Understanding Varicoceles: A Common Cause of Testicular Pain and Infertility

What is a Varicocele and Why Does It Happen?

The veins in the scrotum, like all veins, contain one-way valves that help blood flow back toward the heart. When these valves fail, blood can pool in the veins, causing them to stretch and enlarge. This collection of enlarged veins is a varicocele. They most commonly occur on the left side, likely due to the position of the left testicular vein.

Symptoms of a Varicocele

Many varicoceles cause no symptoms and are harmless. However, when symptoms do occur, they can include:

• A dull, aching pain or discomfort in the scrotum, which often worsens over the course of the day or with long periods of standing.
• A feeling of heaviness in the testicle.
• A visible or palpable mass of twisted veins, often described as feeling like a "bag of worms."
• A noticeable size difference between the testicles (the affected testicle may be smaller).

The Link to Infertility and Low Testosterone

Varicoceles are a common cause of male infertility. The pooling of blood raises the temperature within the scrotum. The testicles require a slightly cooler temperature than the rest of the body to produce sperm and testosterone efficiently. The increased heat can:

• Impair Sperm Production: Leading to a lower sperm count, poor sperm movement (motility), and a higher number of abnormally shaped sperm.
• Reduce Testosterone Levels: Over time, the increased temperature can also impair the function of the Leydig cells in the testicles, which are responsible for producing testosterone.

Diagnosis and Treatment

A varicocele is typically diagnosed through a physical examination. Our specialist can often feel the enlarged veins, especially when you are standing. In some cases, a scrotal ultrasound may be ordered to confirm the diagnosis and assess the extent of the varicocele.

Treatment is not always necessary. If the varicocele is not causing pain, testicular atrophy, or fertility issues, it may be monitored. If treatment is needed, the options are surgical (varicocelectomy) or a minimally invasive radiological procedure (percutaneous embolization), both of which aim to block off the affected veins and redirect blood flow through healthier vessels.