or twisted veins that are quite noticeable.
  4. Pain: Dull or sharp recurring ache in the scrotum with the pain gradually worsening throughout the day or with physical exertion. When you lie on your back, you feel better.
  5. Infertility, impotence, and spermatorrhea (involuntary ejaculation): Typically, men with varicoceles have lower or impaired testosterone production. Some men who have varicoceles have erectile dysfunction and reduced virility.

Apart from the above, men may have testicular atrophy.

  • Another symptom of varicocele is testicular atrophy or shrinkage.
  • During a sports physical exam, adolescent boys are frequently diagnosed with the condition when one testicle is smaller than the other.

Problems caused by a varicocele include:

  • Elevated scrotal temperatures affect sperm development and maturation.
  • Hormone changes between the hypothalamus (upper brain), pituitary (main message center in the brain), and testicles.
  • Blood clots around the testicles.
  • At the microscopic level, there is a loss of testicular mass.
  • A varicocele on one side can harm the opposite testicle.
  • Semen analysis may reveal a low sperm count, low motility (swimming ability), an increase in the number of abnormally shaped sperm, and poor sperm function (on a sperm penetration assay).

Varicoceles may enlarge and become more visible over time. A large varicocele is often described as resembling a “bag of worms.” The condition may result in a swollen testicle, most commonly on the left side.

What are the common causes of a varicocele?

A varicocele is an enlargement of the veins within the loose bag of skin that contains your testicles (scrotum).

Veins in the body transport blood from various organs back to the heart. They usually have valves that ensure the blood flows in the right direction. However, if the valves in the testicular vein fail to function properly, gravity can cause blood to get collected in the scrotum, resulting in a varicocele.

To put it simply, a varicocele is a dilation of the veins that surround the testicle:

  • It is a common condition that affects about 15 to 20 percent of men.
  • A varicocele is most commonly found on the left side, but it can be bilateral (on both sides) in 30 percent of men.
  • A right-sided varicocele is uncommon and should be evaluated as soon as possible to rule out other causes.
  • There is no connection to other defects, ethnicity, or place of birth. Although a varicocele is frequently found in men who are tested for infertility, 8 out of 10 men with varicoceles do not have fertility issues.

There are numerous theories as to why varicoceles occur, which may be caused by four factors, including:

  1. In the upright position, the left internal spermatic vein is 8 to 10 cm longer than the right and acts as a hydrostatic column with increased pressure.
  2. Left spermatic veins have 40 percent fewer valves than right veins, whereas right spermatic veins have 23 percent fewer valves than left veins.
  3. Nutcracker phenomenon: The left renal vein is compressed between major blood vessels, resulting in increased pressure in the left internal spermatic vein.
  4. Swollen lymph nodes or other masses behind the stomach can occasionally obstruct blood flow. This can cause scrotal veins to swell unexpectedly. This is frequently excruciating.

The primary cause of a varicocele is unknown to medical professionals. Doctors agree that the condition develops when there is a problem with blood flow in the spermatic cord.

The issue arises when the valves in the veins fail to function properly, allowing blood to flow back. As a result, blood pools in the veins and dilates them. Although the condition is most common in adults, it can develop in adolescents during puberty.

During this growth cycle, the testicles usually require more blood than usual. This condition can cause vein problems, preventing blood from flowing where it should. This does not occur in a single day or two but rather over time.

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How to diagnose a varicocele

A varicocele rarely manifests clinically before early adolescence. It is not thought to regress once it is present. The diagnosis of a varicocele is an important step in the treatment process.

A varicocele is diagnosed in four ways:

  1. Self-diagnosis:
    • Many boys and men are aware that they have a varicocele because they can feel a mass of dilated veins in their scrotum. Usually, it looks like a sack of worms or spaghetti.
    • Moreover, men may notice that the testicle on that side is smaller. Because there are so many veins on the varicocele side, the scrotum may appear larger.
    • When the testicle is felt, it is smaller than the one on the opposite side. Men may notice discomfort in that testicle or on that side of the scrotum.
  2. Physician’s diagnosis:
    • A varicocele can be diagnosed during a physical examination. It is most noticeable when a man is standing, and it will feel like a bag of spaghetti.
    • It may vanish when the man lies down (as the weight of the blood and veins is no longer pushing down past the malfunctioning valves into the scrotum).
      • Valsalva technique: The physician may ask the man to bear down while standing (like he is having a bowel movement). When blood pushes back into the scrotum due to increased pressure inside the abdomen, the physician may feel an impulse.
  3. Doppler studies:
    • The sound of blood moving past a Doppler stethoscope is amplified. Only the artery's pulsing should be audible at rest
    • Blood flow in the veins is so sluggish that in the normal testis, no venous sound is produced. In cases of a varicocele, more blood runs back into the scrotum when the man presses down, creating a rushing sound.
  4. Ultrasound:
    • Duplex ultrasound is currently regarded as the best non-invasive method to detect or confirm the presence of a varicocele and consists of two parts:
      • A thorough ultrasound of the testis is performed first. The veins' diameters can be measured. Other abnormalities may be discovered. Almost one-third of men with infertility had an abnormal ultrasound finding that was not suspected during the physical examination.
      • The blood that flows past the probe when the man pushes down is measured in the second part of the ultrasound evaluation. This blood flow confirms the presence of a varicocele. This blood flow can be seen in color as well as heard.

Because a varicocele can have varying degrees of severity and can affect your sperm health, a thorough evaluation must be performed.

How to treat a varicocele

If the man is asymptomatic or has mild symptoms and infertility is not an issue, the condition can be managed by wearing an athletic supporter or snug-fitting underwear to provide support to the scrotum.

If the varicocele causes pain or atrophy, damages the testicle(s), or causes infertility, surgery may be recommended.

The majority of varicoceles can be corrected surgically through a procedure known as varicocelectomy (surgically “tying off” the affected spermatic veins), following these three methods:

  1. Surgical ligation (tying off):
    • General or regional anesthesia is usually required. A two- to three-inch incision is made in the groin or lower abdomen, the affected veins are visually located, and the surgeon cuts and ties the veins off above the varicocele to reroute the blood through unaffected veins.
    • A translingual (groin) incision is most commonly used, whereas a retroperitoneal (lower abdomen) incision is used in men who have scar tissue from a previous varicocelectomy or hernia repair.
    • Surgery can be done as an inpatient or as an outpatient procedure. Light activity can usually be resumed within a week, and strenuous activity can be resumed in about six weeks.
  2. Embolization:
    • It is a non-surgical procedure that takes about an hour and a half to complete. To stop the flow of blood to the varicocele, a catheter (small tube) is inserted through a small incision in the groin.
    • Venography is used to visually guide the catheter and highlight the varicocele on an X-ray. The catheter is then used to insert tiny coils into the dilated vein to block blood flow. This relieves pressure, reduces swelling, and restores normal circulation.
    • During the procedure, light sedation (also known as twilight anesthesia) is used; the man does not lose consciousness.
    • Stitches aren't required. Generally, normal activity is resumed within two days.
  3. Laparoscopy:
    • Through a small incision, the surgeon inserts a tiny camera attached to a long cylindrical tube into the abdominal cavity.
    • After locating the varicocele with the camera, the surgeon inserts other instruments through the same incision to isolate and tie off the dilated veins.
    • This technique, which is less invasive than surgical ligation, requires a smaller incision.
    • The laparoscope can occasionally damage abdominal organs, which is not a risk factor in open surgery.
    • The procedure lasts about two hours, and the recovery time is about two days.

Common side effects

  • Recurrence (the varicocele comes back)
  • Hydrocele (fluid accumulating around the testicle)
  • Damage (to the testicular artery)
  • Loss of testicle (extremely rare)
  • Bruising at the entry site
  • Mild backache
  • Nausea

When a lump is discovered in a testicle, it should be evaluated right away. Numerous urologic conditions can cause a lump or swelling, which can be treated once properly diagnosed.

Most of the time, these are harmless conditions that, once treated, may no longer be of concern. However, the condition must be evaluated to rule out more serious conditions such as testicular cancer.

If you find a lump in your testicle, consult your doctor or urologist right away.

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Medically Reviewed on 12/7/2021
References
Image Source: iStock Images

Varicoceles: https://www.urologyhealth.org/urology-a-z/v/varicoceles

Varicoceles in Children: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=160&contentid=61

Varicoceles: Overview: https://www.ncbi.nlm.nih.gov/books/NBK279346/

Varicoceles: https://www.bsir.org/patients/varicoceles/