Varicocele – your go-to guide

Ever heard of varicocele? If you haven’t, don’t worry, you’re not alone. Despite being pretty common, the condition is not often spoken about or understood – until you find yourself in a doctor’s room being told you have one. 

Whilst varicoceles don’t usually call for concern, they can sometimes impact your fertility. That’s why it’s good to know what to look out for and what to expect if you develop one.

Here we’ll run through what varicoceles are, what risks they pose, and what treatments are available. 

So, what is a varicocele? 

The scrotum holds the testes and the epididymis – the tube which transports sperm. If you’ve read our blog “Testicle Temperature: How Heat Impacts Fertility” you’ll know that for optimum sperm production, testes need to have a temperature of 2-4°C lower than body temperature. Part of this is down to the pampiniform plexus – which is a network of veins surrounding the testicles and the epididymis. The pampiniform plexus acts through a “heat exchange” mechanism to cool down the scrotum.

A varicocele is when the pampiniform plexus becomes enlarged. It’s a condition which affects approximately 1 in 6 men (15%). A varicocele will usually be found on the left side of the scrotum, but can be on both sides or, in rare cases, just the right side.

What are the causes?

Varicoceles generally form during puberty when the testicles need a lot of blood flow for rapid maturation.

Experts currently think this is due to a defect in the valves which stops the regular blood flow to and from the testicles. This can then cause the blood to pool or flow backwards and cause a swell. 

Since they usually happen during puberty and are down to a random defect, there’s no sure way to prevent a varicocele. There’s also no link between varicoceles and any specific ethnic group or medical condition, so predicting who will develop varicoceles is near impossible.

That being said, hypertension and being overweight both increase the risk of blood pooling. Varicoceles usually come on between the ages of 15-25, but there’s a chance of developing one later in life. Keeping physically active and following a good diet can limit your chances of developing high blood pressure, which is good for your heart and lungs, as well as your balls!

What are the symptoms? 

The common symptoms of varicoceles:

• swelling in the scrotum
• visibly twisted and enlarged veins in the scrotum, which can look like a bag of worms.

And less common:

• a lump in one of the testicles
• a dull pain in the scrotum

While most cases of varicocele happen between ages 15-25, it’s still important to practice regular self-examinations no matter your age. If you do feel changes or swelling of the veins, your doctor can diagnose a varicocele with a physical examination of your testicles, or a scrotal ultrasound. The ultrasound gives the doctor more detailed information about the varicocele, including its size.

Unusual changes in appearance or feel (especially in the testicles!) can’t go ignored and need to be reported to the doctor. 

Can varicoceles impact my fertility? 

The sad truth is yes, they can. While most men with a varicocele do not experience fertility issues, around 1 in 3 infertile men do have a varicocele.

Sperm production is all about balance and keeping the perfect conditions. So when the veins needed to regulate heat are swollen, it can get too hot for proper sperm production. Research shows that men with a varicocele often have lower sperm concentration and sperm quality, and that this gets worse with time as the varicocele increases in size. 

Varicoceles may also impact testosterone production, and lead to lower T levels. This isn’t always a concern for fertility or overall health, but lower testosterone levels can cause erectile dysfunction and fatigue among other issues. You can read more in our blog “Low Testosterone, Symptoms and Impact on Fertility” to learn more.

How can I be sure a varicocele isn’t impacting my fertility?

Since most varicoceles don’t cause serious pain, they go untreated or ignored after a diagnosis. This means if you’re living with a varicocele, you could be subfertile or even infertile without knowing it!

Without treatment, varicoceles won’t go away and can get progressively worse with age. This means it’s really important to keep an eye on your sperm health if you have varicoceles, especially if you’re currently trying to conceive.

An ExSeed home-test kit makes it easier than ever to monitor your sperm health. Not only can you test from the comfort of your home, but you can also receive detailed results of your sperm count and quality. ExSeed provides expert guidance to improve your fertility through lifestyle changes, and also offers support through the difficult journey of infertility.

Is there treatment that can help?

Most of the time, varicoceles aren’t something to worry about. Minor painkillers can usually manage any pain or discomfort. But if varicoceles are causing more serious pain or fertility issues, then there are options available for treatment:

Embolization. The doctor will insert a small needle into the varicocele to temporarily cut off the blood supply. It’s performed under local anaesthesia, so the patient is awake but won’t feel any pain. The procedure has a very easy and quick recovery, usually without much pain other than tenderness.

Embolization has a failure rate of around 3.2% to 18.9%, and is largely dependent on which side the varicocele is on. 

There’s also the option of microsurgery:

Varicocelectomy. Like embolization, a varicocelectomy blocks off the blood supply to the vein. A doctor will put the patient under general anaesthetic. There are just a few days of pain or tenderness during recovery. 

The good thing about surgery is it has a failure rate of less than 5%, and has been successful in increasing fertility for men suffering infertility due to varicocele. 

Conclusion?

Varicoceles are pretty common but almost always start during puberty. So if your squeaky voice and acne phase is a distant memory, developing a varicocele is unlikely. But, it’s not impossible! Take care of your blood pressure by avoiding cigarettes, keeping physically active, and managing your emotional stress. 

If you have a varicocele and are worried about your fertility health, then an ExSeed sperm analysis is just one delivery away.