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A varicocele is a mass of dilated and twisted veins of the spermatic cord. It's often likened to a "bag of worms" in its appearance. A varicocele is not unusual. At least 15 percent of boys and young men aged 10 to 19 have diagnosable varicocele, and the actual percentage may be much higher. About 35 percent of men who have fertility issues later in life have varicocele. However, 85 percent of men who have had varicocele are able to have children later in life even without treatment; the percentage of men who become fathers is 75 percent in those who have had treatment. (The lower percentage of fertility in men who had surgical treatment may be due to the fact that the more severe cases are treated, not due to surgery's causing infertility.)

Varicocele almost always occurs in the left testicle, not the right. That's because of the angle at which the left testicular vein enters a larger vein that carries blood away from the kidneys back to the heart. The left testicular vein does not have any valves that keep blood from back up and swelling it. And the renal vein into which the left testicular vein empties itself undergoes a kind of "nutcracker" effect, because of two other blood vessels that place pressure on it. However, some men have varicoceles in both testicles, the venous distortion in the right testicle not as noticeable, or only noticeable during the Vasalva maneuver, attempting to exhale with the mouth and nasal passages closed.

The way varicocele lowers the viability of sperm is by overheating the testes. Blood that backs up around the testicle keeps it warmer. The body's core temperature is about 98.5 degrees F (37 degrees C). Sperm develop best at temperatures 1 or 2 degrees F lower than core temperature. Spending time in a hot tub or sitting on a heating pad is enough to affect a "batch" of sperm. Even tight underwear can affect sperm quality in men who don't have variocele. All of these factors are compounded by knotted, twisted veins that hold blood in the testicle so the testicle is naturally closer to the body's core temperature.

There are things all men can do whether they have varicocele or not to increase their fertility. These concepts are even more critical for men who have varicocele:

  • Avoid sexually transmitted diseases. If you are having sex with someone you don't know, always use a condom. If you develop symptoms of chlamydia or gonorrhea (penile discharge not due to intentional ejaculation or nocturnal emission, burning during urination, sensation of retained urine or having to "go" all the time), get the infection treated promptly. Take all the medications you are prescribed even if you feel better.
  • Avoid use of steroids. Anabolic steroids reduce sperm production, and cause other health issues.
  • Get varicose veins in your penis treated, too. Blue, twisted veins in your penis also affect blood flow to your testicles. They also need medical treatment.

You can't have varicocele surgery for at least six months after you have a vasectomy (in which case, you didn't want to have children, but you still might want to repair your testicle). Varicocele surgery could cut off too much circulation to the testicle and cause atrophy. On the other hand, if you want to have surgery so your testicle will finally grow to its normal size, be sure you have the surgery as soon as possible (preferably while you are still a teenager), When you do have the surgery, remember that pink is safe but purple is deadly. A little pinkness around your testicles is normal. Purple, black, or blue are a sign that a hematoma has formed, and that would require immediate medical attention.

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