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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Varicocele

What is it?

A varicocele is an enlarged, knotty, swollen (varicose) vein in the scrotum. Veins are the vessels that return blood to the heart after oxygen has been delivered to the body's tissues. All along the walls of the veins are valves that permit blood to flow in only one direction. Varicose veins occur when these valves are absent or become weak or defective, allowing blood to flow backward or stagnate within the vein. Varicoceles are simply varicose veins in the scrotum; they are not a serious health risk and in many cases do not require treatment. However, varicoceles may lead to infertility in some men. It is thought that the pooled blood in the engorged vein may increase testicular temperature and impair blood flow; both can inhibit sperm cell production. In such cases fertility may improve when the varicocele is surgically treated. Varicoceles are quite common, affecting about 10 percent of all men.

What Causes It?

  • Weak or defective valves in the veins leading from the testicles may produce a varicocele.
  • Infrequently, an obstruction of the vein due to a tumor or blood clot may lead to a varicocele.

Prevention

  • There is no known way to prevent varicocele.
  • Regular testicular examination aids in early diagnosis and treatment of any abnormalities (see Testicular Cancer for more on testicular examination).

Diagnosis

  • Testicular examination, involving gentle palpation of the testicles and scrotum, is performed by the doctor to determine the size and consistency of any lumps.
  • A special bright light can be shined through the scrotum to aid in diagnosis; varicoceles are opaque and do not allow the light to shine through, while other abnormalities (such as a hydrocele or a spermatocele) appear translucent.
  • An ultrasound examination may be performed to confirm the diagnosis.
  • Seminal fluid is analyzed in infertile men.

How to Treat It

  • In many cases treatment is unnecessary.
  • Wear an athletic supporter or snugly fitting briefs to provide extra support for the scrotum and to relieve pain.
  • Surgery to remove the enlarged veins through a small incision in the scrotum may be performed to improve fertility.Other remaining veins compensate for the absent ones.
  • An x-ray approach (angiography) can be used to block blood flow to the enlarged vein, thus sealing off the varicocele.

When to Call a Doctor

  • Call a doctor if you feel an unusual lump in the scrotum.While a varicocele is not a serious health risk, all such lumps should be examined by a doctor to rule out cancer.
  • Call a doctor if you are concerned that a varicocele may be impairing fertility.