A varicocele is an enlargement of veins inside the scrotum, similar to a varicose vein that can appear in the leg. The scrotum is the pouch that hangs below the penis and holds the testicles. Veins carry blood from tissues and cells back to the heart, where the blood cells get oxygen. The scrotum has two sides, the right and the left. A varicocele can form in either side or both sides. It often forms on the left because these veins are normally under more pressure than the ones on the right. A varicocele may result in an enlarged scrotum.
Varicoceles are common. About 15% of all men get them. They can develop in childhood, but most often they occur in teenage boys and young men. Varicoceles are usually harmless, but they can affect fertility (the ability to make a woman pregnant). About 40% of infertile men have a varicocele.
Veins contain one-way valves that push blood in one direction, toward larger veins. When valves inside the veins in the testicles and scrotum don’t work properly, blood backs up and causes these veins to swell. A varicocele is the result.
A varicocele usually causes no symptoms. People don’t know that it exists until a health care provider examines the scrotum. Sometimes a man or boy becomes aware of a larger scrotum, but this is painless. There may be a dull pain or a heavy, dragging feeling in the scrotum. A varicocele may also cause the testicle on the affected side to shrink because of the pressure. People may notice a painless swelling in the scrotum that feels like a bag of worms. The enlarged veins make the scrotum feel like this.
The health care provider will diagnose a varicocele by examining the scrotum. If the diagnosis is unclear, the health care provider may order an imaging test called ultrasonography. This test can get pictures of the veins with the scrotum. Other causes of swelling of the scrotum can be ruled out.
No treatment is needed unless pain or other symptoms occur, the testicle shrinks, or fertility problems appear. Treatment, if needed, involves an operation called a varicocelectomy. In this operation, veins may be taken out or tied so that the blood supply is stopped and the veins collapse. A doctor called a urologist will do this surgery. A urologist specializes in treating the male and female urinary system and male reproductive system. This procedure may help fertility. Surgical removal of the veins is a minor operation, and 1 to 7 days off work will be needed. Discomfort or bruising may occur. There’s about a 15% chance that the problem will return. If it does, the surgery can be done again.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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