Condition: Varicocele
Brief Overview: According to Johns Hopkins Medicine, “Varicocele is a term used to describe abnormally dilated veins (called the “pampiniform plexus” of veins) in the scrotum.”
Prevalence: According to UpToDate, varicoceles are “present in 15 to 20 percent of postpubertal males.”
Etiology: According to UpToDate, varicoceles are “caused by dilatation of the pampiniform plexus of spermatic veins.”
Commonly Associated Conditions:
- Male infertility
- Low testosterone
- Secondary varicocele
Common Medications:
- NSAIDs
Common Labs, Imaging, and Tests:
- Diagnosis can be made on physical exam
- Scrotal ultrasound if needed
- Abdominal US, CT, MRI may be indicated in some cases
Common Symptoms:
- Can be asymptomatic
- Left testicular atrophy
- Dull, achy, scrotal pain (typically left-sided). Usually is most noticeable when standing and improves with lying down
- Visible or palpable dilated veins (“bag of worms”)
- Testicular asymmetry
- Heavy feeling in one testicle
Common Treatments:
- No treatment/intervention may be needed
- Surgical ligation
- Percutaneous venous embolization
- Scrotal support
Physical Findings:
- According to UpToDate, “A varicocele is diagnosed by its characteristic physical findings, which range from minimal left-sided scrotal fullness on Valsalva maneuver to a large, soft, left-sided scrotal mass ("bag of worms") that decompresses and disappears in the recumbent position.”
Potential Complications and Contraindications:
- Fertility problems
- Scrotal pain/discomfort
- Decreased testosterone production
General Health and Lifestyle Guidance:
Suggested Questions to Ask Patients:
- Do you experience scrotal pain, swelling, or heaviness?
- Is your discomfort worse after standing or physical activity?
- Have you noticed any changes in testicular size or fertility?
- Are you currently trying to conceive?
- Have you had any prior scrotal injuries, surgeries, or infections?
- Has your provider discussed surgical options or fertility evaluation?
Suggested Talking Points:
- A varicocele is like a varicose vein in the scrotum—it’s common and often treatable.
- It can affect sperm quality, but surgery or embolization can often improve fertility.
- Supportive underwear and lifestyle changes can help relieve mild discomfort.
- If you experience pain or fertility concerns, a urologist can review treatment options.
- Even after treatment, regular follow-up is important to monitor for recurrence.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/nonacute-scrotal-conditions-in-adults?search=varicocele&source=search_result&selectedTitle=1~15&usage_type=default&display_rank=1#H196748973
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/varicocele
- https://my.clevelandclinic.org/health/diseases/15239-varicocele
- https://www.urologyhealth.org/urology-a-z/v/varicoceles