A varicocele is like varicose veins of the small veins (blood vessels) next to one testicle (testis) or both testicles (testes).
What are the symptoms?
My guess is that the first doctor to write about a varicocele was a fisherman, because it is described as feeling like a bag of worms. I can't imagine why anyone would otherwise want to be walking round with a bag of worms, or even think of putting worms in a bag. Just think, if the first doctor to describe the condition was an amateur cook we might all be talking about a bag of spaghetti. But we are stuck with the worm thing. No matter.
Varicoceles are pretty common. Men have a good chance of getting one - about 1 in 7 - usually around the age of 15 to 25. Just the time in your life when it would be handy not to have a bag of worms between your legs. Mother Nature can be a cruel mistress.
Varicoceles are, like the rest of the body, prone to the effects of gravity. So you might get a bit of discomfort if you've been on your feet for a while. You can make a varicocele disappear by lying flat. A neat party trick, but not one likely to get you past the first round of Britain's Got Talent.
Read more about the symptoms of a varicocele.
What are the causes?
We're mainly back to gravity again. The veins are fitted with valves that are meant to keep blood flowing towards the heart and stop it from flowing backwards. This sort of thing happens when you stand up. If the valves leak, the blood hangs around in the veins, which expand to form a varicocele. The same sort of thing happens with varicose veins in the legs. Nobody knows why the valves stop working. We don't know everything. The same thing happens to my internet but I don't lose any sleep over it.
In older men, a blockage of larger veins in the tummy can cause a varicocele in the scrotum. This is only likely to happen in men aged over 40. It can be a sign that a tumour of the kidney has developed.
Learn more about the causes of a varicocele.
How is it diagnosed?
When a doctor examines you they will most likely be able to feel the swollen veins in your scrotum. Forgive them if they use the term 'bag of worms'. It's a reflex action which has been drummed into them at medical school.
These days you may end up having a type of scan called a colour Doppler ultrasound to confirm the diagnosis. They have these fancy toys, so you might as well use them.
Men over 40 are likely to have other tests because of the link with tumours such as kidney cancers.
Find out more about the diagnosis of a varicocele.
What are the options for treatment?
When I was a medical student there was an old joke doing the rounds which went like this:
Q. What does a surgeon operate on a varicocele for?
A. Fifty pounds.
As time's gone on we have come to realise that most varicoceles don't need treatment. . There are some notable exceptions. Persistent discomfort is a good reason, particularly if you do a lot of standing in your job. It's now generally accepted that varicoceles, like some brands of underpants, heat up the nether regions and affect sperm production. In young infertile men who meet certain criteria, removing the varicocele can help to restore fertility.
Teenagers in whom the testicle is demonstrated to be getting smaller may also benefit from treatment to prevent fertility reduction .
The treatment is to tie the enlarged veins off or inject them with a substance to make them shrink.
Sometimes, the veins left behind also enlarge and you have to go through the whole process again. Mother Nature can be a cruel ... oh sorry, I've already done that bit.
Read more about the treatment of a varicocele.
Further reading and references
Guidelines on Male Infertility; European Association of Urology (2015)
D'Andrea S, Micillo A, Barbonetti A, et al; Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men. J Endocrinol Invest. 2017 May 25. doi: 10.1007/s40618-017-0695-x.
Kolon TF; Evaluation and Management of the Adolescent Varicocele. J Urol. 2015 Nov194(5):1194-201. doi: 10.1016/j.juro.2015.06.079. Epub 2015 Jun 25.
So, i and 20 years old and im sitting at the doctors atm waiting to get my 3rd ultrasound this year to check for hernias, my pain is completely random but i find it mostly happens in the afternoon,...rory06390
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