Varicose veins in the scrotum, often overlooked, but relevant
A varicocele is a dilation of veins in the scrotum, usually on the left side, caused by congestion of blood flow in the pampiniform plexus. It is the most common vascular disease of the male genitalia and occurs in approximately 5–15% of all men, and in around 20% of adolescents and young adults.
In many cases, a varicocele goes unnoticed; around 80% of those affected experience no symptoms or fertility problems. Nevertheless, it can play a role in men with an unfulfilled desire to have children: studies show that up to 25% of infertile men have a varicocele.
Symptoms and complaints
Although mostly asymptomatic, symptoms can occur:
- A dull or pulling sensation in the testicles, intensified when standing.
- Visible or palpable veins in the scrotum
- Pain, heaviness or testicular atrophy
- Hormonal imbalance can cause symptoms such as loss of libido , elevated estrogen , depressive mood, or erectile dysfunction.
Diagnostics
Diagnosis is usually made by palpation while the patient is standing and lying down, supplemented by a Doppler ultrasound , often bilaterally including the kidney area. If secondary causes such as a kidney tumor are suspected, further imaging is indicated. A semen analysis is also frequently useful as part of the diagnostic process to assess fertility .
Treatment: When and how is it appropriate?
Treatment is usually unnecessary if there are no symptoms or fertility problems. Indications for treatment include:
- pain or a great feeling of tension
- Desire to have children with impaired sperm quality
- Testicular atrophy or cosmetic problems in adolescence
Treatment options:
- Microsurgical ligation of the affected veins
- Sclerotherapy (sclerosing) or embolization with microcatheters and coils
- Good results in improving semen quality and, if applicable, fertility.
Connections to other health topics
- An untreated varicocele can indirectly disrupt testosterone production (through overheating), which in some cases can lead to testosterone deficiency .
- In cases of abnormal sperm quality, a comprehensive hormone status should always be checked, including testosterone , SHBG , LH/FSH , possibly combined with a TRT check from Adon Health.
- Tips on regeneration , exercise and nutrition can help relieve venous stasis and support testicular health.
Conclusion
Varicocele is a common, usually unnoticed vascular change in the scrotum that should be investigated in cases of fertility problems, including sperm analysis , hormone status and, if necessary, urological therapy.
