In males, the scrotum acts as support for the reproductive system by holding the testicles up and away from the body. The testes are responsible for the production of both sperm and the hormone testosterone. Inside of the scrotum, a spermatic cord made of nerves, the vas deferens, arteries, and the testicular veins (pampiniform plexus) work to support the testicles. Testes need to be at optimal temperatures to function properly, so scrotal support is critical. Additionally, the pampiniform plexus regulates temperature but can sometimes become enlarged. When this happens, the enlarged veins are called varicoceles. To better understand your health, and when to see a doctor, here’s what you need to know about varicoceles.
What are Varicoceles?
A varicocele is when the veins in your scrotum (pampiniform plexus) become enlarged. It’s very similar to getting a varicose vein and is relatively common among men. Varicoceles occur in about 10-15 out of every 100 males and usually form around puberty. Over time, they can worsen—the vein gets bigger and circulation is compromised. The appearance of a varicocele is similar to a varicose vein in that it’s swollen, has a bulging appearance, and takes on a dark blue/purple color. Due to the specific anatomy of men, varicoceles are more common on the left side of the scrotum but can, and do, occur on the right.
Causes of Varicoceles
Each testicle is supported by a spermatic cord. This cord contains veins, arteries, and nerves that help the testicles function as they should. In healthy veins, a one-way valve moves the blood from the testicles to the scrotum and on to the heart. Sometimes this valve system doesn’t work as it should and blood flow is restricted. When this happens, the blood can start to pool in a vein, causing it to enlarge.
Again, this malfunction is almost identical to how varicose veins form on different parts of your body. However, unlike varicose veins, the causes and risk factors for varicoceles are unknown. They develop slowly over time and may or may not require treatment. While the cause is fairly unknown, it’s important to stay healthy and take care of your urologic health.
Symptoms of Varicoceles
Varicoceles present themselves in a number of different ways. For some people, there are no symptoms aside from visual changes. For others, you may notice a lump in one of your testicles, swelling of the scrotum, a dull, persistent pain localized in your scrotum, sharp pains, pains that increase when standing or during physical exertion, or pain that worsens throughout the day. The main distinguishing symptom of a varicocele is the visible definition of large, twisted veins that are scattered around your scrotum. Many people have described varicoceles as looking like a “bag of worms.”
While many men have no problems with their varicoceles, those that do can suffer from debilitating pain or fertility problems. If you’re experiencing high levels of pain, or are trying to conceive, schedule an appointment with your doctor. There are treatment options available to address enlarged veins in the scrotum. It’s also important to properly diagnose lumps or swelling to rule out anything more serious.
Complications of Varicoceles
While most men who experience varicoceles will show no symptoms or subsequent complications, there are always risks. The two primary complications that can occur are shrinkage of the affected testicle, also known as testicular atrophy, and infertility.
Shrinkage of the Affected Testicle
Since most of the testicle is comprised with sperm-producing tubules and veins, damage from a varicocele sometimes leads to shrinkage. While the direct cause of this isn’t 100% clear, it can become serious. Severe untreated atrophy increases the pressure in the testicle, which can result in long-term damage. If you notice one or both of your testicles starting to shrink, schedule an appointment with your doctor. Damage from varicoceles can be treated and repaired using one or more techniques discussed below.
Infertility
Varicoceles increase the temperature around a testicle, therefore affecting the sperm’s formation, movement, and overall function. This is because the pampiniform plexus is responsible for cooling the arterial blood. When it is not working efficiently, blood temperatures rise therefore decreasing the efficiency of sperm production. Any infertility is exasperated by a decrease in circulation leading to low sperm production and a reduction in sperm quality.
Diagnosing Varicoceles
A simple physical exam is the first step in diagnosing varicoceles. If they’re pronounced, your urologist will be able to feel them and make a diagnosis without further tests. Since the enlarged blood vessels can often resemble a lump, similar to those found in testicular cancer self-exams, a physical is important. If the lump is diagnosed as testicular cancer, your doctor will take you through the next steps of screening and diagnostics.
If a diagnosis isn’t possible with a simple physical, your doctor may order a scrotal ultrasound. This test uses high-frequency sound waves to create an image of the affected area and is critical to rule out other problems.
Different Ways to Treat Varicoceles
If you’re diagnosed with varicoceles, you have options. While treatment is not always necessary, it’s a viable consideration if you’re experiencing any pain, atrophy, or are worried about infertility. If you are unaffected by your varicocele, no action is needed. You and your urologist will monitor progression over the years and reevaluate if anything changes. If you’re considering assisted reproductive techniques, talk to your doctor about your options. If you do undergo treatment, there are two primary approaches used.
Varicocelectomy
A varicocelectomy is a surgery that’s performed to remove varicoceles. Once completed, your circulation will normalize and your blood flow with strengthen. Depending on the intensity of your condition, your doctor may require general anesthesia, but it can often be done using a local numbing agent. Your doctor will use a microscope to see small veins through a 1-inch cut that’s made on your scrotum. Once found, your doctor will either clamp or tie off any abnormal veins so that blood is redirected into a healthier route. You may need to follow a pre-op treatment plan, which your doctor will discuss with you prior to surgery.
This surgery can be done laparoscopically to help reduce complications and speed up recovery time. If your varicoceles are larger or more serious, your doctor may need to perform this procedure using an open surgery. You may need to be catheterized during this surgery.
Varicocelectomies are usually outpatient procedures so you can return home the same day. However, make sure that you avoid strenuous activity following the procedure and give yourself some time to heal. Always follow your doctor’s instructions and avoid immersing your scrotum in water, do not strain during bowel movements, don’t have sex for up to two weeks, and make sure that you clean your incisions. If you have any questions about the surgery, talk to your doctor.
Varicocele Embolization
Another popular treatment option is varicocele embolization. This is also an outpatient treatment, but less invasive than a varicocelectomy. A radiologist will insert a small catheter into your groin or neck vein so instruments can be passed through to view the enlarged veins on a monitor. This process takes about an hour and requires the use of a dye to help identify which veins aren’t working properly so they can be targeted.
Once targeted, your doctor will release coils or a sclerosing solution that causes scarring. The scarring then creates a blockage in the affected testicular veins, which causes the blood to naturally reroute to healthier, unaffected veins. This is similar to how many varicose veins are treated and is coupled with minimal, if any, amounts of pain. Once dysfunctional veins are closed, the effect is immediate, and your blood flow transfers to a healthier route. This relieves discomfort associated with the symptoms of varicoceles, which you’ll notice quickly after the procedure. You will still need to follow a post-procedure treatment plan.
For less invasive considerations, try different underwear. It’s been shown that wearing tight underwear or a jock strap can help provide extra support that alleviates pain and discomfort caused by varicoceles.
Post Treatment Recovery
Luckily, most of the treatment options for varicoceles include relatively fast healing times that are associated with minimal levels of pain or discomfort. Always follow your doctor’s treatment plan and avoid exercising for about 10 to 14 days after surgery. Plan ahead so that you can take some time off of work and make sure you’re regularly following up with your urologist. While the studies about how treatment can impact or restore fertility vary, there have been promising statistics.
To learn more about the importance of maintaining good urologic health and how you can access discrete, urologic supplies, contact Byram Healthcare today.
