Varicocele: Symptoms, Diagnosis, and Concerns Explained

Varicose veins

Hello doctor, I would like to ask if the blood vessels involved in varicocele are prominent and can be felt as noticeable veins.
I don't see any protruding veins on the surface of my scrotum, but when I pull back the wrinkled areas, I can see something that looks like blood vessels, although they are not protruding and I cannot feel any mass.
Is that just normal blood vessels? Also, is the epididymis located above the testicle? Is it present on both sides? Does the epididymis hurt when squeezed? Currently, I don't have any discomfort; I just happened to come across information about this condition and became worried...
When I palpate above the testicle, I can feel the vas deferens, but it doesn't seem to be varicose; it feels straight, and it feels the same whether I am standing or lying down.

Niming, 20~29 year old female. Ask Date: 2019/03/30

Dr. Du Mingyi reply Urology

Varicocele, if severe, can be visually apparent and should be evaluated at a urology clinic.
The normal pressure of the epididymis should not be painful, and it can occur bilaterally.

Reply Date: 2019/03/30

More Info

Varicocele is a condition characterized by the enlargement of veins within the scrotum, similar to varicose veins that can occur in the legs. Understanding varicocele involves recognizing its symptoms, diagnosis, and potential concerns.

Symptoms of Varicocele
Many individuals with varicocele may not experience noticeable symptoms. However, some common symptoms can include:
1. Visible or Palpable Veins: In some cases, the affected veins may become enlarged and can be felt or seen as a "bag of worms" in the scrotum. This is often more prominent when standing and may decrease in size when lying down.

2. Discomfort or Pain: Some men report a dull ache or discomfort in the scrotum, especially after prolonged standing or physical activity. The pain may improve when lying down.

3. Testicular Atrophy: In some cases, varicocele can lead to a decrease in testicular size, which may be a concern for fertility.

4. Fertility Issues: Varicocele is associated with male infertility, as it can affect sperm production and quality.

Diagnosis of Varicocele
Diagnosis typically involves a physical examination by a healthcare provider, who will look for signs of enlarged veins. In some cases, a Doppler ultrasound may be used to assess blood flow and confirm the diagnosis.

Concerns Regarding Varicocele
1. Fertility: One of the primary concerns with varicocele is its potential impact on fertility. Studies suggest that varicocele can negatively affect sperm parameters, leading to challenges in conception.

2. Pain Management: While many men do not experience significant discomfort, those who do may require treatment options, which can range from lifestyle changes to surgical intervention.

3. Surgical Options: If varicocele causes significant pain or fertility issues, surgical options such as varicocelectomy may be considered. This procedure involves tying off the affected veins to redirect blood flow.

Addressing Your Concerns
Regarding your specific questions:
- Feeling of Blood Vessels: It is common for the veins in the scrotum to be palpable, especially if they are slightly enlarged. However, if you do not feel any prominent or engorged veins, it may not indicate varicocele. The appearance of veins can vary, and not all visible veins are pathological.

- Location of the Epididymis: The epididymis is located on the upper part of each testicle and is responsible for storing and maturing sperm. Yes, both sides have an epididymis.

- Pain When Palpating the Epididymis: It is normal for the epididymis to be sensitive, but it should not cause significant pain. If you experience discomfort that is concerning, it is advisable to consult a healthcare provider.

- Positioning: The position (standing or lying down) can affect the appearance of varicocele. It is often more pronounced when standing due to gravity.

Conclusion
If you have no significant discomfort or symptoms, it may not be necessary to worry excessively about varicocele. However, if you have concerns about fertility or experience pain, it would be prudent to consult a urologist for a thorough evaluation. They can provide personalized advice and determine if any intervention is necessary. Regular check-ups and open communication with your healthcare provider are key to managing any potential issues related to varicocele.

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