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Why do varicocoeles occur?
There are many theories for this, and a detailed discussion is outside the scope of this FAQ page. Most varicocoeles are idiopathic, i.e. without cause, or cause unknown. However, sometimes, tumours in the abdomen and other conditions may compress the veins of the testes and cause varicocoeles. Vascular malformations in the scrotum, such as haemangiomas, may sometimes present as varicocoeles.
Are all men with varicocoeles infertile?
No. Only 35-40 % of patients (about a third) with varicocoeles will develop infertility. Others won't. The relationship between a varicocoele and infertility in men is not completely understood. Maybe there is a variation in susceptibility among men. Even in men with varicocoeles, the varicocoeles may not always be the (only) cause of the infertility. Other causes may well coexist with the varicocoele. These must be looked for and addressed. If there are other causes, and the varicocoele is hastily treated instead, the results may not be fruitful. This is very important to bear in mind.
About 35-40 % of all men with varicocoeles will be infertile as a direct consequence of the varicocoele.
What about diagnosis? Is it very difficult?
The diagnosis of a varicocoele is essentially clinical, i.e. one made by a skilled physician through physical examination. An enlargement of the veins is easy to assess with the fingers. By asking the patient to cough, a reversal of blood flow can also be ascertained. For academic purposes, many grades of varicocoeles have been described. However, it is necessary to understand that there is no direct correlationship between the size and severity of a varicocoele, and the harm it can cause. Men with very large varicocoeles may yet father children (Figure 1), while those with smaller varicocoeles may have severe afflictions of their sperm counts and other seminal parameters, with consequent infertility (Figure 2).
Figure 1: One of Dr. Sudhakar Krishnamurti's patients with a large varicocoele. The patient had neither infertility nor pain.
Figure 2: This man with a moderate sized varicocoele had infertility with very poor semen quality. After microsurgery by Dr. Sudhakar Krishnamurti, his counts improved considerably, and he fathered three children subsequently.
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| Sex is Not a Four-Letter Word |
| Publisher: Rupa & Co., India |
A sex edutainment book by Dr. Sudhakar Krishnamurti.
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