It is commonly believed that varicoceles are caused by improperly functioning valves within the veins. When these valves do not open and close properly, blood flow can become restricted. This backed-up blood stays within the veins, causing them to swell and become enlarged. Puberty seems to trigger this response due to the increased blood flow that is required for appropriate growth and development of the testicles. While valve problems may account for the majority of these cases, it is also possible for a man to experience a varicocele if there is pressure on any of the veins within the scrotum that reduces or cuts off proper circulation.
There are not always noticeable symptoms for someone who is suffering from a varicocele. In fact, a man may not even know that he has this condition unless it is discovered during a physical examination. When symptoms do occur, the pain is typically more of an ache or a heaviness, though it can also be felt as a sharp or shooting pain in some individuals. Pain may increase with extended activity or through the course of the day, especially during warmer weather. A varicocele may be seen or felt during an examination. The testes may be different sizes, with the left side affected in about 80% of cases. Because there is reduced circulation, the temperature in the scrotum may become higher, potentially damaging sperm. Those without other obvious symptoms may not know that they have a varicocele unless there are problems with fertility. Even then, a smaller varicocele may not be detectable without the use of certain imaging tests.
If there are no symptoms present, a varicocele may not need any type of treatment at all. A varicocele that results in pain or fertility problems may require surgical intervention to restore appropriate blood flow to the testicles. The surgical incision can be made in the groin or in the abdomen for laparoscopic procedures. The most common type of surgery cuts off or restricts blood flow to the affected vein. Once blood flow to the varicocele has been eliminated, the body will naturally reroute blood to healthy veins. This surgery is generally performed on an outpatient basis, allowing the individual to go home afterward.
Most normal activities can be resumed from two days to a week following the procedure. While success rates vary when it comes to an increase in fertility following varicocele repair, it is estimated that up to half of men who have the surgery will be able to have children within a year.