Varicocele

What is a varicocele?

Who gets a varicocele?

Varicoceles are common. About 1 in 7 men develop a varicocele - usually between the ages of 15 and 25. In about half of cases the varicocele is on the left hand side. In just under half of cases there is one on both sides. In a small number of cases it is just on the right side. The reason why most occur on the left side is because of the different route the left veins take out of the scrotum compared to the right.

What are the symptoms of a varicocele?

Varicoceles are usually painless and usually cause no symptoms. A small number of affected men notice a 'dragging' feeling or slight discomfort from their varicocele. This may only occur at the end of a day, especially if you are on your feet all day. The size of a varicocele varies from case to case. Some cannot be seen, only felt. Some are large and can be easily seen. If you lie down, the blood from the veins drains away and the varicocele may seem to disappear. On standing, gravity will cause the blood to pool again and the varicocele reappears.

Are varicoceles serious?

Usually not. In themselves they are usually harmless. Causes of concern include the following:

Possible cause of infertility

Studies have shown that there is a higher rate of infertility in men with a varicocele compared to those who do not have a varicocele. It is thought that the pooled blood causes a slightly higher temperature in the scrotum than normal. This may reduce the number and quality of sperm made by the testis which can reduce fertility. Even if you have a varicocele only on one side, both testes can be warmed by the increased amount of blood pooled in the enlarged veins. However, most men with varicoceles are not infertile. It is just that the chance of being infertile is increased if you have a varicocele.

Small testis

If a large varicocele develops in a teenager, the testis on the side of the varicocele may not develop as much as would be expected. The testis may end up being smaller than normal. This may contribute to infertility too.

Sudden onset of a varicocele in an older man

Rarely, a varicocele quickly develops as a symptom of a blockage of a larger vein in the abdomen (see below). This would normally only occur in men over the age of 40.

What causes varicoceles?

Do I need any tests?

Usually not. Most varicoceles occur in young healthy men. The diagnosis is made by a doctor's examination. A varicocele is associated with some cases of infertility. Therefore, a semen test may be asked for if you are part of a couple that is being investigated for infertility. In the rare situation of a varicocele first developing in a man over 40, then tests to check out a possible underlying cause may be advised. Also, a solitary right-sided varicocele is unusual. If this occurs you may need some tests to rule out any unusual cause.

What is the treatment for varicoceles?

No active treatment is needed in most cases

If a varicocele is causing no symptoms or problems, then it is best left alone. If there is just mild discomfort then supportive underpants (rather than boxer shorts) may help to ease or prevent discomfort. If a varicocele develops in a teenager, then your doctor may wish to monitor the growth of the testes. For example, an annual measurement of the testes may be advised. This may help to clarify if a testis is not growing to its full size.

Treatment may be advised in certain situations

For example, treatment may be a advised if you have persistent discomfort. Also, treatment may be advised if a testis is not growing properly in a teenager with a varicocele.

Treatment involves tying off the veins that are enlarged. Another method of treatment is to use a special substance injected into the veins to block them. Both methods are usually successful. Your surgeon will advise on the pros and cons of the different techniques.

However, after successful treatment, some men have a recurrence of a varicocele months or years later. This is because the veins left behind to do the job of taking the blood from the testes may themselves enlarge or dilate with the extra blood they will now have to carry. A recurrence can be treated in the same way as the first time.

Is treatment for varicocele a possible cure for male infertility?

Probably not. For many years it was thought that treating a varicocele in an infertile man would increase his chance of becoming fertile again. Studies have shown that after treatment, the sperm count may improve. This was assumed to increase the chance of fertility. Some studies did indicate that fertility may be increased with treatment.

However, a recent large analysis (meta-analysis) of studies looking at this issue found that there was no good evidence to say that fertility is increased by treatment. Some experts are critical of this analysis and maintain that more research is needed to clarify whether treating a varicocele improves fertility. If you are infertile, your specialist will advise on current research related to this issue. But remember, most men with a varicocele are not infertile.