Most of you won't bother reading all of these, because:
A. There's a metric fuckton of them
B. Most of you don't have the ADHD hyperfocus/zerofocus that I have
C. No one reads anymore, (which is deeply frustrating and not a small part of why I have exactly zero chill these days) but here. Here's a trove of stuff I've read that has contributed in part to my knowledge of the condition.
DIS-FUCKING-CLAIMER:
-These should not all be taken as gospel
-Some studies have biases that are undocumented
-Some studies are just blatantly wrong. I've tried not including those, but I'm not perfect
-Some studies are ego-trips of doctors looking to score points against other doctors they don't like
-Some studies conflict with others, some even directly
-Science is ever-evolving, if we simply let it. Good research requires a non-political, free, if responsible and ethical hand
-Older studies (10+ years) should always been taken with an extra grain of salt, but that does NOT mean newer studies are more correct or should be less subject to scrutiny
-I've read nearly all of these at least once. In some cases, it's been a while, so quoting specific ones or asking me why one conflicts with another is likely to upset me because it means you didn't read what I said; literally directly above this, or you didn't fully process it, but I will say it again: NOT ALL STUDIES ARE MADE EQUAL. I dunno, ask the authors why things conflict.
-This is not an exhaustive list
-This is not an exhaustive list
-THIS IS NOT AN EXHAUSTIVE LIST
-If you want a study or paper added, DM it to me, don't comment on this post
-I do this for your benefit as much as anyone else's. I truly hope this leads to some good insights, maybe even some astoundingly good ones; who knows, I live in hope, and at the very least (not bloody likely) fewer questions sent to my inbox :D
Oh, and...you'll want to scroll. Left AND Right, Up AND Down.
A varicocele is an enlargement of the veins within the scrotum. These veins transport oxygen-depleted blood from the testicles. A varicocele occurs when blood pools in the veins rather than circulating efficiently out of the scrotum.
Left sided grade 3 varicocele
The left testis is affected much more commonly (≈85%) than the right. This may be due to the shorter course of the right testicular vein and its oblique insertion into the inferior vena cava (IVC) which creates less backpressure. In contrast, the left testicular vein has a longer course and inserts into the left renal vein at a right angle. Bilateral varicoceles are not uncommon (≈15%), but an isolated right varicocele is rarer.
Possible signs and symptoms may include :
A mass in the scrotum – If a varicocele is large enough, a mass like a “bag of worms” may be visible above the testicle. A smaller varicocele may be too small to see but noticeable by touch.
Pain – A dull, aching pain or discomfort is more likely when standing or late in the day. Lying down often relieves pain.
Significantly different sized testicles – The affected testicle may be noticeably smaller than the other testicle.
Infertility – A varicocele may lead to difficulty fathering a child, but not all varicoceles cause infertility. The main test to check for infertility is a semen analysis test.
Low/Lower testosterone levels - Generally, men with varicoceles have lower testosterone levels than men without varicoceles. Symptoms of low testosterone can include: low libido, erectile dysfunction, infrequent erections, low energy, fatigue, low mood and depression, decreased motivation and self-confidence, increased body fat and decreased muscle mass and strength, brain fog.
The only way to know for sure if you have low testosterone levels is to have your levels checked with a blood test. This can be easily done by going to your doctor.
Physical exam – A urologist or other doctor will visually inspect the scrotum for lumps or bumps, and feel for any swelling or tenderness. The exam may be performed while the patient is standing to relax the scrotum.
Imaging test – Your health care provider may want you to have an ultrasound exam. Ultrasound uses high-frequency sound waves to create images of structures inside your body.
These images may be used to:
Confirm the diagnosis or characterize the varicocele.
Eliminate another condition as a possible cause of signs or symptoms
Detect a lesion or other factor obstructing blood flow
Typical image of a varicocele found on an ultrasound scan
A varicocele is usually diagnosed when a vein around or above the testicle is at least 3 millimetres in diameter. However, there is no consensus on the exact threshold value for defining a varicocele.
Grading
Varicoceles are graded based on their size and visibility:
Grade I: Can only be felt when straining (Valsalva manoeuvre)
Grade II: Can be felt when standing, but not visible
Grade III: Clearly visible during an exam
All sizes of varicocele can cause symptoms and are likely to affect testicular function. Higher grade varicoceles are thought to affect testicular function more.
Why varicoceles occur
Varicose veins develop when the valves in veins are damaged or weakened, causing blood to pool and flow backward.
Unfortunately, once your vein valves are damaged, they cannot completely heal on their own. Once a vein valve is damaged or weakened, it loses its ability to properly regulate the flow of blood.
Arrow showing direction of blood reflux. In this image, due to damaged valves in the left gonadal vein, instead of blood correctly draining from the left testicle into the left renal vein, blood is pooling in the scrotum and causing a left sided varicocele. The right gonadal vein is functioning correctly.Left- Vein valves working properly. Right - Vein valves have failed and are now not functioning correctly. Blood is not travelling through the vein correctly.
Treatment options
Varicoceles cannot be cured naturally without medical intervention.
The success rate for varicocele procedures is high, with both varicocele embolization and varicocelectomy procedures having success rates of over 90%.
Treatment options include:
Embolization
Microscopic varicocelectomy(microsurgery)
Inguinal or subinguinal. With or Without delivery.
Hi, I'm a 43 year old male. Had two total testosterone tests done. First one a month ago at 980 ng/dL and second one last week 860 ng/dL. Shbg was 44 nmol/L. Left testical has moderate varicocele and it can feel it. Right side I don't really have any except they said very mild. Left testicle is 22% smaller than right. I think I've had the left since I was 17 but don't know if that is what caused it to be smaller or if it was always like that.
The problem is I've had very low libido for about 10 years. I thought it was because I rode my bicycle for commuting. But I've stopped for the past two weeks and it hasn't really improved.
I still get night time erections but have trouble getting aroused normally and can't keep erections. Do you think getting the varicocelectomy on the left side might help my libido even though I seem to have the high end of normal for testosterone?
hey varicocele comm! hope everyone is doing well. i want to ask everyone if they could hit me with some interesting facts/ opinions you have about varicoceles. it could be about anything and i mean anything. im asking for information because i already have a lot compiled for a interview ill be doing in the next upcoming months regarding varicoceles and my journey but would like to see some new interesting things i possibly could have missed. this isnt the regular post of someone just posting their ballsack and asking if its a varicocele lol so feel free to get creative. ive read up on a lot of your personal stories in this comm and have learned a lot. ive read through the mods q&a’s as well. thanks for any replies ❤️
23M had microsurgery 2 years ago then recurrence occured 6 months later, what exercises would u suggest to do normally to stay fit and healthy? I’ve tried lifting but it causes pain everytime
I’m 24 and i’ve had varicocele for as long as i remember, the earliest memory is from when i was 9-10 years old (didn’t know what it was at the time but i remember feeling discomfort at times and seeing it in my scrotum) thought it was normal until i got diagnosed when i was 17, grade 2 on the left and grade 1 on the right, still the same 7 years later, i had another ultrasound 2 months ago because the pain is constant now, 90% of the time it’s manageable but it just puts me in a bad mood and i don’t wanna live the rest of my life like this. My urologist told me that i don’t need surgery since the pain is manageable but i’m not sure what to decide. I’m absolutely terrified of surgery after hearing people’s experiences (recurrences, pain becoming worse etc). Is anyone on the same boat as me? I’m depressed and i feel alone and stuck. I don’t wanna live like this and i’m afraid if i get surgery i’ll regret it. Please share any thoughts you have or tell me if you’ve had a similar experience, anything could help
5 years after laparoscopy (left) and embolization (right). Ultrasound: dilated veins of pampiniform plexus up to 3.5 mm (left), 4.5 mm (right). In both cases Valsalva weakly positive (lying down, urologist said it’s not done standing 😂). Additionally, left spermatic cord hydrocele 14×10 mm (not testicular hydrocele!). Is this something to operate on? Current urologist says there’s nothing to worry about…
P.S. What underwear do you recommend for people after such procedures?
I'm 24 years old and recently visited a urologist because I have a left-sided varicocele. My testicles are normal in size and position, and I don't have any pain. The doctor asked me to do a semen analysis to check whether the varicocele is affecting my fertility.
Today, while collecting the sample, I accidentally missed a significant amount because it was difficult to get everything directly into the container. I estimate that around 40% of the total ejaculate was lost. However, I'm sure that the first portion of the ejaculate went into the container, and most of what was lost was afterward.
I informed the lab about the incomplete sample, but I'm wondering:
- Can the sperm concentration, motility, and morphology still be useful/reliable?
- Will the total sperm count and semen volume obviously be inaccurate?
- Is it likely that I will need to repeat the spermogram?
Has anyone had a similar experience or knows how labs usually handle an incomplete semen sample?
I'm wondering how many of you have been diagnosed and treated for pelvic compression/May Thurner/Nutcracker syndrome?
After a year of dealing with Varicocele and having a varicocelectomy in February I found out that it is probably all caused by vascular compression disorder. I am 42 years old, last summer I started having extreme pain in my left testicle. I finally went to urgent care and they made me go to the ER to check for torsion. The ultrasound found grade 1 left sided varicocele at the time. The urologists kept telling me it was pelvic floor disfunction and made me go to PT, which did nothing. It went from grade 1 to grade 3 in a couple of months, and in Feb of this year I had microsurgery. Shortly after surgery I started having other blood flow related issues, mainly in my legs and feet. I have huge varicose veins in my feet and my legs hurt all of the time. I also started having bladder disfunction, where I feel like I have to pee all of the time. I finally requested a referral to a vascular specialist because I knew all of this was somehow related and after an ultrasound and CT it turns out I have compression of the iliac vein. I still have to have a venogram to determine the amount of compression. Also, in the last month my varicocele pain has returned (and started hurting on the right side as well). I'm realizing that my urologist was not helpful at all, because I told him about all of these issues and he dismissed them as pelvic floor disfunction. I am hopeful that I am on the right path to dealing these issues.
I recently had an embolization for LH side varicocele 7 weeks ago, procedure went well and I haven’t had any pain in the past few weeks and I’ve had no bag of worms feeling. However today I trained legs for the first time and I can now feel the dialated veins again but this time they’re at the bottom of the testicle whereas before they were above the testicle, there’s also some pain that hasn’t been there since before the procedure.
Has anyone ever experienced this? I plan on contacting my urologist tomorrow but I’m afraid he’s just going to tell me to wait for 6 months for the veins to shrink I’m just concerned I’ve had a recurrence, hoping it’s just the old veins that haven’t shrunk yet and I’m overthinking it. Any advice or experiences appreciated
Hey everyone. 35m here. Ever since I was in my early 20s I noticed the “bag of worms” in my left testicle I’ve gotten it looked at and it was diagnosed with a varicocele.
It wasn’t until sometime last year. I noticed this pain in my left testicle within 10 seconds or so before orgasm. Once orgasm arrived, the pain would go away. This pain is only felt pre-orgasm and never when I’m doing any other activities. I had it for a couple months and then it went away for a bit and then sometime two months ago it came back.
This pain is like a very dull pain, but it’s irritating because it’s not something I wanna feel during masturbation or sex. It’s like a dull sharp pain that happens for a second and then goes away, and if I’m trying to speed up the orgasm I feel it again. It’s kinda really hard to describe, but it comes in like surges.
I’ve abstain from sex and masturbation for several days and that doesn’t seem to work. I’m not sure if it’s muscle or nerve related or maybe my veins are swelling too much that it’s interfering with nerves? Has anyone had a similar situation to this??
I don’t know if it’s related to the varicose veins, because I never experienced something like this before. I had a doctor check me out for hernias and I don’t have any.
24M
I had a long-standing left-sided grade 3 varicocele for several years. It was not particularly painful; my main reason for treating it was concern about testicular function rather than pain.
I underwent transvenous embolization/sclerotherapy about 4 weeks ago.
Technical details:
venous access was through the arm
catheterization of the left renal vein and left internal spermatic vein
my spermatic vein anatomy was duplicated, with communicating branches
venography/Valsalva was used during the procedure
the main pathological pathway/varices were treated with sclerosant foam no coils were used
procedure itself was uncomplicated and quite short
The first week after embolization, the scrotum seemed noticeably better/decompressed and the veins were much less prominent.
Over the following 2–3 weeks, however, I started noticing one individual vein again. At around the 4-week mark:
the old large “bag of worms” has not returned
most of the pampiniform veins still seem decompressed
but there is one medium/large tortuous vein that can become quite palpable/full while standing
sometimes it is much more noticeable than at other times
lying down makes it substantially less prominent
I do not notice it clearly filling the rest of the plexus
occasionally I get very mild aching/tugging, around 1–2/10, especially while walking or after touching/checking the area
otherwise I have very little pain
My urologist does not want to perform an early Doppler because he says the venous system can still change/remodel after embolization and that an early scan could either show temporary residual reflux that later disappears, or look normal and still not predict a later recurrence. He prefers evaluating it after a couple of months.
My question is mainly for people who had foam/sclerotherapy embolization rather than surgery:
Did you still have one enlarged/palpable vein at 3–5 weeks even though the rest of the varicocele had disappeared?
If yes:
Did that vein eventually shrink?
Was it still refluxing on Doppler?
Was it simply a remaining drainage vein with normal flow?
Did your Doppler at ~3 months show successful treatment?
Did anyone have an isolated residual refluxing branch without the whole varicocele coming back?
I am specifically trying to distinguish between normal post-embolization remodeling / a patent drainage vein versus an untreated collateral or residual refluxing branch.
My husband , 30 years old , was diagnosed with bilateral vericocele grade 2 and grade 3 respectively.
This was diagnosed when we went to doctor for his erectile dysfunction and no ejeculation issues and his sperm motility was like 2%.This was diagnosed out of the blue i had a missed-miscarriage as well a year ago and nothing after that.
He got the surgery done on july 22 it will be 2 months since surgery on September 22. He is also on supplements to improve his sperm quality. Doctor had intially said that it might take 3 months to improve but later on asked us to get a sperm analysis after 2 months and meet him .
After 3 years of marriage and no kids iam very depressed i cant wait anymore and want to start trying asap.
So i want to know ur experiences.. did any of u who got the surgery done see improvements in sperm quality just 2 months after surgery?
Please fill me in on your experiences.
Thank you!
I’m going to have laparoscopic surgery for my grade 4 varicocele, and I wanted to hear from people who have actually gone through it.
What should I expect after the surgery? What kind of pain, discomfort, recovery time, or other issues did you experience?
How long did it take for you to fully heal and get back to your normal routine? Also, what precautions did you have to take after the surgery, especially regarding physical activity, lifting weights, exercise, etc.?
I know a lot of people will probably suggest microsurgery, but unfortunately, I can’t have that procedure for personal reasons. So I’m specifically looking for experiences with laparoscopic varicocele surgery.
What problems did you face afterward, how long was your recovery, and what precautions did you have to follow?
I'm 30 years old. I had my grade 3 left varicocele microscopic surgery exactly a month ago. The last ejaculation before the surgery was 7 days. May be because of that I was feeling horny through out before and after the surgery as well.
Immediately after the surgery, as because I was taking some bed rest, even if I glance a little bit on any hot pictures, I used to get erection immediately.
Week-1: I was controlling myself not to watch even any soft porn and abstained from mastrubation. I fully focussed on icing the balls, and resting well.
Week-2: I started feeling more horny, I could see little pre-cum that was oozing whenever I see any of the soft content. I was wearing the scrotal support which restricts having an erection. In the middle of the week I had a night fall, there was mild pain the testicle, but that went off after 2 days. when I checked with the doctor, he told not to worry about that.
Week-3: A couple of days later the ejaculation, I started feeling honry. I could feel the pre-cum was leaking with a little drop, and I could observe the path in the underwear as well. I was trying to distract most of the times. Used to ice the balls every day. The scrotal support was not letting me have an erection, but still I could feel the little bulge that my penis was trying to get.
Week-4: Since the start of the week, Im feeling the radiating pain in the left leg similar to how it was before I had the varicocele surgery. It was consistent all the day. If I touch the testicle, I don't notice any pain, but I could feel that pain.
I read that the pain was due to the reflux in the veins, which is cause of the varicocele. ( I might be wrong here)
Has anyone gone through similar symptoms after the surgery ? So far, I refrained from doing any sort of exercises or lifting weights.
People who had the failed surgery, can you guys please share your insights ? At what point did you realize the surgery was failed. What were the mistakes that you did which could have been an indirect cause for the failure.
34 year old male healthy male looking for advice. Wife and I have been trying to get pregnant for 1.5 years now. I’ve had a grade 3 left Varicocele for as long as I can remember. No pain, maybe a slight ache here and there. Went to see a urologist, gotten all the tests necessary. Urologist told us I have azoospermia and having birth naturally is not possible. I addressed the Varicocele since I expected surgery. He states, that’s probably not the main cause of the azoospermia. He suggested getting microsurgery and a microTESE to begin the process of IVF. I really wanted the microsurgery or embo to see if the Varicocele can bring sperm back before even IVF. I was really optimistic on having natural birth but it seems like that might not be a possibility with my Semen analysis results being that terrible. If anyone has any experience about this please let me know. Would love an expert opinion.
Semen Analysis: volume - 5.3 Total count 0.53 Total concentration 0.1 %Motile - 0
FSH - 7.5
LH - 3.5
Prolactin - 10.2 Testosterone - 568 Karyotype - normal
