What Is Varicocoele?
This is a condition in men where one (or rarely both) of the testicles becomes enlarged due to the veins around it becoming enlarged and dilated - similar to varicose veins in effect, but on a much smaller scale.
What Causes Varicocoele?
The testicular veins within the scrotum become engorged due to blood flowing back from the renal veins around the kidneys, or from pressure on them from the testicular artery in the scrotum. It can also occur temporarily in otherwise healthy adolescents.
What Are The Signs And Symptoms Of Varicocele?
Many men are unaware they have a varicocoele. There may be a sensation of pain or aching in the scrotum, as the testicle pulls down on the spermatic cord - sometimes described as a 'heaviness' in the scrotum.
They are most easily felt when standing, especially after a warm bath. They have been described as 'feeling like a bag of worms' behind the scrotum, and more commonly affect the left side. The scrotum usually hangs lower on the affected side (the left testes hangs lower than the right normally in 85% of men anyway), and straining makes the veins become more prominent. Lying down makes it more difficult to feel a varicocele.
Will I Have Any Tests Or Investigations?
The diagnosis is usually obvious from the clinical examination and no specific tests are usually needed. It may become apparent only when a man attends their doctor because of fertility problems.
What Treatment Might I Need?
There is an ongoing debate between fertility specialists and urologists as to how relevant varicocoeles are in causing fertility. It is felt that they raise the testes' temperature slightly and so may damage sperm production, since optimum sperm production occurs at a temperature 3 or 4 degrees cooler than the rest of the body.
Tying off (ligation) of the testicular veins is sometimes performed to try to improve a mans sperm count as a consequence of this, but there is little hard statistical evidence to prove this works. It remains a popular treatment in infertile men however, with the procedure being called a varicoloelectomy.
What Course Will The Illness Follow?
Unless infertility or discomfort is a problem, many men with a small varicocoele will need no treatment. As a general rule however, most varicocoeles will slowly get bigger over time and will eventually require surgery, sometimes in old age.
Can I Do Anything To Help Myself?
Proper scrotal support is important - wear a jockstrap rather than boxer shorts. If you are concerned about a lump in your scrotum, always get them checked by your doctor. Remember that testicular cancer usually feels firm or hard rather than soft.
Tell Your Doctor
1. How long have you noticed your symptoms?
2. Have you been trying to start a family for a long time with no effect?
3. Do you think your testicles are enlarging?
4. Are your symptoms worse when you are standing?
5. Do you have any other problems such as passing water or sexual difficulties?
Ask Your Doctor
1. Will I need an operation?
2. Do I need any treatment at all?
3. Will exercise make it worse?
4. Are my sons more at risk of developing the same problem?
5. Does it make it more likely I will develop testicular cancer?