Understanding varicocele

Varicocele is a urological condition in men that’s very common and doesn’t cause issues for many. When problems do arise, they range from discomfort to the possibility of affecting infertility. Leading consultant urological surgeon Mr Giangiacomo Ollandini has put together this expert men’s health guide when it comes to understanding varicocele.

What is a varicocele?

Varicocele is a condition that affects veins in the scrotum – the loose skin that holds your testicles. A varicocele is simply enlarged veins above one or both testicles.

Think of it like this: veins are tubes that carry blood back to your heart. Sometimes, these veins can stretch and widen, similar to how a garden hose might bulge if there's a kink in it. When this happens to the veins near your testicles, doctors call it a varicocele.

How common are varicoceles?

Varicoceles are actually quite common. About 15 out of every 100 men will develop a varicocele. They usually appear during puberty when the body is going through many changes.

Most often, varicoceles develop on the left side. This is because of the way veins are arranged in our bodies. However, some men might have varicoceles on both sides.

What does a varicocele feel like?

Many men with varicoceles don't feel anything unusual at all. However, some men might notice:

• A dull ache or heaviness in the testicle, especially after standing for a long time
• A lump or swelling above the testicle
• A feeling described as ‘a bag of worms’ when touching the scrotum
• Discomfort that gets worse throughout the day or during physical activity

Why do varicoceles matter?

While many varicoceles don't cause problems, they're important for two main reasons:

1. They can cause discomfort for some men, ranging from a mild ache to more noticeable pain.
2. They might affect fertility in some cases. The extra blood in enlarged veins can increase temperature around the testicle. Testicles need to be cooler than body temperature to make healthy sperm. When they get too warm, it might affect how well they work.

How are varicoceles found?

Varicoceles are usually found in one of these ways:

• During a physical exam: A doctor checks the scrotum while you're standing and might ask you to take deep breaths while they feel for any abnormal swelling.
• Using testicular ultrasound: This is a painless scan that uses sound waves to create pictures of the inside of your scrotum. It can show the enlarged veins clearly.

What can be done about varicoceles?

Not all varicoceles need treatment. If a varicocele isn't causing pain and fertility isn't a concern, your doctor might simply suggest keeping an eye on it.

If treatment is needed, there are several options:

1. Surgery: A urologist (a doctor who specialises in men's reproductive health) can tie off the affected veins during a minor operation. This redirects blood flow to healthier veins.
2. Embolisation: A radiologist (a doctor who specialises in medical imaging) can block the affected veins using small coils or a special solution. This is done through a tiny tube inserted through a vein in your neck or groin.

Both treatments are usually successful and have short recovery times.

When should I see a doctor?

It's a good idea to see your GP if:

• You notice a lump or swelling in your scrotum
• You have pain or discomfort in your testicle that doesn't go away
• You and your partner have been trying to conceive without success for more than a year

Remember, varicoceles are common and usually not serious. However, it's always better to have unusual lumps or persistent pain checked by a doctor.

Taking care of your reproductive health

As a urologist, I encourage all men to be aware of how their bodies normally look and feel. Checking your testicles regularly means you'll notice any changes early.

Varicoceles are just one aspect of men's reproductive health. Regular check-ups with your doctor, especially if you notice any changes or have concerns, are an important part of staying healthy.

If you're concerned about fertility, pain, or have noticed any changes in your testicles, please speak with your doctor. We're here to help with any concerns you might have about your reproductive health.