Varicocele

A varicocele is dilation of the veins of the pampiniform plexus in the scrotum, caused by valve failure and impaired venous drainage. It affects roughly 15% of men, is far more common on the left for anatomical reasons, and is often discovered incidentally. Many varicoceles cause no symptoms and need no treatment. Where they matter is fertility: varicocele is found in around 40% of men presenting with primary infertility, and the mechanism is thought to be raised scrotal temperature and oxidative stress affecting sperm production, with associations to lower sperm count, motility and DNA integrity, and in some men reduced testosterone. Symptoms, when present, include a dull aching heaviness worse on standing or at the end of the day, and the classic bag-of-worms feel on examination. Surgical repair or embolisation improves semen parameters and pregnancy rates in appropriately selected men - typically those with a palpable varicocele, abnormal semen analysis and an infertile partnership - and can improve testosterone in some. Antioxidant supplements have been studied as adjuncts around this: coenzyme Q10, L-carnitine, zinc, selenium and vitamins C and E have modest evidence for improving semen parameters, mostly small trials. They are supportive rather than corrective, and a sudden or right-sided varicocele that does not empty when lying down requires prompt assessment.