‘Bag of worms’

If you feel something in your testicle like a bag of worms (most obvious when you are standing), you probably have a varicocele.

What a varicocele is
The ‘spermatic cord’ that leads upwards from the scrotum carries a tube for sperms to reach the penis, and also veins and arteries (see diagram on Testicle problems main page). The veins of the spermatic cord can become swollen, elongated and looped, similar to varicose veins in the leg – this is a varicocele. If the veins are only slightly swollen they will be unnoticeable, but moderately swollen veins can often be felt. Varicocele does not usually cause any symptoms, although some men report discomfort or may feel embarrassed if the swollen veins are visible under the skin. About 15% of normal healthy young men have a varicocele, usually on the left side.

Varicocele and fertility
Doctors have been arguing for years about whether a varicocele affects fertility, by damaging the development of sperms in the testicle. For example, the blood in the swollen veins could act like a hot water bottle, keeping the testicle too warm. Developing sperms like to be cool, which is why the scrotum hangs outside the body. In fact, varicocele is only slightly more common in men with sperm problems and, if it does affect fertility, it is only a small effect.

Treating a varicocele probably won’t improve fertility. In 2001, the Cochrane Collaboration, an international network of experts who look at every scrap of scientific evidence about medical problems, investigated varicocele treatment for fertility. They concluded that routinely treating varicoceles in men who are having fertility problems is ‘ill-advised’, because there is not enough evidence that it does any good.