Varicoceles are veins that become enlarged inside the scrotum of men – comparable to developing a varicose vein in a leg.  The scrotum is a sac that holds the testicles and is part of the male reproductive system that makes, stores, and moves sperm.  The testicles make sperm and the hormone testosterone.  Sperm that are in the process of maturing will move through the epididymis, a coiled tube behind each testicle.

What are varicoceles?

To understand varicoceles, it is important to know that there is a group of connected veins that drain blood from the testicles called pampiniform plexus.  The pampiniform plexus purpose is to help cool the blood in the testicular artery before warm blood enters the testicles preventing it from harming sperm.

If the pampiniform plexus veins in the scrotum become enlarged, this is known as varicoles.  During puberty is when most varicoceles can form becoming larger and easier to notice. They tend to be more common on the left side of the scrotum, however in rare circumstances they can exist on both sides at the same time.  Around 10 to 15 males out of 100 have a varicocele. 

The majority of the time varicoceles are harmless causing no problems. 

Symptoms of varicoceles

Usually there are no symptoms of varicoceles.  However, they may cause infertility and slow growth of the left testicle during puberty.  For about 4 in 10 men they can be the reason of fertility problems in men.  In men who have been tested for fertility often have varicoceles, but 8 out of every 10 men who have them do not have fertility issues.

Causes of varicoceles

There can be a variety of reasons why a man may have varicoceles:

·Valves in the veins may not be working well

·If blood flow is sluggish, blood may pool in the veins

·In rare cases, swollen lymph nodes or other abnormal masses behind the abdomen may be blocking blood flow

Diagnosing varicoceles

The most common way of diagnosing varicoceles is through self-examination of the scrotum or during a routine doctor’s visit.  Many describe varicoceles by how they look and feel as a “bag of worms.”

In order for a urologist to find the enlarged veins of varicoceles, a man will stand and be asked to take a deep breath holding it and bearing down while the doctor feels the scrotum above the testicle. 

 An ultrasound may be ordered to help find the veins which are usually wider than 3 millimeters.

Treatment of varicoceles

In most cases, varicoceles are left untreated as there are no medications to treat or prevent them.  But treatment may be offered to man who are having fertility problems, pain or if the left testicle is growing more slowly than the right in a child. If a man is having pain then pain killers such as acetaminophen or ibuprofen may be offered.

It is believed that boys with a smaller testicle may have a higher risk of fertility problems when they are older.