If you’ve ever heard of varicose veins, the visible blue or purple enlarged and swollen veins often appearing on people’s legs, then varicoceles shouldn’t be too hard to understand. They are similar to varicose veins, though these enlarged and swollen veins happen on the scrotum, the loose area of skin that houses the testicles.
Sometimes, varicoceles can cause both reduced sperm count and sperm quality, which can lead to infertility. Other times, varicoceles don’t affect sperm production at all. Other Varicoceles can also cause sperm to fail to develop properly or shrink in size.
In the majority of cases, varicoceles develop slowly and are diagnosed easily. Many times, cases do not even require treatment. Treatment becomes necessary only when symptoms develop. In these cases, surgery can often fix the issue.
Varicoceles affects about 15 percent of men. It’s not usually considered a serious condition because of how treatable it is. This is especially true in non-severe cases or those that don’t affect fertility. When men discover they have issues with infertility, around 30-40 percent are caused by varicoceles.
Men with varicoceles often worry about how it will impact their sex lives. Varicoceles typically do not lower a man’s sex hormones, so it has little to no effect on a man’s sex drive. It also has very little association with erectile dysfunction. Still, if you notice enlarged or swollen veins on your scrotum, talk to your doctor about it as soon as you can. If treatment is necessary, the sooner you get it, the better. It’s worth the initial awkward conversation to have a healthy sex life.
The Individual Elements of Varicoceles
Blood arrives to and leaves from the testicles by way of what is called the spermatic cord. The cause of the enlarged veins in the scrotum that are varicoceles is still uncertain. Experts have a key theory, though. They believe varicoceles form when the valves inside the spermatic cord keep the blood from flowing in and out the correct way. This can lead to backup, in turn causing the veins to get wider.
Most often, varicoceles begin to form during puberty. They are more common on the left scrotum as a result of the positioning of the left testicular vein. No significant risk factors for developing a varicocele has been identified to date.
Symptoms of Varicoceles
It is not that common that a varicocele will produce obvious symptoms. However, in rare cases, they can cause pain. The pain can consist of:
• discomfort that varies from dull to sharp
• increased pain when standing up or with physical activity, specifically lengthy physical activity
• the pain gets worse throughout the course of the day
• pain relief occurs by lying face-up
Other symptoms of varicoceles include:
• decreased fertility
• noticeably enlarged or swollen veins on the scrotum (some describe their appearance as looking like worms)
• a swollen testicle, most often on the left side
Unless you’re experiencing pain, varicoceles don’t usually require treatment. Many people discover they have varicoceles during fertility exams or other regular exams, not from any symptoms they noticed on their own.
That being said, if you experience swelling or pain or notice that your testicles are clearly different sizes, it’s time to see a doctor for potential varicoceles. Also, issues with fertility could be caused by varicoceles. A visit to the doctor is recommended in this case as well. Regardless, many different conditions can cause pain in the scrotum and testicles. Some of them require treatment as soon a possible.
Treatment
If your case of varicoceles is more severe, treatment will likely be necessary. Still, lots of men with this condition can produce the sperm to have children without the need for treatment. Treatment tends to be necessary only when the condition causes pain, progressive testicular shrinkage, or because of infertility.
Treating varicoceles with surgery will close off the vein or veins that have been affected. Then, they redirect the blood flow. Treatment can often lead to improved or completely restored fertility. It can also improve sperm quality. Varicocele treatment comes with few risks. They include:
• infection
• artery damage
• more varicoceles in the future
• fluid buildup around the testicles
There are a couple of different kinds of surgery and treatment for varicoceles. Open surgery involves a surgeon entering the vein by way of the groin with the use of a general or local anesthetic. Post-surgery, at least two weeks of rest from straining activities is recommended. Around three months after the surgery, new sperm will begin to develop. At this point, sperm quality will likely improve. Open surgery has a high success rates. Laparoscopic surgery is another option, one that requires a general anesthetic. A surgeon will make a tiny incision in the patient’s stomach to go in and repair the varicocele.
Percutaneous embolization is one more treatment option. A radiologist puts a tube into your groin to view the enlarged veins. Then, a doctor inserts coils or another type of solution to block offnearby testicular veins. The idea is to stop the blood flow to the varicoceles so they can repair themselves.
Percutaneous embolization is a much less common treatment option. However, it is equally effective at reducing or curing infertility and costs about the same. The Society of Interventional Radiology calls it a treatment that could and should be used more frequently. Recovery time takes only a couple of days on average. Remember that treatment through surgery includes weeks of recovery time.
Sexual Wellness and Varicoceles
Most cases of varicoceles don’t interfere with a man’s testicular function or sex life. However, in severe cases that often cause pain, erectile dysfunction, and/or infertility, treatment is necessary to remedy these issues. These situations can affect a man’s sex life in significant ways. The stress caused from infertility can be a lot to handle, both for the man with varicoceles and his partner. It can put a strain on the relationship. Infertility can also cause personal issues with self-esteem, which can eventually lead to depression if not dealt with. Talking openly with your partner about how you feel can help ease those feelings. Otherwise, talking to a therapist might also provide the insight needed to get over infertility-related self-esteem issues.
If you and your partner are having trouble getting pregnant, even if no other symptoms are noticed, varicoceles could be the cause. Seeking diagnosis and treatment from a doctor then becomes necessary. Luckily, treatment for varicoceles is not uncommon and often very successful. Plus, it can make all the difference in a healthy sex life, especially for couples actively looking to have children.
Additionally, if a varicocele does cause pain, this can make having sex painful or uncomfortable and ultimately lead to a diminished sex life. Even though conversations with a partner about genital discomfort or pain can be difficult, they should not be avoided. Otherwise, this can put even more unnecessary strain on the relationship. Make it a priority to keep communicating with your partner about what is going on despite any potential awkwardness. Most partners will be grateful about your openness and happy to provide the support you may need, both physically and mentally.
Summing Up
Most cases of varicoceles are mild and require no treatment. That means they tend to go unnoticed and don’t get in the way of a healthy sex life. Regardless, it is always important to take care of your body by making note of anything out of the ordinary that could lead to more serious issues. Regular checkups with a doctor can contribute to maintaining good sexual health as well. If you begin to notice pain in the scrotum or that region in general, it could be a varicocele. Speaking with your doctor about it sooner than later tends to lead to better outcomes with both pain and fertility overall.
Sources
Mayo Clinic Staff. Varicocele. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/varicocele/symptoms-causes/syc-20378771
University of Iowa Hospital and Clinics. Varicoceles. University of Iowa Health Care, 2017.
https://uihc.org/health-topics/varicoceles
Keller, J. et al. Varicocele Is Associated with Erectile Dysfunction: A Population‐Based Case‐Control Study. The Journal of Sexual Medicine, 2012. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1743-6109.2012.02736.x
UCSF Department of Radiology and Biomedical Imaging. Nonsurgical Treatment for Male Infertility Caused by Varicoceles.
https://radiology.ucsf.edu/patient-care/sections/ir/advanced-services/varicocele
Jess Lakritz 