The Boy with the Varicocele
The case of the month is an actual patient of The Turek Clinic
His head was topped with bobbing red hair and his face full of freckles. Thin as a beanpole, he spoke softly as if trying to control his cracking pubertal voice. All in, he appeared to be the stuff that teenage boys are made of. But he was also in pain.
“When does it hurt down there?” I asked.
“Mainly after soccer practice,” he said.
“How long have you had the pain?
“Since soccer season started.”
“Does the pain go anywhere else?”
“Nope. And it’s not, like, you know, pain, but more like a heaviness,” he said.
“Do you wake up with it in the morning?”
Even before I examined him, the diagnosis was pretty clear. Athletic, pubertal kid right smack in the middle of a growth spurt develops scrotal pain. Unlikely to be an infection or a twisted testicle. A hernia is possible. But the best fit is…a varicocele. Sure enough, the exam showed no hernia and a large (visible) left varicocele.
Boys to Men
Varicoceles in a teenager? You probably thought that this was something only infertile guys got. Well, truth is infertile guys get them as teenagers, but if they never have pain, they end up coming to medical attention when they cause another issue later on: infertility.
Varicoceles are simply veins in the scrotum that become enlarged due to the effects of gravity. Ever since we stood up as Homo Erectus people 2 million years ago, we changed the way that blood flows from the scrotum back to the heart. On all fours, blood drains level or flat from one organ to the other. But when we stood, blood now had to drain uphill to the heart, against gravity. And, as everyone who has aged at all knows, gravity always wins. Combine this G-force with rapid linear growth of the teenage boy at puberty, and leaky valves result. Due to leaking valves, blood that should be going uphill from scrotum toward the heart reverses direction and goes downhill and settles around the testicle. And that causes the ache. Since this blood is also warmer than normal, later on it can affect sperm production and cause infertility.
Some argue that our standing upright was as significant an event in becoming human as developing the opposing thumb. I would agree fand also suggest that, because of the varicocele, standing up has also had a major influence on human fertility through the ages.
So we fixed it. After one hour of microsurgery, two pain pills and a weekend of down time, he was pain-free again, even during soccer season. And his parents felt better too, knowing that they had done all they could to improve their son’s potential as soccer star and future father.