Varicocele


Last Updated September 4th, 2019

What is varicocele?

Enlargement of veins present in the scrotum is called varicocele.  These veins are medically called pampiniform plexus.  The onset of varicocele generally occurs during puberty.  During the initial stages, you could hardly have any symptoms and the minimal symptoms that occur generally go unnoticed.  Over a period of time, the veins become enlarged and can be visually seen.  It is quite rare to experience serious problems associated with varicocele.

In a few cases,  pain may be associated with this condition.  More severe cases include infertility due to low sperm count and reduced testosterone levels.  One of the important functions of pampiniform plexus is to maintain temperature levels in the scrotum.  Since these veins become enlarged, the temperature levels rise above the desired value leading to impaired sperm production.  This, in turn, can cause problems with fertility and other related issues.

How is varicocele caused?

varicocele-infectionAs discussed earlier, the enlargement of pampiniform plexus leads to this condition.  An important question that arises here is what makes these veins to become enlarged.  The main reason for this condition is due to the abnormal blood supply.  The valves present in by the spermatic cords malfunction and this reduces the blood supply to the pampiniform plexus.  There is no clear indication as to why there is an abnormality in the blood supply.

The only reason for this could be faulty valves that supply blood.  Once there is inadequate blood supply, the pampiniform plexus become dilated and over a period of time stop working.

Type of varicocele

Varicoceles are mainly divided into two types.  These include pressure varicocele and shunt varicocele.

Pressure varicocele

In this condition, the veins supplying blood to the spermatic cord swells up due to the accumulation of blood in the veins.  This condition is also termed as first-grade varicocele.

Shunt varicocele

This is a more severe case where the veins become damaged due to the accumulation of blood in the veins.  The severity of the damage determines the grade of the varicocele.  These are also called second grade and third-grade varicocele depending on the severity.

Health concerns related to varicocele

Health problems associated with varicocele is not common.  In fact, the majority of men suffering from varicocele end up leading a normal life without any medical intervention.  Having said that it does not mean that there is no complications altogether.  In certain cases, the anatomy of the organ can lead to complications such as:

Reduced sperm production

This is considered as the most serious complication associated with varicocele.  Reduced sperm count generally leads to male infertility and is one of the extremely rare health conditions affecting men.  Dilation of the vein called pampiniform plexus vein is the root cause of this condition.  As discussed earlier, one of the important functions of this vein is to maintain the temperature of the scrotum.  It should be noted that the temperature of scrotum is generally lower as compared to the temperature of the abdomen.

The temperature that is maintained in the scrotum is ideal for the production of adequate sperm count.  In the case of varicocele, when the pampiniform plexus becomes dilated, it leads to the temperature becoming higher.  When the temperature becomes higher, it affects the production of sperms and hence leads to male infertility.

Testicular atrophy

One of the important glands present inside the scrotum is the testis.  In fact, there is a pair of testis present in the scrotum.  This is the gland that aid in the production of sperm.  Testes generally shrink for two reasons.  When the temperature is cooler, the testes get close to the body and maintain the temperature which resembles shrinking of testes.  On the other hand, old age can lead to testicular shrinking.  In the case of varicocele, testicular shrinking occurs due to the inadequate blood supply to the testes and hence is also called first-grade varicocele.

Lower testosterone levels

Reduction in the levels of testosterone is one of the side effects of testicular atrophy.  Both the sperms and the testosterone hormones are secreted by the testes.  When there is inadequate blood supply to the testes, there is increased pressure exerted leading to an increase in the levels of luteinizing hormone and a decrease in the levels of testosterone.  This is a condition where the pituitary gland secretes more luteinizing hormones in order to compensate for the decreased levels of testosterone from malfunctioning testes.

How is varicocele diagnosed?

Diagnosis of varicocele generally happens only when you visit the doctor for an underlying health condition related to the reproductive system.  It is quite rare to consult the doctor due to pain in the scrotum because of varicocele.  The first step of diagnosing this condition involves a physical examination.  During the physical examination, the doctor would look for enlarged veins in the scrotum.  Next, the scrotum would be felt in order to find any abnormalities.  If the outcome of the examination is uncertain, the next step would be diagnosing the problem with the help of ultrasound.

Is varicocele treatable?

Treatment for varicocele is required only when it leads to many complications such as pain in the scrotum, infertility, or abnormal levels of testosterone.  An important point to be noted here is that varicocele cannot be treated with non-invasive methods.  The only way varicocele can be treated is with the help of surgery.  The main concept of undergoing the surgery would include rerouting the blood flow to the veins.  Once this is achieved, the majority of the complications associated with varicocele can be treated.  Some of the factors that are considered for surgery include testicular pain, testicular atrophy, and inadequate semen production.

The surgery associated with varicocele includes three types namely open surgery which is medically termed as varicocelectomy.  Next is the laparoscopic surgery where three incisions are made in the abdomen and laparoscopic instrument is used to perform the surgery.  Finally, percutaneous embolization method is used to perform the surgery.

Open surgery (varicocelectomy)

Open surgery involves surgery under general anesthesia.  There are two ways of approaching this procedure.  The most common accessing point would be through the groin region while the less common accessing point includes through the abdomen.  With the use of a microscope, the affected veins would be rerouted in order to provide adequate blood supply.  Once the procedure is completed, sutures are placed.  The pain following the surgery is maintained with the help of non-steroidal anti-inflammatory drugs.

Laparoscopic varicocele surgery

The procedure is undertaken with the help of general anesthesia.  The incision is made in the groin and the affected area is accessed with the help of laparoscopic instruments.  This procedure generally involves multiple incisions in order to perform the surgery.  The laparoscopic instrument would also include a camera and a light source to assist the surgeon.  The same procedure of rerouting the blood supply is undertaken as discussed in open surgery.  Finally, the incisions are closed with the help of sutures.  The size of the incision is considerably smaller as compared to the open procedure.

Percutaneous embolization

This is the most preferred type of invasive surgery among the three surgeries.  Here, catheters are passed through the groin to access the affected area.  Once the affected area is reached, the affected veins are blocked which leads to the rerouting of blood.  This is minimally invasive surgery and can be undergone even as an outpatient.

Complications from surgery

Complications associated with surgery is considerably rare, but are not ruled out.  One of the most common complications would include recurrence.  In the case of open and laparoscopic surgeries since sutures are placed, there is a possibility of infection at the incision site.  Another complication may include the occurrence of hydrocele, a condition where fluids get accumulated surrounding the testicles.  Finally, there is also a possibility of damage to the artery.

Natural treatments for varicocele

Improve blood supply

Trying to improve blood supply to the scrotum is one of the important ways to naturally treat varicocele.  There are certain postures available in yoga that can be performed in order to improve the blood supply to this region.  Research has also indicated that yoga, in particular, can help relieve stress and improve blood flow when certain postures are performed.  Few examples for these postures include a shoulder support stand, bridge posture, and breathing by meditating.

Try supplements

Certain herbal supplements are recommended to treat this condition.  A supplement prepared from the seed of horse chestnut can be tried.  It should be noted that the main ingredient present here is aescin which is highly poisonous.  The supplement form is the goodness of aescin which has been extracted and helps in relieving the symptoms of varicocele.  These types of supplements can be dangerous and should be taken only under medical supervision.

Reduce the temperature

One of the ways to naturally treat this condition would include reducing the temperature of the scrotum.  This can be achieved by allowing cold running water to flow on the scrotum.  Since the temperature of the scrotum is generally lower as compared to the abdomen, it is important to maintain this temperature which helps in the production of sperms from the testes.

Eat a healthy diet

It is important to eat a healthy diet containing antioxidants to help treat varicocele.  Antioxidants help in many ways.  Studies have revealed that antioxidants help in protecting the veins of the scrotum from the harmful effects of oxidative stress.  Another important function of an antioxidant is by halting the progression of varicocele.

Practice Kegel exercise

Kegel exercise or pelvic floor exercise is one of the safest ways to strengthen the pelvic floor muscles and improve the blood supply to the scrotum.  Practicing these exercises for five minutes daily can provide good results in treating varicocele.

The above-mentioned treatments are just an alternative method of treating this condition.  It is also one of the ways where surgery can be postponed to a future date and first try with these natural treatments.  It should be noted that these treatments do not guarantee a cure to the condition and should be implemented only under medical supervision.

Facts

  • Varicocele has a prevalence rate of 15% among the general population.
  • Boys in the age group of 15 to 17 years have the highest prevalence.

Facts

  • Studies indicate that around 35% of men facing fertility problems are generally affected by varicocele.
  • Did you know that 72% of men affected with varicose veins also suffer from varicocele?

Facts

  • It is also surprising to know that the majority of men suffering from varicocele have a low BMI.

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Dos and Don'ts

Dos
  • Consider getting tested if you are facing the symptoms of varicocele.
  • Avoid the use of tobacco.
  • Stay away from caffeinated beverages.
  • Keep stress at bay.
Don'ts
  • Delay medical care.
  • Use tobacco.
  • Drink caffeinated beverages.
  • Wear tight-fitting undergarments.

 

 

 

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