The Secret Life of Varicoceles

What is a Varicocele?

What’s squishy, worm-like, fills the space in the scrotum above your left testicle, can ache after a run and wreak havoc on your fertility? No it’s not your Johnson; it’s a varicocele. A very-what? A vari-ko-seal.

What is a Varicocele?

Varicoceles are dilated, tortuous veins that drain the testosterone-rich blood from the testicles. They come in three sizes: small, medium and large and are diagnosed on physical examination, generally by a specialist. Varicoceles exist when blood travels in the wrong direction through these veins. Normally, blood leaves the testicle and travels uphill to drain to the upper back, near the kidney. This is a long way to go and it’s all uphill. Since we stand as a species, good ole gravity, clearly our enemy as we age, acts over time here too and pulls the blood back down the veins and causes it to pool around the testicle.

Developing at puberty in active boys, varicoceles are an evolutionary consequence of man’s upright posture. Our quadruped ancestors and pets do not get them. They are common, occurring in 1 out of every 6 adult men, and are generally nothing to worry about as they are often asymptomatic.

Why Do Varicoceles Matter?

The fact is, though, that varicoceles are not always innocent. In an odd way, they remind me of my dog Pretzel (my daughter named him) who will sit at your side all day when you’re home, but will grab that half-eaten burger off the table as soon as nobody’s looking. Although varicoceles don’t cause cancer, they can hurt and they can cause male infertility. Also, a few others think that varicoceles can cause testosterone levels to drop.

The discomfort they cause is again due to gravity. It is usually mild and is worsened with physical activity and relieved by lying down, which neutralizes the effect of gravity. So, men can have varicocele pain after a long day of standing, but it never hurts in the morning upon awakening.

Its role in male infertility actually dates back to the 1st century AD. Celsus, a Greek physician, described them in De Medicina: “The veins are swollen and twisted over the testicle, which becomes smaller than its fellow, in as much as nutrition has become defective.” In reality, 40% of men who are having trouble conceiving their first child will have a varicocele, a rate almost three times higher than in the general population.

How varicoceles cause infertility is not entirely clear, but the most popular theory is that warm blood from the body that is flowing downhill into the scrotum heats up the testicles to the point that sperm production and quality are affected. Basically, the factory (testicle) is overheated and the workers aren’t putting out as many, or as good, a product.

Away with Thee, Varicocele

Fortunately, there are several ways to treat varicoceles and they work well to relieve the pain and improve semen quality. I typically spend an hour with the patient and an operating microscope and tie off all of the enlarged veins. This stops the reverse flow of blood; elegant, simple and safe. I do this a lot. In fact, varicocele is the single most correctable abnormality found among infertile men.

So, if you find yourself having trouble conceiving with an abnormal semen analysis and just can’t figure out why it’s happening, see a specialist as you might just be the average guy with a varicocele.