Many young, active men come to the clinic complaining of pain or discomfort in the scrotum (the scrotum). They often assume the complaint is caused by a sports injury. However, upon further examination, the cause is revealed to be a varicocele , a condition often mistaken for a sports injury but actually a disorder of the blood vessels surrounding the testicles.
What is a Varicocele?
A varicocele is a dilation of the veins in the scrotum, similar to varicose veins in the legs. This condition occurs when blood flow from the testicles is disrupted, causing blood to pool in the veins, causing them to enlarge.
Varicoceles are most often found on the left side of the scrotum due to differences in the anatomy of the blood vessels on the left and right sides of the body. This condition usually begins to appear during puberty and can progress slowly over time.
Why is it often mistaken for a sports injury?
Men who actively exercise often experience pain or heaviness in the groin area after physical activity. These symptoms are similar to those caused by muscle strains or other sports injuries.
However, exercise is not the primary cause of varicoceles. Strenuous physical activity can only exacerbate symptoms by increasing pressure within the veins. As a result, sufferers may experience pain, soreness, or discomfort after exercise, leading them to believe they have suffered an injury.
Varicocele Symptoms to Watch Out For
Most people with varicoceles don't experience any symptoms. However, in some cases, symptoms may include:
- Dull pain or discomfort in the scrotum.
- Heaviness on one side of the scrotum.
- Pain that worsens when standing for long periods or after physical activity.
- Complaints that improve when lying down.
- Visible or palpable winding blood vessels like a "bunch of worms".
- The size of one testicle appears smaller than the other.
Because symptoms are often mild, many men only discover they have a varicocele when undergoing fertility testing.
Are Varicoceles Dangerous?
Varicoceles aren't always dangerous, but they shouldn't be ignored. In some cases, they can affect testicular health and sperm quality. Increased temperature around the testicles due to blood buildup is thought to interfere with sperm production, potentially leading to infertility in men.
It's estimated that around 40% of men experiencing infertility have varicoceles. However, not all varicocele sufferers will experience fertility problems.
How to Diagnose Varicocele?
A urologist will usually perform a physical examination of the scrotal area. If necessary, the examination may be followed by a scrotal Doppler ultrasound to assess blood flow and confirm the presence of dilated veins.
Further testing may also be recommended if the patient has complaints of chronic pain or is undergoing fertility evaluation.
When Does a Varicocele Need Treatment?
Not all varicoceles require surgery. Treatment is usually considered if:
- Causes pain that interferes with activities.
- Causes impaired sperm quality or infertility.
- Causes a reduction in the size of the testicles.
- Causing increasingly severe complaints over time.
Treatment options can include observation, medication to reduce symptoms, or surgery or embolization in certain cases, depending on the urologist's evaluation.
Don't assume all groin pain is an injury.
Not all pain in the groin or scrotum is caused by exercise. If you experience recurring pain, a lump, a feeling of heaviness in the scrotum, or are having difficulty conceiving, consult a urologist immediately.
Proper detection and treatment can help maintain men's reproductive health and prevent complications that may occur later in life.
Don't let a seemingly minor varicocele affect your quality of life and fertility. Seek early examination for proper diagnosis and treatment.
This article was written by Dr. Dwiki Haryo Indrawan, Sp.U (Urology Surgeon Specialist at EMC Pekayon Hospital).