A testicular varicocele is a common but often unnoticed condition that can significantly impact male fertility. It is characterized by enlarged veins in the scrotum, similar to varicose veins in other parts of the body. This condition can cause discomfort, testicular shrinkage, and, most importantly, hinder the production of healthy sperm.
This article explains what a testicular varicocele is, the symptoms, the connection to infertility, the available treatment options, and when to seek medical care.
What is Testicular Varicocele?
A varicocele refers to the swelling of the veins that transport oxygen-depleted blood away from the testicle, located within the scrotum.
Under normal conditions, two arteries (one for each testicle) provide the testicles with oxygen-rich blood. Two testicular veins return the blood to the heart once depleted of oxygen. Along with these larger testicular veins, the scrotum contains many small veins forming the pampiniform plexus network. This network acts as a conduit between the testicle and the testicular vein. A varicocele happens when blood pools in the vessels of the pampiniform plexus, causing the vessels to dilate.
Cause and Risk Factors
The exact cause of varicoceles is unknown, but they are believed to occur when the valves within the veins prevent proper blood flow. This results in pooling, which causes the veins to dilate. Varicoceles often form during puberty and are more common on the left side, probably due to the position of the left testicular vein.
Symptoms and Diagnosis
Many men with varicoceles are asymptomatic and may discover the condition during a fertility evaluation or routine physical exam. Symptoms, if present, include a lump in the testicle, testicular discomfort, or swelling.
When to Seek Medical Attention
Given its potential impact on male fertility, those planning to father children, should seek medical evaluation if they notice any discomfort, lump, or swelling in the testicle.
What to Expect
Medical evaluation involves a physical examination where doctors can often feel a varicocele during a routine physical exam. However, smaller varicoceles might be detected only with an ultrasound, which can precisely determine the presence and size of a varicocele.
Testicular Varicocele and Infertility in Men
Varicoceles can lead to infertility by reducing the quality, quantity, and motility of sperm. They can also lead to testicular atrophy or shrinking. Approximately 10% to 20% of men have a varicocele, and among infertile men, this increases to 40%.
Varicoceles treatment is unnecessary unless there is pain, testicular atrophy, or infertility. Treatment options include over-the-counter pain relievers, supportive underwear, or surgical intervention, which can often improve sperm numbers and function. Lifestyle modifications like wearing looser clothing, avoiding strenuous activities, or taking cold baths can also help.
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