As part of your periodic parent-son chats about sex and sexual development, stress that any sort of genital pain or swelling is cause for concern and should be brought to the immediate attention of Mom, Dad or the pediatrician. One source of scrotal swelling is a varicocele within the scrotum. Like all veins, the veins in the spermatic cord have pairs of flipper like valves interspersed along the inner walls. Their job: to keep blood moving in one direction, toward the heart. Any time the circulation starts to flow backward, the flaps of the valves swing shut.
Varicocele is set in motion when one or more valves fail to close properly. As a result, stagnant blood builds up in the vessel until the wall becomes swollen. The distended scrotal sac is said to resemble a “bag of worms”: a reference to the bulging vessels inside. A varicocele most often develops on the left side of the scrotum.
Symptoms That Suggest Varicocele May Include:
Most varicoceles are painless and do not cause symptoms. Occasionally one may experience dull, persistent ache or sensation of heaviness in the scrotum—often most noticeable after physical exercise. There may be a reduction in testicular size (atrophy).
How Varicocele is Diagnosed
The condition is diagnosed through physical examination and thorough medical history, including probing or palpating the area with the fingers. No radiographic studies are needed unless there is concern about obstruction as a cause. An ultrasound is done if the examiner feels the testicle on the affected side is too small. The varicocele may be apparent when standing.
How Varicocele is Managed
Most pubertal or prepubertal varicoceles do not need to be treated. However, if the varicocele is associated with pain during physical exercise, repair may be needed. Even if there is no pain, the potential for problems of infertility, which has been noted in men with a varicocele, may cause some doctors to suggest surgical repair. There is no absolute test or study that will predetermine which child is at risk for infertility based on his varicocele. Some physicians would encourage repairing a varicocele if there is a noticeable size discrepancy between the two testicles. Therefore, it is important to closely monitor the growth and development of both testicles as a child progresses through puberty. When surgical correction has been recommended, the procedure can be performed in an outpatient setting. Recovery takes about one week; however, it will be another five weeks, on average, before full recovery can be expected.