Varicose Veins in the Scrotum: What’s the Deal?

June 16th, 2010 § 124 comments

The testes must be kept cool for the proper production of sperm.  One way the human body achieves this is to house them outside the body.  Another is to have a network of veins surrounding the artery pumping blood into the testis: the veins take the heat away in a “counter-current” heat exchange similar to a radiator.  (The human body is an amazing piece of engineering.)

Arteries don’t need to worry about moving blood; there’s a huge amount of pressure coming from the heart to help with that.  But once the blood goes through the capillaries and into the veins, getting back to the heart isn’t easy.  Veins have little valves to help hold the blood while it pulses its way back.  If those little valves start to separate, the vein expands, causing the condition known as a “varicose vein.”  Varicose veins can happen in many places in the body, often visibly in the skin of the legs, but, believe it or not, also in the scrotum.  And if varicose veins develop in the scrotum, they can disturb the counter-current heat exchange.  The testes then get hot, posing a problem for developing sperm cells.

Varicose veins in the scrotum are called a “varicocele,” and there are three kinds.  A grade I varicocele can’t be felt or seen without equipment like ultrasound.  Almost all experts now consider grade I varicoceles to be unimportant.  Varicoceles that can be felt (grade II) or visible by the naked eye (grade III) are the ones that may cause problems with sperm production. Some men have such high sperm production that their varicoceles don’t significantly alter their chance of making women pregnant.  But many men’s testes are affected by grade II or III varicoceles.

Inside of a man, the left vein draining the testis back towards the heart is longer than the right. As a result, varicoceles are most often found in the left scrotum. Sometimes, they’re on both sides, and infrequently, they’re on the right side alone. A right sided varicocele that suddenly appears in adult life is worrisome, as it may be a sign of kidney cancer.

What can be done about a varicocele that may be throwing a wrench into the sperm factory?  A urologist can tie or clip the veins in a procedure called “varicocelectomy,” or an interventional radiologist can inject material into the veins to block the flow of blood.

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§ 124 Responses to Varicose Veins in the Scrotum: What’s the Deal?"

  • Gabriela says:

    Hello!
    My husband is 35, he has low sperm count (8.000.000 sperm/ml, 60% motitily before varicocele removal with sklerotherapy. On the hospital letter there is no information about its grade, whether I, II, III-but I assure you we couldn’t see any veins on the scrotum). At 5 months after the surgery his spermcount was 200.000 sperm/ml, no motility. I got no explanation from the dr. It was something like: “Oh, the surgery was a success, the varicocele is no longer there” What about the pooor spermcount? “Well, it seems that varicocele was not the cause”

    I want your opinion about it. How can this happen? Is there a scidentific evidence?

    Thank you very much.

  • maledoc says:

    Sorry, I can’t answer specific questions about your husband’s health. See the FAQ at http://www.maledoc.com/blog/faq/

  • Gabriela says:

    Dear Maledoc, I understand you can’t give answers to specific questions. I’ve been trying to find an urologist who could tell me what can happen during the injection of material into the varicose veins. Is there any risk to inject and block other channels that are supposed to transport sperm? My husband had a new sperm count yesterday showing the same 200.000 sp/ml, immobile. At 9 months after the surgery his spercount is that of a guy just underwent vasectomy. He had 8.000.000 sp before the surgery, this thought drives me crazy and I want an explanation. I’d happily visit you at the university, the problem is that I live in Romania-Europe.

    You have no responsability for my husband’s surgery, I just want your opinion, as a specialist.

    My husband was on Clomid for 50 days, 50mg/day at the end of 2010 and it seems that it did not push spermatogenesis.

  • maledoc says:

    Sorry, Gabriela, I can’t answer specific questions about your husband’s health. See the FAQ at http://www.maledoc.com/blog/faq/ If you’re looking for a urologist with an interest in male reproductive medicine, a great place to start is http://www.ssmr.org/doctors/locate.aspx. Please don’t ask again with specific questions about a patient.

  • Adi says:

    Hi Doc, I think I too have a varicocele in my left testes. There is a mild pain during the day which is occasionally distracting. The problem is I am used to a certain amount of physical actvity. This is where the problem is, If I Jump from as low as a metre, I get this shooting pain. What is the solution for this. Also is it possible to relate this to a mild discomfort in the middle back and left part of the body just above the waist bone.

  • dean says:

    what cpuld be the after affects of having a varacose vein

  • Ray says:

    I just came by accident to this site; you people are asking your questions from a person who is not a doctor go to your doctor or any online doctors to get a medical answer.

    Don’t waste your time go

    • maledoc says:

      Just to clarify, Ray, I am a doctor and one who specializes in male reproductive medicine. I explain that in the “About” section. I can’t answer personal questions about someone’s own health because that requires seeing a doctor in person so that he or she can assess the physical nature of whatever is happening and establish a relationship with the patient.

  • GB says:

    How do varicocele affect sperm count and motility? Could a varicocele be a significant contributor to male infertility?

    • maledoc says:

      By heating up the testes. They’re outside the body cavity to keep them cool, and a varicocele heats them up. Yes, a varicocele that a doctor can feel (grade II) or see (grade III) can cause male infertility. A varicocele that can only be seen on a test like an ultrasound probably isn’t significant.

  • Hussein says:

    if varicocele on the left side of the testes is diagnosed and is either grade II or grade III and left untreated can it cause any other problem in the long haul other than infertility. Say can it destroy the testes that has varicocele veins or cause any other major complications?

  • EW says:

    If the varicocele affects sperm production, can it also affect testosterone levels? If it affects testosterone levels, what are the possible side affects related with that? Should this be mediated with a synthetic testosterone?

    • maledoc says:

      If severe enough, varicoceles may affect testosterone production. For the effects of external testosterone on sperm production, please read other posts on this blog.

  • john smith says:

    Can having 1 big varicose vein lead to more that are connected to that branch of veins? In other words will the back flow of one varicose vein leak into other veins that it is connected to?

    My doc explained that if you remove a varicose vein that the pressure will just flow into the next vein, but it seems like this happens anyway with the back flow of this initial vein.

    Also, what contributes to varicose veins occurring (lifestyle wise)? And why can the occur at random (all of the body) in a healthy person? And what can I do to stop the progression of varicoceles? Will icing help?

    Lastly is there any sort of specialist that treats or diagnosis’s varicose veins as a whole? Such as having them in more than one place, and having a bunch of veins dilating for no apparent reason all over?

    Thanks

    • maledoc says:

      I’m sorry, John, but I can’t answer personal questions about your own health. Please read the FAQ. You really need to ask these questions to your doctor.

  • Chad says:

    Can a past case of severe Obesity during puberty years stunt growth and cause damage to male fertility? Furthermore could it have increased the risk of developing varicose veins in the Testicles? On the other side of the coin could extreme Weight loss in a very quick period of time cause any fertility issues? Any input on this matter would be greatly appreciated.

    • maledoc says:

      Obesity can affect male fertility, but the case that you’re describing is very specific. I’d recommend that such a specific case see a doctor for the best evaluation and treatment.

  • john smith says:

    I am sorry but, how are my questions personal?

    They are knowledge based questions (with a minor reference to my docs description of the disease and whether or not it is accurate), and I was careful to word them that way.

    Please read my questions again.

  • john smith says:

    Can having 1 big varicose vein lead to more that are connected to that branch of veins? In other words will the back flow of one varicose vein leak into other veins that it is connected to?

    Or, will removing these veins cause the extra pressure and lead to varicose veins in other veins? Are they better left alone if symptoms are not present, in general? Or are these veins completely useless?

    Also, what contributes to varicose veins occurring (lifestyle wise)? And why can the occur at random (all of the body) in a healthy person? And what can I do to stop the progression of varicoceles? Will icing help?

    Also is it a different classification of varicocele, if the affected veins are at the base of the scrotum, rather than around the spermatic cord?

    Are men who have varicose veins on their calves allowed to do weight training for those muscles. Such as the leg press? Or should all leg weighted exercise be avoided?

    Lastly is there any sort of specialist that treats or diagnosis’s varicose veins as a whole? Such as having them in more than one place, and having a bunch of veins dilating for no apparent reason all over?

    I hope my revised questions are now acceptable, I am not being facetious, all I want if more knowledge about the disease, and I respectfully apologize if I offended you.
    For a disease that affects so many people, both men and women, there seems to be very little information out there, and efficient treatment options as well.

    • maledoc says:

      Hi John, veins are interconnected, and if the valves fail, blood flows in the wrong direction throughout the veins that had failed valves. Removing the veins causes the blood to go through other veins, and the network is so large that overall pressure remains the same. We don’t know what makes the valves fail in the first place, probably a genetic predisposition. There are a few classification systems; I describe the one that makes the most sense to me. I can’t talk about what men are “allowed” to do–that implies that they’re under the care of a doctor. Such a man should ask his doctor what he’s “allowed” to do. Most urologists and some interventional radiologists treat varicoceles.

  • amarratna patil says:

    my problem is vericocele in scotum last sperm count is zero second last time sperm count is 2 million so please give right treatment about this problem.

    thank you………..

  • Simon says:

    Is a varicocelectomy carried out under local or general anesthetic and what is the usual recovery period – e.g time away from work? Many thanks

  • Laura says:

    Hello,

    I have two questions,

    1) What is the comon substance used by an interventional radiologist that is injected into the veins to block the flow?

    and secondly;

    2) Is there any evidence to suggest that varicocele’s attribute to premature ejaculation?

    Thank You

  • david says:

    Helloo i am 15 and for nearly 2 years now i have noticed on my left side of my scrotum is bigger than the right side and it is visible that i have a vein or arterie which has lumps and causes me some pain when i am sat down i dont know what to do i darent tell my parents and i dont know if it is serious but it sounds like this vericose vein thing can you get back to me with what you think i should do thankyou very much

  • Louann says:

    How does one develop a vericose vein in the testicle? Would a vericose vein cause the testicles to hurt after intercourse? What are the common methods of treatment for such veins?

    • maledoc says:

      (1) Most of the evidence points to a combination of genetics and circumstance, like varicose veins anywhere in the body. (2) Probably not, but anything’s possible. (3) Surgery and interventional radiology.

  • Mike says:

    In general, are varicose veins still useful to the bodies circulation?

    Also how unusual is it to have varicose veins on the base of the scrotum skin, and not necessarily in the spermatic cord?

    Thank you.

    • maledoc says:

      That’s a great question, Mike. As veins are a network, getting rid of the problematic ones still allows blood to get back to the heart. Arteries are different: if one gets blocked, the organ on the other side usually suffers, like a heart attack or stroke. Superficial skin veins are different when it comes to fertility. They may not be pretty, but they usually don’t affect sperm.

  • Jim says:

    Can tthe varice be on the surface and bleed ? Previously diagnosed with varice on scrtom but now one spot bleeding.

  • Raj says:

    1) Grade 1 varicocele can cause a reduction in Motility/sluggish motile ?
    2) Can it cause increase in ‘dead forms’ ?

  • Madhu says:

    Sir,

    I am suffering with vericoce veins in my left testis and sometimes, it give immense pain. Can you please suggest best way to get rid of this problem without surigical correction.

  • daniel says:

    Can having vercoceles be fatal if say it were to be a level 3

    • maledoc says:

      I’m not sure what you mean by ‘level 3’. There is a rare condition where a kidney tumor can make itself known by a sudden appearance of a varicocele, so any man who suddenly gets a varicocele should see his doctor urgently.

  • daniel says:

    Is a scrotom full of dark veins and is common to see them through the skin I’m not referring to myself I just want to gain knowledge about this particular area

    • maledoc says:

      You’re describing something visual with words. I’d really recommend that a man with what you describe see a doctor to have the doctor examine his scrotum and render an opinion.

  • Sami says:

    Hi DR. This is a general question. If someone has vericoce for a long time ‘let’s say grad II”. Will it increase the chance of infertility?…. long time more than 4 years.

  • mack says:

    I had the surgery 2 months ago and still having pain is that common?

  • Ben Kearsey says:

    Hi I’ve have varacosse veins grade 2 I have taken a fertility test and shows my fertility is atleast 5 million but under 20 million. Would you say the varacosse would be effecting my sperm count?

  • mr Smith says:

    Hi Doc, I would just like to know more about the treatment of varicose veins in the scrotum? Could you please explain the different methods preferably the least painful ones?? Thanks

  • Nell says:

    Maledoc, can the veins on a male scrotum mean heart disease?

  • john says:

    I had surgery,when can i have sexual intercourse?

  • Raj says:

    If varicocele found by ultrasound and fertility found normal still is it a MUST that vericocele be repaired ??

    • maledoc says:

      If it can’t be felt but is only seen on ultrasound, then it’s a grade I varicocele as explained in the post. Please read the post where I write that “Almost all experts now consider grade I varicoceles to be unimportant.” Please also read my other posts and comments. There’s more about varicocele on this blog than just this post.

  • rahul says:

    can anyone join army with varicocele grade III is it permanent disqualification in army medicals..

  • Judi says:

    Does having one varicose vein in 1 testicle affect the production of another ?

  • Doug says:

    Do you perform surgery on a patient with severe enough varicose veins on a scrotum? Is so, what procedure do you use? How many patients have you performed this surgery on?

  • Ben says:

    I’ve read that exercise is good for varicose veins, but other sources say running is not good. My question is if running is bad, is fast walking also bad? And if varicose
    Veins are more present (obvious) after exercising, has that exercise permanently affected the veins in a bad way, or will they subside later?

    Should one build up to exercise having varicose veins, and how much exercise per day is appropriate?

  • munna says:

    Sir which type of treatment are available for varicocyle vein in testicle. at grade 3. which surgery improves pregnancy rates,?which is better surgery Micro surgery or embolization? Or any better treatments are available?

    Thanku sir.

  • Jacob says:

    I have been experiencing sporadic waist pain especially when I walk a long distance or when I stand for a long time. It can happen for between 15 minutes to an hour. I have been diagnosed of hydrocele and varicocele and I do not know these are the cause of the waist pain. I did ask my GP and he said it could possibly be. I am awaiting surgery for the two conditions.

    I would like to know if my waist pain is due to the conditions mentioned.

    Thank you

  • Pat Kurtz says:

    Great post. I enjoyed reading it. One of your answers to a question above was in regards to how varicose veins, if severe enough, can effect testosterone levels. Could this lead to gynecomastia? Are surgeries that deal with varicose veins cosmetic or are they covered under insurance?

    Best regards,

    Pat

    • maledoc says:

      Thanks! Gynecomastia in a man doesn’t usually result from declining testosterone. As for insurance coverage of any surgery, that’s a discussion between the insurer and the patient.

  • Chris says:

    Can sperm from a man with untreated varicocele produce a child with deformity?

    • maledoc says:

      That’s a great question, Chris. There isn’t good evidence to link varicoceles and birth defects. Some scientific studies suggest a link between varicoceles and fragmented DNA, but that would likely make a man infertile rather than produce birth defects.

  • yogesh says:

    i m 20 year old n i hv same problem .. if i does surgery then any problem in future reagarding sex n all ???

  • Ken says:

    What if varicose veins in the scrotum do not heat up the testis,should it be a problem?

    • maledoc says:

      Hi Ken, one of the theories why a varicocele may affect a man’s fertility is that it heats up the scrotum. There are other theories, too. A man with a varicocele who is concerned about his fertility should see a doctor so that tests can be done to assess his reproductive health.

  • Ken says:

    Can premature ejaculation be linked to scrotum varicose?

  • kelvin says:

    does varicocele cause pain in the scrotum?

  • Ken says:

    Thank you so much doc,but pls can scrotum varicose caused by excess masturbation be treated with surgery?

  • Ken says:

    How can one know a dead testis?

  • John says:

    If one have veins under left testis,could it be varicose or normal veins? Or is it okay to have veins under left testis that don’t cause pain or discomfort?

  • Mike says:

    After getting surgery for vericose veins is it possible for the doctor to damage a nerve so you have no control or feeling of the testicle? If so can anything be done? Thanks

    • maledoc says:

      Hi Mike, many things are possible with surgery, some predictable, some not. Any man having an effect after surgery that causes him concern should discuss it with his surgeon.

  • Adam says:

    Is it at all common to have veins on the left side of the scrotum?

  • haroon says:

    I have varicocele problem in my left testicle but my sperm count is normal and neither i feel pain nor any dis-comfortability. So should i go to any Doc or ignore it??