Are you, or someone you love, affected by varicoceles?  Do you want to know more about varicoceles (like, what the heck are they?), but are afraid to ask?  Look no further!  We’ve got it covered.  Read here for answers to the most common questions about varicoceles. 

What is a varicocele?

A varicocele is a collection of enlarged small veins in a man’s scrotum.  It occurs next to and above one or both testes.  A varicocele is similar to a varicose vein in the leg.  

Varicoceles most often occur in the left scrotum, but can occur on both sides and rarely in just the right side. The reason why they occur most often on the left-hand side may be explained anatomically. The left spermatic vein is one of the longest veins in a man’s body.  The surrounding structural and vascular anatomy cause there to be increased pressure in the left spermatic vein.  This increased pressure in a long vein can, in some men, cause the vein to dilate or enlarge.  When this happens, the valves in the pampiniform plexus of spermatic veins (the collection of small veins in the scrotum) are not able to close completely, causing the blood to flow back toward the testis.  

What?  I have valves in my veins?  

Yes!  Veins, or blood vessels, have valves to help the deoxygenated blood get back to the heart.  Valves have 2 flaps that act like a gate, opening in one direction.  They are located throughout the vein and open when activated to allow blood through. Then, the valves snap shut to stop the back flow of blood.  The valves must close all the way to prevent the back flow of blood.  If they do not, blood can pool and cause a varicose vein.

Why do varicoceles form? 

When the scrotal veins become larger or dilate, the valves of the small veins in the scrotum are unable to fully close and therefore do not function well. 

If these valves do not work well, blood can flow backwards, due to gravity, and pool in the lower parts of the vein to form a varicocele.  

Why is this happening to me? 

Varicoceles are actually quite common.  They are present in up to 15-20% of adult men.  They generally first appear at puberty, and may get larger with time.  It is not known why some men are more likely to get varicoceles than others.

Why are varicoceles more noticeable when I stand up?

Varicoceles are typically more noticeable, whether it’s a slight fullness in the scrotum or a more defined, soft mass, when standing up or straining or coughing.  The reason for this is that in veins where the valves are not working well, gravity and increased pressure from straining can cause the blood in the scrotal veins to pool.  Often, when a man lays down, the varicocele is undetectable.  

What are the symptoms of a varicocele?

Many men who have varicoceles will not have symptoms.  But, some, unfortunately will.  Here are the possible symptoms:

• Dull aching.  This pain usually occurs in the left scrotum, and is typically noticeable when standing and relieved when laying down. 
• Testicular atrophy, or shrinking of the testicle.  It is believed that the slight increase in scrotal temperature in patients with varicoceles may cause cellular death of the testis, which causes the testis to shrink. 
• Decreased fertility.  It is still not fully understood why men with varicoceles have a higher risk of infertility, and there may be other factors involved, it is true that a large number of infertile men are found to have a varicocele.

What is the treatment for varicoceles?

For men who do not have symptoms, no treatment is necessary.

But for men that do experience symptoms, here are the treatment options:

• Conservative treatment with scrotal support and anti-inflammatory medication may suffice for an older man who has completed his family and who presents with minor scrotal discomfort as his only symptom.  
• Surgery.  Surgical treatment involves ligating, or tying off, the spermatic vein so that black flow of blood can no longer pool in the small vessels in the scrotum.
• Venous embolization.  Venous embolization is an alternative to surgery, where a special substance is injected into the affected veins to divert blood away from the varicocele. 

What are the advantages of choosing varicocele embolization over surgery?

Varicocele embolization is a non-surgical treatment.  It has less risk (less bleeding, infection), less discomfort and the recovery time is quicker than surgery. 

Does varicocele embolization hurt?

There is usually  minimal discomfort with varicocele embolization.  

A local anesthetic (numbing medicine) is injected into the skin where the small incision is made.  You may feel slight pressure when the catheter is inserted, but no serious discomfort.

Can a varicocele come back after treatment?

Possibly. In approximately five to 10 percent of patients who undergo varicocele embolization, the varicoceles return. This rate of varicocele recurrence is similar to the rate reported for more invasive surgical procedures.

If you are experiencing symptoms or would like to discuss treatment for your varicocele, contact us.  Our physicians will meet with you and discuss a treatment plan that’s right for you.