Varicocele is an enlargement of the veins within the scrotum, the loose bag of skin that holds your testicles. A varicocele is similar to a varicose vein that can occur in your leg.
Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to shrink.
Most varicoceles develop over time. They may enlarge and become more noticeable. Fortunately, most varicoceles are easy to diagnose and many don’t need treatment. If a varicocele causes symptoms, it often can be repaired surgically.
A varicocele often produces no signs or symptoms. Rarely, it may cause pain. The pain may:
- Vary from dull discomfort — a feeling of heaviness — to sharp.
- Increase with sitting, standing or physical exertion, especially over long periods.
- Worsen over the course of a day.
- Be relieved when you lie on your back.
Because a varicocele usually causes no symptoms, it often requires no treatment. Varicoceles may be discovered during a fertility evaluation or a routine physical exam. However, if you experience pain or swelling in your scrotum or discover a mass on your scrotum, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.
Your spermatic cord carries blood to and from your testicles. It is not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the cord prevent your blood from flowing properly. The resulting backup causes the veins to dilate.
Varicoceles often form during puberty. Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein. However, a varicocele in one testicle can affect sperm production in both testicles.
A varicocele may cause:
- Shrinkage of the affected testicle (atrophy). The bulk of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It is not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.
- Infertility. It is not clear how varicoceles affect fertility. The testicular veins cool blood in the testicular artery, helping to maintain the proper temperature for optimal sperm production. By blocking blood flow, a varicocele may keep the local temperature too high, affecting sperm formation and motility.
Doctor may recommend not treating the varicocele. If there is pain, the testicle is shrinking, or the patient’s sperm count and quality is affected, something will have to be done. Surgery may be performed to seal off the dilated vein so that blood can flow through healthy veins. This may not always solve the sperm count and quality problem, though. If surgery is needed the patient does not usually have to stay in hospital afterwards. Post-operative pain is generally mild.
To test sperm count and quality the patient will have to wait a few months after the operation for a semen analysis.
A hydrocele is a painless buildup of watery fluid around one or both testicles that causes the scrotum or groin area to swell. This swelling may be unsightly and uncomfortable, but it usually is not painful and generally is not dangerous. Although hydroceles are common in newborns, they can also occur at any age in later life.
The cause of most hydroceles is unknown. Hydroceles in newborns may mean there is an opening between the abdomen and the scrotum. Normally such openings close before birth or shortly after.
Hydroceles that appear later in life may be caused by an injury or surgery to the scrotum or groin area. Or they can be caused by inflammation or infection of the epididymis or testicles. In rare cases, hydroceles may occur with cancer of the testicle or the left kidney. This type of hydrocele can occur at any age but is most common in men older than 40.
Often a hydrocele does not cause symptoms. You may notice enlargement of your scrotum. Symptoms, when present, can include pain, swelling, or redness of the scrotum or a feeling of pressure at the base of the male organ
Hydroceles are not usually dangerous and are treated only when they cause pain or embarrassment or when they decrease the blood supply to the organ (rare). Treatment is not usually needed if a hydrocele does not change in size or gets smaller as the body reabsorbs the fluid. Hydroceles in men of age less than 65, may go away by themselves. But hydroceles in older men do not usually go away.
Fluid can also be removed from a hydrocele with a needle aspiration. But hydroceles that are aspirated often return, and surgery may then be needed. Aspiration is recommended only for men who are not physically able to have surgery because of the risk of infection and recurrence. If the hydrocele gets larger or causes discomfort, surgery to remove the hydrocele may be needed.
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