Illustration Of A Varicocele


Varicocele Symptoms, Diagnosis and Treatment

A varicocele is defined as the enlargement of the veins that drain the testicles.  It’s actually a very common condition among males and up to %20 of all men have a varicocele and up to 40% of infertile men have one.


Doctors aren’t exactly sure what causes a varicocele but the mechanism is well understood.


Since veins are blood vessels that send deoxygenated blood back to the heart, they are equipped with valves that prevent back flow of the blood, like a one-way street.  When the valves malfunction, blood pools in the vicinity and causes inflammation and tortuosity of the veins.


The feeling men describe is like having a bag of worms above the testicle.  One can actually feel the varicocele with the fingers as a tender, twisted mass above the testicle.


Varicoceles can cause pain ranging from a dull ache to a sharp pain, depending on where they are situated.  Some varicocele sufferers experience no symptoms. 


98% of varicoceles occur on the left side of the body.  This is because of the left gonadal vein drains into the left renal vein at a right angle while the right renal vein drains into the inferior vena cava directly.


Varicoceles that occur on the right side are unusual and should prompt examination of the abdomen with ultrasound to determine whether or not a mass is present and causing the venous compression.  While this is certainly a concern, a recent study concluded that most varicoceles are, in fact, bilateral.  That is, they are present on both sides and often missed by ultrasound.


Diagnosing a varicocele typically entails having a doctor exam and feel (palpate) the testes and surrounding area.  If a varicocele is found, it is best to confirm the diagnosis with ultrasound.  This is the most accurate and least invasive diagnostic tool available for finding varicoceles.  Unlike an x-ray or CT scan, ultrasound emits no radiation and is safe to use.  Since even a competent ultrasound technician or radiologist can miss a varicocele it is best to use color-flow Doppler ultrasound if it’s available. 


This procedure is best performed while standing and either bearing down or performing the Valsalva Maneuver. 


This causes a temporary increase in blood pressure and the ultrasound is then able to detect any backflow along the veins of the spermatic chord, which would confirm faulty venous valves (called venous insufficiency) and secure a reliable diagnosis.


A number of potential problems are associated with varicocele including testicular atrophy (shrinking of the testicle), pain, reduced fertility (poorer sperm quality), reduced “male factor” and lowered testosterone levels, since testosterone is produced primarily in the testes.


If, however, tests show a significant impact on these parameters, it may be prudent to consider correcting the varicocele with surgery, laparoscopy, embolization or the Gat Goren procedure. 


On an important side note, it’s crucial to determine that the varicocele is, indeed, the cause of these issues, as hormone levels and sperm quality vary rather widely depending upon many factors including sleep, diet, exposure to sunlight and even just the time of day.  Thus it may be wise to conduct these tests several times before deciding upon having a rather invasive procedure performed. 


The most common reason men undergo varicocele correction is to improve their chances of impregnating their spouses. 


When it comes to varicocele treatment the most common option is surgery.  Essentially, the doctor ties off (ligates) the offending veins so that blood is forced to flow through other channels.  The surgery has potential complications like damage to an artery or the formation of a hydrocele (liquid in the veins) but their incidence is fairly low.  Men can resume normal activity within a couple of weeks of surgery.  One issue that’s present with surgery is that varicoceles recur in up to 20% of patients. 


Another option for varicocele repair is embolization.  Embolization is performed by an interventional radiologist who passes a thin hollow tube through a major vein and guides it down the body to the offending locations where he will inject metal coils or a balloon which cuts the blood flow and forces the blood to reroute.  The procedure is performed using x-ray imaging and thus emits radiation to the patient.  The procedure, itself, is minimally invasive and the patient can typically resume normal activity within a few days of the embolization. 


As with surgery, varicoceles can still recur after an embolization.  One concern with embolization is the small but serious risk that the metal coils will migrate away from the site of the varicocele to the heart, which can be fatal. 


In the Gat-Goren procedure, invented by an Israeli Gynecologist, essentially the same thing happens as with an embolization.  The difference, however, is that instead of using metal coils or a balloon to stop the blood flow to the site of the varicocele, a liquid which selectively closes off the offending veins is injected.  The procedure is performed in Israel by doctor Goren and at the time of this writing costs approximately $9000 US.  The steep pricetag, however, doesn’t deter the hundreds of people who flock from all over the world to undergo the procedure.  And this is certainly understandable considering the risks of surgery and traditional embolization coupled with the high recurrence rate of varicocele.


As you can see, varicocele repair is far from foolproof.  If you elect to manage your varicocele without surgery or embolization, your efforts should be geared towards keeping systemic inflammation as low as possible, maintaining general health and engaging in habits beneficial to fertility. 


While the issue is contentious, I believe that the Paleo diet is the clear winner among dietary practices for reducing systemic inflammation both on the somatic and cellular levels.  The removal of grains, alone, can produce significant health benefits for the average male and the increased intake of high quality fat, protein and cholesterol (which is a chemical precursor to testosterone) all contribute to improved fertility among men and women. 


Any exercise is better than none, but it is heavy resistance exercise that confers the greatest physiological benefit among training routines.  Specifically, studies have shown that resistance exercise using heavy weights with a medium amount of repetition in sessions no longer than 45 minutes incites the greatest hormonal release.  There are several efficacious variations, such as kettle bell workouts, sprinting and even body weight exercises done to failure with significant recovery periods.  Exercise is indeed one of the top preventative and treatment tools at your disposal.


Intelligent supplementation can and should play a role in selectively augmenting health parameters.  The amino acids l-carnitine and acetyl-l-carnitine have been demonstrated to significantly increase sperm quality when used in conjunction with cinnoxicam (an anti-inflammatory medication) in an Italian study.  In the same study, supplementation with l-carnitine and acetyl-l-carnitine alone also improved sperm quality, albeit to a lesser degree than when used with cinnoxicam.


I’ve observed in my extensive body tracking that several other supplements have a mitigating effect on varicocele pain such as fish oil, krill oil, creatine, l-glutamine, whey protein, adequate vitamin D, cannibus and others. 


I hope you see that your options are many and much power lies in your own hands!



Video of a Varicocele Surgery

Video of a Varicocele Embolization