You've heard of varicose veins — those swollen veins that sometimes show up in the legs. You've probably heard your grandma and her old lady friends talking about their varicose veins and never thought twice about them.
But hopefully you've never heard your grandma mention a varicocele, which is also a swelling of the veins. A varicocele happens just to guys, and you probably won't sit around and talk about it with your pals. That's because it occurs not in the legs but in a place a bit more private and a lot more tender — the scrotum. It's generally harmless and basically the same kind of thing as varicose veins in the legs. But what exactly is a varicocele and how do you get rid of it?
What Is a Varicocele?
In all guys, there's a structure that contains arteries, veins, nerves, and tubes — called the spermatic cord — that provides a connection and circulates blood to and from the testicles. Veins carry the blood flowing from the body back toward the heart, and a bunch of valves in the veins keep the blood flowing one way and stop it from flowing backward. In other words, the valves regulate your blood flow and make sure everything is flowing in the right direction.
But sometimes these valves can fail. When this happens, some of the blood can flow in reverse. This backed-up blood can collect in pools in the veins, which then causes the veins to stretch and get bigger, or become swollen. This is called a varicocele (pronounced: var-uh-ko-seel).
Who Gets Them?
Although they don't happen to every guy, varicoceles are fairly common. They appear in about 15% of guys between 15-25 years old, and they mostly occur during puberty. That's because during puberty, the testicles grow rapidly and need more blood delivered to them. If the valves in the veins in the scrotum aren't functioning quite as well as they should, the veins can't handle transporting this extra blood from the testicles. So, although most of the blood continues to flow correctly, blood begins to back up, creating a varicocele.
An interesting fact is that varicoceles occur mostly on the left side of the scrotum. This is because a guy's body is organized so that blood flow on that side of the scrotum is greater, so varicoceles happen more often in the left testicle than the right. Although it's less common, they can sometimes occur on both sides.
What Are the Signs and Symptoms?
In most cases, guys have no symptoms at all. A guy might not even be aware that he has a varicocele. However, if there are symptoms, they tend to occur during hot weather, after heavy exercise, or when a guy has been standing or sitting for a long time. Signs include:
- a dull ache in the testicle(s)
- a feeling of heaviness or dragging in the scrotum
- dilated veins in the scrotum that can be felt (described as feeling like worms or spaghetti)
- discomfort in the testicle or on that particular side of the scrotum
- the testicle is smaller on the side where the dilated veins are (due to difference in blood flow)
What Do Doctors Do?
It's a good idea to get a testicular exam regularly, which is normally part of a guy's regular checkup. In addition to visually checking for any unusual lumps or bumps, the doctor generally feels the testicles and the area around them to make sure a guy's equipment is in good shape and there are no problems.
A testicular exam may be done while a guy is standing up so that the scrotum is relaxed. (Some abnormalities like a varicocele can be more easily felt in a standing position.) The doctor checks things like the size, weight, and position of the testicles, and gently rolls each testicle back and forth to feel for lumps or swelling. The doctor also feels for any signs of tenderness along the epididymis, the tube that transports sperm from the testicles.
The spermatic cord is also examined for any indication of swelling. If the doctor suspects a varicocele, he or she might confirm suspicions by using a stethoscope to hear the blood flowing backward through the faulty veins or might even use an ultrasound, which can identify malfunction of the veins and also measure blood flow.
Do Varicoceles Cause Permanent Damage?
Although there is no way to prevent a varicocele, it usually needs no special treatment. A varicocele is usually harmless and more than likely won't affect a guy's ability to father a child. Some experts believe, though, that in some cases a varicocele might damage the testicle or decrease sperm production. In those cases, a doctor will probably recommend surgery.
What If the Doctor Finds a Varicocele?
Varicoceles are generally harmless, but if there is any pain and swelling the doctor may prescribe an anti-inflammatory medication to relieve it. If the varicocele is causing discomfort or aching, wearing snug underwear (like briefs) or a jock strap for support may bring relief. If pain is persistent and support doesn't help, the doctor may recommend a varicocelectomy (a surgical procedure to remove the varicocele).
A varicocelectomy is done by a urologist (pronounced: yoo-rah-luh-jist), a doctor who specializes in urinary and genital problems. The procedure is usually done on an outpatient basis (meaning there's no need for an overnight stay in hospital). The patient usually receives general or local anesthesia. Then, the doctor simply ties off the affected vein to redirect the flow of blood into other normal veins.
In some cases, instead of surgery, doctors can pass a plastic tube into the vein that's causing the varicocele and treat the problem by causing a blockage in the blood flow to the enlarged vein. Talk with your doctor about whether this form of treatment might be an option for you.
After surgery, the doctor probably will recommend that a guy wears a scrotal support and places an ice pack on the area to bring down any swelling. There may be discomfort in the testicle for a few weeks, but after that, any aches and pains will go away and everything should be back in full working order.
Reviewed by: Steven Dowshen, MD
Date reviewed: February 2009