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What is a varicocele?

The formation of a varicocele can result from vein abnormalities that restrict blood flow in a testicle. This restriction can cause swelling and result in decreased sperm concentration, decreased sperm motility (movement), and decreased sperm morphology (form or structure). These anomalies are benign and unrelated to testicular cancer or other testicular conditions. During self-examination, they may feel like a lump located on the side of the scrotum, or above a testicle. Because sperm is affected, this can impact male fertility. Whenever a lump is felt in the scrotum, a physical examination should be performed by a physician as soon as possible.

What are the symptoms of a varicocele?

Individuals may experience symptoms, however, they may also be asymptomic (without symptoms). Some symptoms may include:

  • Discomfort in the scrotum
  • Dull pain in the scrotum
  • Problems with fertility
  • Testicular atrophy (shrinkage)

Evaluation process

Scrotal swelling or testicular enlargement should be evaluated by a urologist to determine its cause, and to rule out other medical conditions. When visiting the office, the urologist will discuss the patient’s personal and family medical history, and conduct an in-office physical examination to evaluate the current condition and assess predisposing conditions. If a varicocele is suspected, but the diagnosis is uncertain, a scrotal ultrasound is usually obtained. When it is large, painful, and/or associated with testicular shrinkage, treatment should be considered. If it is discovered that the patient is actively trying to father a child, but has been unable, this will also indicate a need for treatment.

What causes a varicocele?

There are a series of one-way valves within the veins that take blood away from the testicles. If these one-way valves fail, they can have a domino effect and result in other valves failing. The end result are vein abnormalities that can cause restrictions and swelling.

How does this affect sperm parameters?

A varicocele causes “stress” to the testicle. There are many theories for how this stress affects the testicle and sperm. One common theory is that it increases the temperature of the testicle and also increases the reactive oxidative species. The end result is that the testicles’ function can be impaired, leading to decreased sperm parameters and decreased testosterone levels.

How can a varicocele be ruled out?

A physical exam by an experienced urologist is the most reliable way to rule out a varicocele. When they are discovered during a physical exam, they will be graded depending on their severity:

  • Grade 1 – Palpable only with a bearing down maneuver.
  • Grade 2 – Palpable without bearing down.
  • Grade 3 – The largest kind of varicocele which can be spotted by visual inspection.

If you discover a lump in the scrotum, contact Urology Austin to schedule an evaluation with one of our urologists.