Varicocele: Symptoms, Diagnosis, and Management

Varicocele repair

Hello, doctor.
Last week, one night after taking a shower and sitting on a chair, I suddenly experienced severe pain in my testicles.
The pain was so intense that I couldn't sleep that night.
Although it improved slightly the next day, I still felt pain.
Thinking it would gradually alleviate, I went to work as usual.
However, the pain did not improve that evening, and I noticed swelling in my testicles.
Therefore, I went to the urology department the following day.
Dr.
A examined me through palpation and ultrasound and diagnosed me with mild varicocele, indicating that there was no severe inflammation, so I shouldn't worry too much.
He prescribed antibiotics and painkillers and scheduled a follow-up appointment with Dr.
B three days later.
The pain improved over the next two days, but I still experienced persistent discomfort.

When I visited Dr.
B for the follow-up, he examined me and reviewed my urine test results.
He concluded that there was no varicocele but rather a urinary tract infection causing inflammation and swelling.
He also prescribed a different set of antibiotics and painkillers.
After taking the medication as prescribed for two days, I no longer felt pain, and after stopping the painkillers, I did not experience any unusual symptoms.
I was able to perform light exercises without discomfort.

However, yesterday, due to work commitments, I walked for an hour in the afternoon and did a few push-ups before bed (only half the usual number I perform).
Unfortunately, my testicles began to feel uncomfortable and painful again, and I noticed some prominent veins on my scrotum, which seem to align with the symptoms of varicocele.
Although the pain is much milder than when it first occurred last week, I still feel discomfort today, and the prominent veins on my scrotum have not subsided.

My questions are: Do the prominent veins caused by varicocele disappear? If they do, can they easily reappear and cause pain due to exercise or sexual activity? Additionally, if Dr.
A's initial assessment was correct and I indeed had varicocele, does the absence of discomfort after stopping medication in the second week, along with my ability to jog and perform light core exercises (since Dr.
B said it was an infection, I thought I had recovered and resumed my exercise routine), indicate that my condition is not severe? However, why did my symptoms seem to worsen after just a slight increase in physical activity, especially when the exercise load was only half of what I usually do? Does this mean that once diagnosed with this condition, it is difficult to return to previous exercise habits without surgery? (Due to family medical history, I need to pay close attention to exercise, primarily engaging in jogging, ball sports, push-ups, and core stability exercises, without heavy weight training.) Thank you for your assistance, doctor.

JANM, 30~39 year old female. Ask Date: 2020/01/17

Dr. Du Mingyi reply Urology

After recovering from testicular inflammation, it may be more appropriate to rest for a while before resuming exercise.
It is advisable to monitor the situation for some time, and if there are still issues with pain, then seek medical attention.

Reply Date: 2020/01/17

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. It is a common condition, particularly in young men and adolescents, and can lead to various symptoms, including pain, swelling, and potential fertility issues. Understanding the symptoms, diagnosis, and management of varicocele is crucial for effective treatment and maintaining quality of life.

Symptoms of Varicocele
The symptoms of varicocele can vary from person to person. Common symptoms include:
1. Pain or Discomfort: Many individuals report a dull ache or sharp pain in the scrotum, which may worsen after prolonged standing or physical activity. The pain can sometimes be relieved by lying down.

2. Swelling: The affected testicle may appear swollen or enlarged due to the engorged veins.

3. Visible Veins: Some men may notice prominent, twisted veins on the surface of the scrotum, often described as looking like a "bag of worms."
4. Infertility: Varicocele is associated with decreased sperm production and quality, which can lead to fertility issues.

Diagnosis of Varicocele
Diagnosis typically involves a physical examination and imaging studies. During a physical exam, a healthcare provider may palpate the scrotum to identify any abnormal veins. An ultrasound may be performed to confirm the diagnosis and assess the severity of the varicocele.
In your case, it seems that two different doctors provided differing opinions on the diagnosis. The first doctor suspected a mild varicocele, while the second attributed your symptoms to a urinary tract infection (UTI). This discrepancy highlights the importance of thorough evaluation and possibly seeking a third opinion if symptoms persist.

Management of Varicocele
Management strategies for varicocele depend on the severity of symptoms and the impact on fertility. Options include:
1. Observation: If the varicocele is asymptomatic or causing minimal discomfort, doctors may recommend monitoring the condition without immediate intervention.

2. Medications: Pain relief can be managed with over-the-counter pain relievers. In cases of infection, antibiotics may be prescribed, as seen in your treatment.

3. Surgery: If the varicocele causes significant pain or fertility issues, surgical intervention may be necessary. The most common procedure is varicocelectomy, which involves tying off the affected veins to redirect blood flow.

Addressing Your Concerns
Regarding your specific questions:
1. Floating Veins: The appearance of prominent veins can fluctuate based on various factors, including physical activity and body position. They may not disappear completely but can become less noticeable when lying down or resting. However, they can become engorged again with physical exertion or sexual activity.

2. Symptoms and Activity: If you initially experienced improvement after stopping medication but then noticed a resurgence of discomfort after light exercise, it may indicate that your varicocele is sensitive to physical strain. This does not necessarily mean your condition is severe, but it does suggest that you may need to modify your activities to prevent exacerbation of symptoms.

3. Long-term Management: Many individuals with varicocele can manage their symptoms effectively without surgery, especially if they are mild. However, if you find that your symptoms significantly impact your lifestyle or if you have concerns about fertility, discussing surgical options with a urologist may be beneficial.

4. Exercise and Lifestyle: Maintaining a healthy lifestyle is important, especially with a family history of varicocele. While you may need to adjust your exercise routine to avoid exacerbating symptoms, many individuals with varicocele can still engage in moderate physical activity. Consulting with a healthcare provider or a physical therapist can help tailor an exercise program that minimizes discomfort.

In conclusion, varicocele is a manageable condition, but it requires careful monitoring and sometimes intervention. If symptoms persist or worsen, further evaluation and discussion with a healthcare provider are essential to determine the best course of action.

Similar Q&A

Managing Varicocele: Symptoms, Treatment Options, and Relief Strategies

Hello Doctor, I have been experiencing varicocele for about two years. Recently, I had an examination, and the doctor stated that "surgery is not necessary," but on that day, the varicocele was less pronounced due to the cold weather. Normally, the left side shows a sig...

Dr. Du Shixi reply Urology
Hello: Please take care of your lifestyle and avoid excessive abdominal strain for prolonged periods, as neglecting this after surgery can increase the risk of recurrence. It is advisable to have regular follow-ups at a major hospital. Wishing you good health.

Understanding Varicocele: Symptoms, Diagnosis, and Treatment Options

I would like to ask the doctor, I was recently diagnosed with varicocele, and my scrotum appears to be uneven in size. I have a slight feeling of fullness in my lower abdomen, and I had a semen analysis done once, which showed a sperm count of approximately 6 million; this test w...

Dr. Fu Shizhang reply Urology
Varicocele is primarily diagnosed through visual inspection and palpation, with ultrasound serving as an auxiliary tool that is not always necessary. The main treatment approach for varicocele is surgical intervention.

Understanding Varicocele: Symptoms, Risks, and Management Tips

Hello, I would like to ask about a previous diagnosis of varicocele on both sides, with the left side being more severe (a significant mass surrounding the testicle). A year and a half ago, I had a semen analysis, which showed a slightly low concentration (42 x 10^6/ml), but ever...

Dr. Xu Weikai reply Urology
Mr. Lin: Hello, it is recommended to have regular check-ups, preferably including a testicular ultrasound to measure size, every six months. If there are significant changes, active treatment is advised. Additionally, semen analysis and male endocrine evaluations can be conducted...

Understanding Varicocele: Symptoms, Concerns, and Treatment Options

Hello Doctor, I am starting my freshman year this year, but I have noticed since my first year of high school that sometimes when I go out with my family and walk for a long time, I feel a kind of swelling sensation in my left testicle, which is a bit uncomfortable. It's not...

Dr. Du Shixi reply Urology
Hello: 1) Intense exercise can inevitably exacerbate symptoms, but varicocele is caused by impaired blood flow. You might try exercising at different times and avoid prolonged sitting or standing to prevent poor venous return. 2) Many people have varicoceles, and it is perfectly ...