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Varicocele   arrow

Are your testicles hot?  Probably not the way you might be thinking, and certainly not good for your health!

The Issue:  Varicocele (pronounced varik-o-seal) is an abnormal dilation or englargement of testicular veins.  These veins normally drain blood from the testicles and send it back toward the heart.  Pooling of blood in these enlarged veins causes the testicle to become hotter temperature than normal (think of your car’s engine!) and this affects the cells in the testicle.  Varicoceles become an issue if you are a man with low testosterone, difficulty having children, or testicular pain.

Varicocele is the most frequent cause of infertility in a male, occurring in up to 15% of the general adult male population, and in up to 40% among men with infertility (difficulty having a child when the female partner has no fertility issues).  With increased heat in the scrotum, the testicles and their cells (Sertoli cells play a key role in sperm production and the Leydig cells in testosterone production) start to have major issues and do not perform well.  The significance of acting early to diagnose and treat varicocele is that the testicle function (sperm and testosterone production) decreases more and more over time when a varicocele is present (more).  Therefore, an undiagnosed varicocele can result in abnormalities in a man’s sperm count, sperm shape, sperm movement, or even sperm genetic code (DNA), and decreased testosterone in the blood (more).

Diagnosis: The varicocele may not have been bothersome or noticed by the patient before, but your urologist can often detect these just by examining the scrotum.  There is a grading system (1 = smallest, to 3 = largest) that is used and the varicocele can also be confirmed on ultrasound imaging (no radiation and painless, completed in less than 30 minutes).  A varicocele is considered significant if can be detected on physical exam or if the veins are  >2.7 millimeters on ultrasound imaging).  Once confirmed by exam and or imaging, discuss further with your physician regarding your semen analysis (checks for sperm abnormalities) and blood total testosterone level.

Treatment:  If a patient has sperm abnormalities or low testosterone, or less commonly dull aching pain in the testicle, then varicoceles are most commonly eliminated with a surgery called varicocelectomy.  This surgery takes the dilated veins (again, the blood vessels that drain the testicle) and these are pinched off, and blocked permanently.  This can be done on one or both testicles.  There are other veins that carry the necessary blood away from the testicle so this does not cause any issue.  For more in-depth information about varicocelectomy, see our article.

Varicocelectomy will stop additional testicular damage from the varicocele and in many men lead to improved semen parameters, increased Leydig cell function, and subsequently increased testosterone especially if your testosterone was low before the surgery (more).  During this surgery, it is ideal for the artery (vessel that supplies blood from the heart to the testicle) to be spared, although sometimes the artery is eliminated.  There are multiple ways to perform this surgery, but the outcomes have been shown to be the best (with the fewest varicocele recurrences) when the surgeon uses a microscope (microsurgical subinguinal approach) (more).  Feel free to read more about microsurgical varicocelectomy or ask your urologist who specializes in this procedure.

For more information on low testosterone, see our posts on hypogonadism.  For more information on microsurgical varicocelectomy treatment, see our post.

Matthew Wosnitzer, M.D.
March 2, 2014

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