Varicocele - Symptoms, Causes, Prevention, Treatment

A varicocele is an anomalous enlargement or dilation of veins located inside the scrotum (a pouch that holds the testicles). Varicocele is a prevalent condition affecting males, and it generally affects the left testicle, usually of men between the age of 18 and 25 years. (an organ of the male reproductive organ that produces sperms). They are usually painless; however, in some cases, varicoceles can cause testicular pain.

Varicocele is an abnormal dilation of the pampiniform plexus (veins located inside the scrotum). It is a common condition affecting millions of males worldwide, and it generally only affects the left testicle. 

There is not much evidence on the exact aetiology of a varicocele; however, many causes have been proposed.

Generally, a varicocele is not associated with any significant symptoms, so most of the cases go undetected.; however, in some cases, it can result in testicular pain. Once a varicocele is formed , it will not go away on its own.  Additionally, in cases, of larger varicoceles, you may experience some of the following symptoms: 

1. Infertility (Usually testis function optimally at colder temperatures (3 degrees below the body temperature) But due to varicocele, warmer blood is carried from the abdomen to the testis inside the scrotum affecting the normal sperm functions and morphology) 
2. Soreness and discomfort in and around your scrotum 
3. Dull Testicular aching which is relieved on lying down and raising legs, aggravated during the day
4. Visually enlarged veins in your scrotum, which are often referred to as "bag of worms"
5. Palpable lump above the affected testicle.

On medical examination, varicoceles can be categorized into the following grades, based on their severity: 

1. Grade 0: Can be noticed only after an ultrasound of your scrotum, cannot be detected physically.  
2. Grade I: Can be palpable only when the patient performs the Valsalva manoeuvre (In a standing position, you will be asked to take a deep breath, hold it for a few seconds and bear down while the urologist examines your scrotum)
3. Grade II: Visible on physical examination, without the Valsalva manoeuvre.
4. Grade III: Visible, along with some deformity caused to the scrotum. 

Additionally, you would be instructed to undergo semen analysis if you are concerned about your fertility. 

On medical examination, varicoceles can be categorized into the following grades, based on their severity: 

1. Grade 0: Can be noticed only after an ultrasound of your scrotum, cannot be detected physically.  
2. Grade I: Can be palpable only when the patient performs the Valsalva manoeuvre (In a standing position, you will be asked to take a deep breath, hold it for a few seconds and bear down while the urologist examines your scrotum)
3. Grade II: Visible on physical examination, without the Valsalva manoeuvre.
4. Grade III: Visible, along with some deformity caused to the scrotum. 

Additionally, you would be instructed to undergo semen analysis if you are concerned about your fertility. 

Varicoceles can be either treated at home or at the hospital depending on the severity of your symptoms:

At home:

1. Most varicoceles do not cause any symptoms and hence do require any treatment. You may try homeopathy or ayurvedic treatments from a registered and qualified practitioner of these branches of medicine. 
2. Ice packs: Apply ice packs near and around your scrotal region as it provides relief if you have scrotal soreness and pain associated with varicocele. Do not apply the ice directly but wrap it in a thin cotton cloth and apply for 15-20 minutes at a stretch; repeat this procedure 2-3 times daily for maximum benefit. 
3. Over-the-counter painkillers:  Ibuprofen or Paracetamol can help provide you relief from pain and discomfort associated with varicocele.
4. Lifestyle changes: Avoid strenuous activity like weight lifting or running as they can trigger varicocele symptoms. You can also wear tight underwear or an athletic supporter (jockstrap), which are beneficial in easing stress-induced after prolonged exercise or standing. 

If your symptoms are severe, your doctor may recommend you undergo a surgical or non-surgical procedure, both of which are outpatient procedures. 

There are two approaches to treating varicocele surgically:

1. Laparoscopic varicocelectomy: Your surgeon makes 3-4 small cuts in your abdomen and passes a tube (laparoscope) through one of the cuts and other tools from one of the cuts, following which the surgeon ties the veins feeding the varicocele. 
2. Microsurgical varicocelectomy: It is one of the most common open surgical approaches as it has a high success rate and carries the lowest risk. 

There is one approach to treating varicocele non-surgically:

Varicocele embolization: Your doctor uses tiny coils that penetrate your veins located in the abdominal region to cut off the blood supply to your scrotum.

Varicoceles can be either treated at home or at the hospital depending on the severity of your symptoms:

At home:

1. Most varicoceles do not cause any symptoms and hence do require any treatment. You may try homeopathy or ayurvedic treatments from a registered and qualified practitioner of these branches of medicine. 
2. Ice packs: Apply ice packs near and around your scrotal region as it provides relief if you have scrotal soreness and pain associated with varicocele. Do not apply the ice directly but wrap it in a thin cotton cloth and apply for 15-20 minutes at a stretch; repeat this procedure 2-3 times daily for maximum benefit. 
3. Over-the-counter painkillers:  Ibuprofen or Paracetamol can help provide you relief from pain and discomfort associated with varicocele.
4. Lifestyle changes: Avoid strenuous activity like weight lifting or running as they can trigger varicocele symptoms. You can also wear tight underwear or an athletic supporter (jockstrap), which are beneficial in easing stress-induced after prolonged exercise or standing. 

There is one approach to treating varicocele non-surgically:

Varicocele embolization: Your doctor uses tiny coils that penetrate your veins located in the abdominal region to cut off the blood supply to your scrotum.

1. Prevents testicular atrophy
2. Helps in treating male infertility
3. Helps in increasing the sperm count which has been otherwise hampered by the increased temperature in the scrotum
4. Helps in relieving the pain caused by blood pooling in the testicular veins.

As in most cases, varicocele does not require treatment; it is generally not a life-threatening condition. However, rarely varicocele can have deadly consequences if not treated on time, such as:

1. Decreased testosterone production by the testis (increased temperatures in the scrotum due to warmblood supply affects its ability to make expected testosterone levels.)
2. Scrotal discomfort
3. Azoospermia (no sperm found in the semen) 
4. Abdominal blockage like a mass or tumour (this is very rare, only if size of varicocele is not reduced then some abdominal tumour might be causing the mass.)

As in most cases, varicocele does not require treatment; it is generally not a life-threatening condition. However, rarely varicocele can have deadly consequences if not treated on time, such as:

1. Decreased testosterone production by the testis (increased temperatures in the scrotum due to warmblood supply affects its ability to make expected testosterone levels.)
2. Scrotal discomfort
3. Azoospermia (no sperm found in the semen) 
4. Abdominal blockage like a mass or tumour (this is very rare, only if size of varicocele is not reduced then some abdominal tumour might be causing the mass.)