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What is a varicocele?
Varicoceles are found in approximately 15% of the general population, 35-40 % of men with primary infertility (men who have never fathered a child) and in 75-81% of men with secondary infertility (men who have fathered children in the past but are now unable to). A varicocele is a condition in which the veins of the scrotum get enlarged and tortuous, much like varicose veins in the legs, a problem that many of us are familiar with. The veins in the scrotum are collectively known as the pampiniform plexus. This is a network of vessels that surrounds the testes and regulates its temperature even as it takes blood back to the heart. Physiologically, it is important for the testes to have a temperature that is a few degrees lower than body core temperature in order for sperm production to occur normally. This is why nature has placed the testes outside the body in many mammals, including man - the higher internal core body temperature is deleterious to sperm production. This also explains why many men with undescended testes are infertile. Testes that are trapped higher up in the body do not have the heat regulating protection of the pampiniform plexus. The presence of a varicocele interferes with this temperature regulation mechanism and often increases testicular temperature. This can cause infertility in many men. Infertility is a condition where a man, woman, or couple cannot have children by natural methods, even after a year to a year and a half of regular, unprotected sexual intercourse.
A classical left varicocele
Half of all infertility (50 %) is male partner related, and a varicocele is often the culprit.
A varicocele frequently presents as a visible swelling in the scrotum, and the scrotum itself may hang lower than usual. Damage to the testis, with reduction in size and function, can sometimes occur. Often, there is a dull, dragging pain accompanying this condition. Frequently, however, the varicocele is not prominent, and may be completely asymptomatic, i.e. without symptoms. It is only discovered incidentally during a male infertility evaluation. varicoceles occur more frequently on the left side and are somewhat more common in lean, tall males.
The varicocele is the commonest treatable cause of male infertility.
What about varicoceles in adolescents? Is this something to worry about?
The adolescent varicocele has been studied quite well over the years. Many of these disappear with age and do not cause any problems in later life. Infertility is uncommon. However, regular examination of the boys until the disappearance of the varicoceles is recommended. Only persisting varicoceles and those causing complications like reduction in testis size must be treated.
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