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, testicular varicocele is the last in our list as it creates the less discomfort, but it is the base of all other sexual problems. Varicocele, like a multi-headed monster, first blocks the normal flow of testosterone from the testicles into the system blood, and then affects both the testes and the prostate and impairs their functions gradually during a life. It appears the first in our life; recent studies found testicular varicocele prevalence in less than 1% boys aged 2-10, whereas by sexual maturity (11-14 years) it stands for about 15%. This suggests that the venous inadequacy specific for 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; left-side vein is longer than the right-side vein and enters the left renal vein with the 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, resulting in the stagnation of venous blood and increased hydrostatic pressure what is attributed to the erect posture of man.
Both theories partially explain the left-side varicocele predominance: left-sided varicocele is 10 times more common than the 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 the 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 with vein varicose incidence in lower limbs and testicular varicocele there is no doubt that both of them have the same cause. This cause is an extreme physical tension in the organ and damage of 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 peoples engaged in hard physical work and all day on feet, it is somewhat obscure in the case of teenage varicocele.
I believe that improvement in living conditions, as well as increased animal protein and sex hormone intake, lead to increased androgen production and ultimately to the acceleration of sex maturation of young people. High levels of blood testosterone stimulate sexual system in an immature organism and often keep its arousal for a long time particularly at nights. 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 a 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 erect posture of men or the anatomy of venous blood vessels, we have control 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 the men with primary infertility – 35% and in the men with secondary infertility – up to 80%. Primary infertility refers to couples who cannot become pregnant after at least one year, 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 cause hypoxia or suffocation in the testicular tissues. And this, in turn, leads to a deterioration of spermatogenesis and reduction of the 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 has no incidence of hypogonadism
Total blood testosterone is the most generally accepted indicative to prove the presence of hypogonadism. While there are no strict lower limits of normal, testosterone level lower 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 the vast majority of 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 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 trying to treat them as the independent entities. The aim of these and a few upcoming articles is to present a holistic view of the principal sexual issues of man 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.