Varicoceles (swollen veins in the scrotum) hinder one in every five men and are mostly symptom-free. You may not need treatment for varicoceles, but it can be a reason for male infertility. So, varicocele surgery can be an alternative to improve fertility in men.
This blog discusses everything about varicoceles along with symptoms, causes, treatment options and much more!
What are Varicoceles?
Varicoceles refers to when the veins in your scrotum become enlarged or swollen. The scrotum is a pouch-like sac of skin where testicles are held. Varicocele is quite a common concern and is similar to varicose veins, a condition one gets in the leg when the veins get twisted or swollen.
Varicoceles transfer the sperm to the testicles and can be seen through the skin. Since these veins are larger than they might otherwise be, blood can rack up in your scrotum or even flow reverse into your testicles. A varicocele may cause a reduction in both sperm quantity and quality, potentially leading to infertility in certain instances. Moreover, it can contribute to testicular shrinkage. A varicocele is detected in 15% of men without health issues and in as many as 35% of men experiencing primary infertility. (source)
Symptoms of Varicoceles
Generally, varicoceles do not show any symptoms. But you may notice:
- Swelling or enlargement in the scrotum
- A lump that feels like a bag of worms
- Pain or discomfort, especially when standing or exerting pressure on the abdomen
- Aching or dragging sensation in the scrotum
- Testicular atrophy (shrinking of the testicle)
- Visible veins in the scrotum
- Feeling of heaviness in the scrotum
- Worsening symptoms throughout the day, especially in warm weather or after physical activity
- Infertility in some cases due to decreased sperm quality or production
What Causes Varicoceles?
Varicoceles may occur as a result of a faulty switch (or valve) inside specific veins in the spermatic cord, a belt of tissues that retains the testicles in place. Much is still unknown about the causes of varicoceles.
Blood flows from the testicles to the rest of the body via these veins. The valve serves as an on/off switch. Excess blood may accumulate inside testicular veins when a valve fails to function properly. This impairment causes veins to swell over time.
- Genetics play a role, as individuals with a family history of varicoceles are more prone to develop them.
- Increased pressure in the abdomen, such as from heavy lifting or straining during bowel movements, can contribute to the development of varicoceles.
- Hormonal imbalances, particularly those related to testosterone levels, may influence vein dilation and contribute to varicocele formation.
Who Can Get Varicoceles?
Anyone who has testicles can get varicoceles, irrespective of age. As per the healthcare experts, several cases of varicoceles are present at birth. During their teen years, many people become aware of a varicocele.
Research reveals that approximately 8% of boys aged 11 to 14 and 14% of those aged 15 to 19 experience varicoceles.
This timing is thought to be related to puberty when the blood circulation to the genitals accelerates. Moreover, the varicocele can sometimes prevent the testicle from developing properly.
How Common is Varicoceles?
Out of every 100 men, nearly 10-5 men have varicoceles. However, you cannot predict how many men with varicoceles will face fertility issues. Nearly, 40% of men with fertility problems have reduced sperm movement and varicocele. Despite the fact that varicoceles can be found usually in men having infertility, around 80% of men with varicoceles do not face fertility problems. There is no linkage to other defects, race, place of birth, or ethnic group.
What are the grades of a varicocele?
Varicoceles, abnormal enlargement of veins within the scrotum, are graded based on their severity. The grading system typically ranges from I to III.
- Grade I varicoceles are palpable but not visible, often requiring a Valsalva manoeuvre to detect.
- Grade II varicoceles are palpable and visible without the need for the Valsalva manoeuvre.
- Grade III varicoceles are large, palpable, and visible, sometimes associated with testicular atrophy.
These grades indicate the extent of venous dilation and can help guide treatment decisions, with higher grades often necessitating intervention to prevent complications like infertility or testicular atrophy.
Who Will Need a Varicocele Surgery?
- As long as your varicocele does not cause discomfort or pain, your doctor will recommend you skip surgery to avoid the risks involved in the surgery.
- Generally, varicocele occurs on the left side of the scrotum. If varicoceles appear on the right side, there is a higher chance that they are caused due to growth or tumours. If you get a varicocele on the right side, your doctor may perform varicocele surgery to remove the growth.
- A frequent cause of a varicocele is infertility. If you want to have a baby but have trouble getting pregnant, your doctor might suggest this procedure. You may also want to have this procedure done if you are experiencing any of the side effects of low testosterone production. Such as gaining weight or declining sex drive.
What is Varicocele Surgery?
Also known as varicocelectomy, varicocele surgery is performed to pull the swollen veins inside the scrotum. Varicocele surgery is a surgical procedure that is conducted for a proper revival of blood flow to the reproductive organs. There are three surgical options for varicocele surgery performed on an outpatient basis.
Varicocelectomy: This surgery is performed under local or general anaesthesia. The surgeon will enter the area through the groin or, less frequently, the abdomen or upper thigh. They will close the affected veins using ultrasound and surgical microscopes to divert the blood through other healthy vessels. Post-operative pain is usually minimal, and the patient can quickly resume usual tasks.
Laparoscopic Surgery: Another alternative for varicocelectomy is laparoscopic surgery. This surgical procedure is done using a laparoscope, a small, thin tube that enables the doctor to make tiny incisions. The tubes will be inserted through your abdomen, where there are fewer veins to tie off. This type of varicocelectomy surgery takes only 30 to 40 minutes.
Percutaneous Embolization: A tube or catheter is inserted into your body through the groin or neck. The instruments depart through the tube, and the doctor utilises coils or chemicals to obstruct the vein by scarring it. This is a minimally invasive, outpatient procedure that needs a short time to recover.
Recovery from Varicocele Surgery
Once your surgery is done, you will be shifted to the recovery room. You’ll need to rest for some hours before your doctor releases you to go home.
While recovering at home, you’ll have to:
- Take medicines as asked by your doctor
- Take pain medication to sustain pain after surgery
- Reduce the swelling on the scrotum by applying an ice pack
- Clean incision as asked by the doctor
- You will have to avoid doing certain tasks like:
- Vigorous exercising or heavy lifting
- Intercourse for one or two weeks
- Swimming bathing or drenching your scrotum with water
- Driving
Final Thoughts
As discussed, varicocele may affect fertility in men and can hinder their efforts of becoming a parent. If you’re experiencing symptoms of varicocele, such as difficulty conceiving with your partner, it’s essential to consult a healthcare professional at Banker IVF & Women’s Hospital in Ahmedabad. It is worth noting that not all cases of varicocele require treatment. But those causing infertility, chronic pain and low testosterone may need it. The experts can assess your condition, diagnose varicocele, and advise you on the most suitable treatment options.
