Last Updated on August 6, 2022 by Max
When we talk about men’s health, we never mean how muscular or obese he is or how tall or short he is; we know exactly
- erectile dysfunction,
- premature ejaculation,
- benign prostatic hyperplasia,
- prostate cancer,
- testicular varicocele.
Notice that testicular varicocele is the last on our list as it creates less discomfort, but it is the base of all other sexual problems. Like a multi-headed monster, Varicocele first blocks the normal flow of testosterone from the testicles into the system blood, then affects both the testes and the prostate and gradually impairs their functions during life. It appears the first in our life; recent studies found testicular varicocele prevalence in less than 1% of boys aged 2-10, whereas, by sexual maturity (11-14 years), it stands for about 15%. This suggests that the venous inadequacy specific to varicocele primarily occurs during testicular development.
What are the leading causes of testicular varicocele?
Two main theories of varicocele occurrence most quoted in the scientific literature are:
- Anatomic differences in the left and right-side spermatic veins; the left-side vein is longer than the right-side vein and enters the left renal vein with increased pressure, perpendicularly, whereas the right-side internal testicular vein normally drains obliquely into the vena cava (explains the predominance of left-sided varicocele).
- The inadequacy of internal testicular venous valves results in the stagnation of venous blood and increased hydrostatic pressure, which is attributed to man’s erect posture.
Both theories partially explain the left-side varicocele predominance: left-sided varicocele is ten times more common than right-sided varicocele. However, none of the theories explain why or how varicocele is connected to the testicular development in puberty when we have a peak of incidence.
In a more recent study, Levinger et al. found that the prevalence of varicoceles is age-related. Out of 504 healthy men observed, 34.7% had a varicocele, and this value increased by approximately 10% for each decade of life: 18% at age 30–39, 24% at age 40–49, 33% at age 50–59, 42% at age 60–69, 53% at age 70–79 and 75% at age 80–89.
Physical exertion during sexual maturation, but not in adulthood may result in testicular varicocele development.
If we draw an analogy between vein varicose incidence in lower limbs and testicular varicocele, there is no doubt that both of them have the same cause. This cause is extreme physical tension in the organ, and damage to the veins is a typical defensive reaction of our body to abnormally high stress. If it is so obvious with the varicose veins being common in people engaged in hard physical work and all day on their feet, it is somewhat obscure in the case of teenage varicocele.
I believe that improved living conditions and increased animal protein and sex hormone intake lead to increased androgen production and ultimately to the acceleration of sex maturation in young people. High levels of blood testosterone stimulate the sexual system in an immature organism and often keep its arousal for a long time, particularly at night. This causes an almost permanent tension and stress in the sex organs of young people, similar to the muscles in athletes or physical workers.
Another factor promoting to stagnation of venous blood in the pelvic area is the changed lifestyle of young people. The system of universal education characteristic of our time forces children to spend quite a long time in a sitting state, not only at school but at home also.
If we can do nothing with the erect posture of men or the anatomy of venous blood vessels, we have control over what we feed our children and how they get educated.
Testicular varicocele and man’s infertility
The reported average rate of varicocele in the general male population is 15%, in men with primary infertility – 35%, and in men with secondary infertility – up to 80%. Primary infertility refers to couples who cannot become pregnant after at least one year of having sex and secondary infertility refers to couples who have been able to get pregnant at least once but now are unable.
Although the majority of men with varicocele are fertile, the incidence of infertility among varicocele-affected men is abnormally high. Numerous studies of infertility etiology suggest that testicular varicocele or venous stasis in the internal spermatic vein increases the intratesticular temperature and causes hypoxia or suffocation in the testicular tissues. And this, in turn, leads to a deterioration of spermatogenesis and reduction of testosterone production. As a result, sperm quality and quantity decline.
In a large-scale evaluation of semen quality (sperm samples from 9034 men) conducted by the World Health Organization, the prevalence of varicocele in men with normal semen was more than two times lower than in men with abnormal semen quality (11.7% and 25.4%).
Moreover, a varicocele may result in testicular atrophy accompanied by dysfunctional testicular tissue. An association of varicocele with hypogonadism and impaired erectile function was confirmed; 30% of patients (45 out of 130) were identified as hypogonadism, while the control group had no incidence of hypogonadism
Total blood testosterone is the most generally accepted indicative of proving the presence of hypogonadism. While there are no strict lower limits than normal, testosterone levels lower than 350 ng/dl should be a diagnostic alert for hypogonadism. In the study by Gorelick JI and Goldstein M varicocelectomy significantly improved serum testosterone in infertile men, especially those with hypogonadism.
Nowadays, most surgeries on varicocele are made in connection with infertility. About half of the operated men become fathers. Gut Y et al. showed that the treatment of testicular varicocele resumes the flow of oxygenated blood to the testicles and renewed sperm production in 4 out of 10 patients. The success rate was conditional upon the level of irreversible damages caused by hypoxia.
So far, we have studied the relations of testicular varicocele to benign prostatic hyperplasia and men’s infertility, and we see clearly that these conditions are the links of one chain. When we diagnose them separately, we lose their unity and try to treat them as independent entities. These and a few upcoming articles aim to present a holistic view of men’s principal sexual issues, including varicocele, prostatitis, infertility, erectile dysfunction, premature ejaculation, and prostate cancer. When we have such an idea, it is easier for us to make decisions and take responsibility for our health.
Gat Y et al. Azoospermia and Sertoli-cell-only syndrome: Hypoxia in the sperm production site due to impairment in venous drainage of
Gorelick JI, Goldstein M Loss of fertility in men with varicocele. Fertil Steril. 1993 Mar; 59(3):613-6.
The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. World Health Organization.
Fertil Steril. 1992 Jun; 57(6):1289-93.
Andrologia. 2007 Jun; 39(3):77-80.