Have you ever felt something like a ball of thread or a few small worms inside your scrotum? Or do you sometimes feel a slight heaviness or pulling pain in that area? This condition, which occurs in many men, especially in their youth, is called Varicocele in medical science. Don't be scared when you hear this name. It's not that serious. But it's very important to know exactly what it is. So today we'll talk about it all, very simply, in a way that you can understand.
Simply put, what is Varicocele?
Varicocele is a condition in which the veins inside your scrotum, the veins that carry dirty blood, become swollen, enlarged, and twisted. To be precise, you must have seen some of our legs have twisted veins, right? We call it `(Varicose veins)`. The same condition occurs inside the scrotum.
Normally, there is a network of small veins that carry dirty blood from our testicles back to the heart. Inside these veins are small valves. It's like a valve in a water pipe that only lets water flow in one direction. The job of these valves is to stop the blood from flowing back down after it has gone up. But sometimes when these valves don't work properly, the blood flows back down and collects in those veins. Over time, this blood collects and the veins swell, stretch, and become knotted like a ball of string. That's what we call a Varicocele.
Most of the time, this doesn't cause much pain . However, some people may feel a slight pulling or heaviness at times, such as when working or exercising and standing all day. The pain usually subsides when they lie down.
The important thing is that Varicocele is not a life-threatening condition. However, in some cases, it can affect your ability to have children. Therefore, it is very important to be aware of this.
What is the relationship between Varicocele and fertility?
Yes, this is a question that many people ask. There may be a link between the condition of Varicocele and infertility. In fact, it has been found that about 40% of the causes of male infertility are related to Varicocele. But that does not mean that everyone with Varicocele cannot have children. Most people with Varicocele have children without any problems.
Doctors still don't know exactly how a varicocele affects fertility. But the main idea is this. When the veins inside the scrotum fill with blood, the temperature in that area increases slightly above normal. Our testicles are located outside the body, hanging down. This is because they need a slightly cooler temperature than normal body temperature to produce sperm.
So when the temperature around the testicles increases due to varicocele, it can interfere with the sperm production process. It can reduce sperm count, reduce sperm motility, or change the shape of the sperm. All of these can affect the ability to conceive a child.
If you are married, expecting a baby, and think you have a Varicocele, definitely see your doctor and talk about it .
How common is this? What are the symptoms?
This is actually a very common condition. On average, between 15% and 20% of men, or about 1 in 5 men, may have a Varicocele.
Most often, this occurs in the left testicle . This is due to a small structural difference in the way the vein that carries blood from the left testicle is connected to the left side of our body. However, it can rarely occur on the right side or on both sides.
Most people don't have any symptoms. It's often discovered incidentally during a medical test for something else. However, some people may experience the following symptoms:
| Symptom | Description |
|---|---|
| Pain or discomfort | A dull, aching pain that comes from inside the scrotum. This pain can be especially intense when you stand for long periods of time, exercise, or lift heavy objects. It usually subsides when you lie down. |
| A knot that gets caught in the hand | Above the scrotum, under the skin, you may feel something that looks like worms or a ball of string. Doctors call this a "bag of worms." |
| Swelling of the testicles | Sometimes the scrotum or the sac around it can become swollen. |
| Testicular shrinkage | The testicle on the side with the varicocele may become smaller than the other side. We call this testicular atrophy . |
| Infertility | If you have been trying for a year without any protection and still haven't conceived, the cause may be a Varicocele. |
Why does Varicocele occur? Who is most likely to develop it?
The exact cause of this has not yet been found. But the main theory is that, as I mentioned earlier, there is a weakness in the functioning of the valves in the veins. This is probably something that is inherited.
Varicoceles are often first noticed or felt during the teenage years . That is, around the ages of 13, 14, or 15. This is because during puberty, the blood supply to the genitals increases. Then, the veins, which have weak valves, can no longer handle the increased blood pressure and the veins begin to swell. This can also interfere with the development of the testicles in some young boys.
Can varicocele cause other complications?
A small Varicocele usually doesn't cause any major problems. However, a large, untreated Varicocele can cause some complications.
- Decreased Testosterone Hormone (Male Hypogonadism): Testosterone is a male hormone. It is produced by the testicles. If the testicles are damaged due to varicocele, the production of this hormone may decrease. This can lead to decreased sexual desire, decreased muscle mass, and depression.
- Azoospermia: This is a more serious condition. Azoospermia is when there are no sperm cells in the semen. This is also a major cause of male infertility.
These complications are very rare, but if you have any concerns, it's best to seek medical advice.
How does the doctor diagnose this?
When you go to see a doctor, he will first ask you about your symptoms and then do a physical examination.
During this test, the doctor will have you stand up and examine your scrotum. He will then tell you to "take a deep breath, hold it, and push your stomach down." This is called the Valsalva maneuver . This increases the pressure inside the veins, so if you have a varicocele, you will be able to feel it clearly.
Sometimes, several more tests may be done to confirm the diagnosis.
- Pelvic Ultrasound: This is a painless, simple scan. It can clearly see the condition of the veins inside the scrotum and how the blood is flowing.
- Semen Analysis: This test is recommended if you are having problems conceiving. This involves taking a sample of your semen and examining the sperm count, movement, and shape.
- Blood Test: This tests your body's hormone levels, especially testosterone and Follicle-Stimulating Hormone (FSH).
Are there grades of varicocele?
Yes. Doctors classify Varicocele into several levels based on its severity. This is very important in determining treatment.
| Grade | Description |
|---|---|
| Grade 0 | This is the smallest level. It is not felt during a physical examination. It can only be detected with an ultrasound scan. |
| Grade I | It's not noticeable when you do a normal check. But it's only noticeable when you do the Valsalva maneuver (when you hold your breath). |
| Grade II | Even without the Valsalva maneuver, you can feel it with your hand during a normal examination, but you can't see it from the outside. |
| Grade III | This is the largest level. It is clearly visible from the outside and easily caught in the hand (like those worms). |
What are the treatments for this?
The decision to treat or not depends on your symptoms, the extent of the Varicocele, and whether you have any problems having children.
Things you can do at home and simple treatments
A small, asymptomatic Varicocele, such as Grade 0 or Grade I, may not require any treatment. However, if there is pain or discomfort, these things can help.
- Supportive underwear: Wearing supportive underwear or a jockstrap while exercising or standing can help reduce pain.
- Ice: When you are in pain, hold an ice pack wrapped in a towel on your scrotum for 10-15 minutes. Do not apply the ice directly to your skin.
- Painkillers: You can take a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen as directed by your doctor. But remember, do not continue to use any medication without medical advice.
Is it treated with surgery?
Yes. Your doctor may recommend surgery for you in the following cases.
- If the pain is severe and interferes with daily activities.
- If the varicocele has affected your ability to have children.
- If the testicles are shrinking (especially in young boys).
This surgery is called a Varicocelectomy . This involves identifying the swollen veins that are collecting blood, cutting them, and tying them together (sealing). This stops the blood from flowing through those veins, and allows blood to flow through healthy, normal veins. This is usually a successful surgery. It can take about 6 weeks to fully recover from the surgery.
When should you see a doctor?
If you have any of the following, don't waste time and see a doctor.
- If you have pain or swelling in your scrotum.
- If you see a big difference between the sizes of the two testicles.
- If you feel a lump or something unusual in your hand.
- If you are a teenager and you see a change like this.
- If you and your partner are trying to have a baby, but are not successful.
Don't be afraid to ask these questions when you see the doctor.
- Are you sure I have a Varicocele?
- Do I need treatment?
- Will my symptoms get worse if left untreated?
- Could this affect my ability to have children?
- What treatment options do I have?
- If I have surgery, will it improve my ability to have children?
Take-Home Message
- Varicocele is a swelling of the veins in the scrotum. This is a very common condition.
- Most people have no symptoms, and it doesn't cause much harm.
- In some cases, especially large Varicoceles can cause pain, testicular shrinkage, and affect the ability to have children.
- If you have pain, swelling, a change in the size of your testicles, or problems having children, be sure to see a doctor.
- There are effective treatments for this. So there is no reason to be afraid or ashamed. Think about your health and take the necessary steps.
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