Varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins
drains the testicles. The testicular blood
vessels originate in the abdomen
and course down through the inguinal
canal as part of the spermatic cord on their way to the testis. Upward flow of blood in the
veins is ensured by small one-way valves that prevent backflow. Defective
valves, or compression of the vein by a nearby structure, can cause dilatation
of the testicular veins near the testis, leading to the formation of a
varicocele.
Symptoms
of a varicocele may include:
·
Dragging-like
or aching pain within scrotum.
·
Feeling
of heaviness in the testicles
·
shrinking
of the testicles
·
Alteration
of testosterone levels
·
Visible
or palpable (able to be felt) enlarged vein
Much like the appearance of varicose veins in
legs, the varicocele can be best seen or felt when standing. In the standing
position, men with varicoceles may note fullness around or above the testicles.
This fullness should disappear when lying down. This is called “reflux” when
blood travels the wrong way (backwards) through a vein called the testicular
vein.
Masturbation is, of course, a
common cause of varicocele, but mental incontinence is just as likely to
produce it. Ungratified sex excitement, frequently repeated, is almost certain
to cause it to a greater or less degree. But if one is much debilitated, with
tissues lacking in tone and circulation weak, one may possibly develop
varicocele without any specific abuse. Tight clothing may have something to do
with it. Constipation is a cause in many instances. The wearing of a truss, the
presence of a tumor, or any other obstruction to the circulation, might cause
it.
Varicoceles, basically raises
the temperature in the testicles, which affect the production of sperm, as well
as sperm movement and/or shape. It may also affect other aspects of sperm
function. But, it is unknown by what mechanism varicoceles may impair
fertility.
Research shows that fifteen
percent of men have varicoceles. Interestingly, varicoceles are identified in
40 per cent of men with fertility problems and 80 per cent of men who have had
a child or children and are having trouble conceiving another one. Based on
these statistics, a few conclusions can be drawn: Not all varicoceles are
significant, many varicoceles are associated with male fertility problems,
there seems to be a damaging effect over time in some men with varicoceles.
To diagnosed varicocele, the
physical exam is performed in a warm room to avoid the “cold shower” effect on
the scrotum. The examination must be performed lying down and standing up.
A varicocele can also be seen
on an ultrasound too. This test is useful for men with very tight scrotums or
for obese men. In both cases, a physical examination can be difficult.
More so, varicocele raises the
scrotal temperature. This has been shown in scientific studies. The average
scrotal temperature is approximately 94 degrees F but it is higher in men with
varicoceles. We know that other causes of increased intrascrotal temperature,
such as hot tub use and excessive laptop use, are associated with decreased
semen quality. This also explains why a man who has a varicocele on the left
side only can have decreased semen quality.
In treating varicocele,
procedures involve blocking the flow of blood in the veins so that they cannot
reflux. This can be done from outside the veins (surgery) or from inside the
veins (embolization). The testicle then drains itself through other channels
which generally do not reflux.
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