Patient's question:
I am 26 years old and unmarried. A few years ago, I noticed varicocele in my left testicle. Since there was no discomfort, I didn't pay much attention to it. However, a few months ago, I discovered varicocele in my right testicle as well, which is slightly less severe than the left one. Additionally, my left testicle is now smaller than the right one—is it atrophying? I suspect this is definitely related to my frequent masturbation habits. I am very worried about infertility. Do I still have hope for fertility? What should I do now?Doctor's answer:
Hello:Treatment of Varicocele:
Mild varicocele without symptoms does not require treatment.
Non-surgical treatment: For mild varicocele or those accompanied by neurasthenia, methods such as wearing an scrotal support or applying cold compresses can be used.
Surgical treatment: For severe varicocele, a history of sperm count below 20 million per time for three consecutive times, or testicular atrophy; if the varicose veins disappear when lying flat, high ligation of the internal spermatic vein can be performed.
Why varicocele occurs more frequently on the left side is closely related to the anatomical relationship of the pampiniform plexus of the spermatic cord. The pampiniform plexus is formed by the veins of the testis and epididymis, which ascends into the inguinal canal, merges to form the internal spermatic vein, and then continues upward. On the left side, it enters the left renal vein at a right angle, while on the right side, it enters the inferior vena cava at an oblique angle. Due to the longer course and vertical entry of the left internal spermatic vein into the left renal vein, this anatomical reason results in higher blood flow resistance. Additionally, the left internal spermatic vein is compressed by the sigmoid colon, the superior mesenteric vein, and the aorta, which in turn compresses the left renal vein and affects the return flow of the left spermatic vein. Furthermore, the surrounding connective tissue of the left spermatic vein is often weak, all of which contribute to why the majority of varicocele patients are on the left side.
Since the 1970s, varicocele has attracted the attention of scholars and has been studied from multiple perspectives with the development of male medicine. For example, in terms of age of onset, it was believed as early as 1800 that this condition is most common in the age group of 16–40 years, with an incidence rate of 16%. However, in studies on the causes of male infertility, the incidence rate of varicocele is as high as around 35%. Most scholars consider varicocele to be one of the main causes of infertility.