The scrotum is the structure that houses the male testicles, which need blood to move in and out of them to work properly. The blood vessels that carry blood away from the testicles via the testicles are called veins. A varicocele is a bulging vein in the testicle, commonly on the left side, for the same reason that varicose veins appear in the legs. If too much blood stagnates in the veins it can also cause inflammatory reactions and poor metabolism. What are the symptoms? Most patients with varicoceles begin with no symptoms, but some have a cramping of the scrotum that worsens and becomes painful, noticeable in the standing position during the day, and a mass of veins in the scrotum. How is the diagnosis confirmed? The diagnosis is usually confirmed by the simplest and most important doctor’s examination. Dilated veins, which are sometimes sensitive in the testicles, are sometimes detected by the patient himself, and other cases are sometimes detected during the examination for infertility. If the patient has pain, but it is not clear to the doctor’s palpation, an ultrasound of the scrotum can also be done. Varicocele decreases sperm count The number of sperm in the semen decreases when there is blood stasis in the testicular veins. Varicose veins are present in 30-50% of cases of male infertility. Most people’s sperm counts improve after treatment. Treatment About 1 in 6 men have varicose veins, but most of them are not severe, when doctors tend to wait for observation without surgery. However, if there is pain and difficulty getting pregnant, the doctor may recommend surgery or other treatment. If there is no pain and no pregnancy is planned, the doctor will recommend monitoring and the patient should actively keep in touch with the doctor. If the condition remains stable, it may not necessarily need to be treated. Surgery (spermatic vein ligation) However, when symptoms appear or the vein dilatation is significant, the doctor will recommend surgical treatment. Quite often nowadays, this can be performed through laparoscopic (special endoscopic) surgery, but also through microscopic techniques. First of all, anesthesia is given; the incision can be located in the abdomen or in the groin; the vein is found and ligated; and the incision is closed. Spermatic vein embolization There are also physicians who can recommend embolization, but it is less frequently performed. It starts with anesthesia; then a very small incision is made in the lateral aspect of the posterior neck of the groin; a thin tube is inserted into the incision; under X-ray guidance, the doctor inserts the tube into the varicose vein; a small spring ring is placed through the tube to stop the blood flow; the tube is removed and it is over. The incision is small and does not need to be closed. When should you contact your doctor again after treatment Persistent soreness, medications that don’t work for pain, bruising around the incision, blood spilling from the incision or swelling of the scrotum, chills and fever over 38.5 degrees. When does a vein go wrong? Blood from the testicles travels a considerable distance upward to the groin and eventually back to the heart. Valves are then formed in the veins that act like a valve to prevent blood from backing up back into the testicles. Physiologically, many valves do not close completely and the muscles in the walls of the ducts are weak. But when the valves are not functioning properly, blood backs up into the scrotum and pools in the upper part of the testicle. This is why the veins become dilated. To treat or not to treat As mentioned above, most varicose veins are not serious. If they are painful or bring about infertility, treatment will most often relieve the symptoms and have the opportunity to improve the sperm count in the semen. With the right indications, your life will become active and vibrant.