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 a chance to have children? 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 and applying cold compresses can be used.
Surgical Treatment: For severe varicocele, a history of sperm count below 20 million three times consecutively, or testicular atrophy; or when 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 ascend into the inguinal canal, merge to form the internal spermatic vein, and then continue upward. On the left side, the internal spermatic vein 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 feature increases the blood flow resistance. Additionally, the sigmoid colon compresses the left internal spermatic vein anteriorly, the superior mesenteric vein and aorta compress the left renal vein during their pulsations, affecting the venous return of the left spermatic vein, and the surrounding connective tissue of the left spermatic vein is inherently weaker. As a result, the vast majority of varicocele patients occur on the left side.
Since the 1970s, varicocele has attracted the attention of scholars and has been extensively studied in various aspects with the development of male medicine. For example, in terms of age of onset, it was believed as early as 1800 that the disease primarily affects individuals aged 16–40, 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.