Varicoceles

Varicoceles are enlargements of veins in the scrotum. Varicoceles most often occur during puberty and affect as many as 10 to 15 percent of all boys. They cause discomfort in the groin area and, in a small number of adolescent boys, reduced testicle size.

What are varicoceles?

Varicoceles are veins that have expanded, or dilated, because of swelling. The condition is much like varicose veins that occur in the legs of many older women and men.

Swelling occurs when veins inside the spermatic cord aren't working properly. The spermatic cord is a structure that contains vessels and other tissues joining each testicle to the body. Veins in the cord normally take blood back to the heart, and tiny valves inside the veins keep the blood flowing in the right direction. Valves that don't fully close allow the blood to flow sluggishly or pool inside the veins, much like water in a dam. This buildup of blood causes the swelling.

Varicoceles most often occur in the left testicle. This could be because the sharp angle at which blood from the scrotum enters the kidney veins can cause pressure to build up in the scrotum.

What causes varicoceles?

There are several reasons why varicoceles develop. Valve deformities or missing valves in the veins in the scrotum are one possibility. Because male teens grow so rapidly, the testicles need more blood than usual. If the veins have even small abnormalities, they may not be able to shuttle the extra blood back to the heart as easily.

Other anatomical problems may also increase the pressure inside the veins, resulting in swelling. In rare cases, swollen lymph nodes can impede blood flow in the veins of the scrotum and cause pain.

What are the symptoms of varicoceles?

Most boys, and men, with varicoceles don't have any symptoms. When they do occur, symptoms can include:

• Heavy sensation in the testicles that gets worse during or after exercise

• Scrotal sac in which swollen blood vessels can be felt

• One testicle that is smaller than the other

• Persistent, dull ache in the scrotum

How are varicoceles diagnosed?

Doctors can usually diagnose varicoceles with a physical examination of the testicles. Sometimes, doctors do an ultrasound as well.

Can varicoceles affect fertility?

In most cases, varicoceles have no effect on fertility, but there is an association between the two conditions. About 40 percent of all men who are tested for infertility are found to have varicoceles and sperm that are less able to move and swim toward an egg, which is called reduced sperm motility.

Treatment of infertility may include surgery or another technique to take out or block the vein with the varicocele. Testing shows that most men are producing healthier sperm within about six months of surgery.

Pain relief and treatment in teens

Some teens with varicoceles have testicular discomfort or pain. Pain-relieving measures include:

• Lying flat on the back, a position that helps the blood flow in the right direction and drain the scrotum

• Wearing undergarments that support the scrotum, including an athletic supporter or brief-style underwear

• Using pain-relieving medicines, including ibuprofen or acetaminophen

Varicoceles in teens don't usually require treatment, unless there is significant testicle shrinkage, potential fertility issues, or debilitating testicle pain. Doctors may suggest surgical treatment if the testicles are of noticeably different sizes. Surgery in adolescence can restore proper blood circulation in the scrotum and help preserve fertility.