What Causes Varicocele?

Varicocele is a vascular disorder that may cause pain, discomfort, and progressive testicular dysfunction, and is one of the most common causes of male infertility. It predominantly affects young and middle-aged men. Traditional surgical treatment involves an inguinal incision to perform high ligation of the internal spermatic vein, along with excision of dilated veins within the scrotum.

What Causes Varicocele?

1. The internal spermatic vein is relatively long and enters the renal vein at a right angle, resulting in increased resistance to venous blood flow. Furthermore, the left internal spermatic vein near the left renal vein lacks valves, predisposing it to venous reflux.

2. Under normal conditions, the muscular fibers within the spermatic cord sheath function as a “muscle pump,” facilitating venous return. When these muscular fibers undergo atrophy or relaxation, venous return is impaired, contributing to varicocele development.

3. Other factors—such as retroperitoneal tumors, renal tumors, or hydronephrosis—may compress the internal spermatic vein, leading to symptomatic or secondary varicocele. In primary (idiopathic) varicocele, symptoms typically resolve rapidly upon lying supine; in contrast, secondary varicocele often persists or resolves only slowly.

4. Venous stasis increases intravascular pressure within the spermatic cord veins, causing hypoxia and inadequate nutrient supply while impairing clearance of metabolic waste products—thereby adversely affecting spermatogenesis and sperm maturation.

Generally, young and middle-aged men exhibit heightened sexual activity and increased blood flow to scrotal contents. Prolonged standing, elevated intra-abdominal pressure, or underlying disease may compress the internal spermatic vein, precipitating symptomatic or secondary varicocele. Mild varicocele may be managed conservatively; however, moderate-to-severe cases—or those associated with infertility or abnormal semen parameters—require surgical intervention.

Prevention of Varicocele

1. Moderation of Sexual Activity

Patients who have undergone varicocele surgery should practice moderation in sexual activity. Specifically, sexual intercourse is contraindicated for the first three weeks postoperatively. After this period, sexual activity should remain infrequent and non-strenuous.

2. Avoiding Excessive Fatigue

For one month following surgery, patients should rest adequately at home and avoid excessive physical exertion. Activities such as mountain climbing, running, ball sports, and prolonged or long-distance cycling are discouraged.

3. Maintaining a Relaxed and Positive Mindset

Patients diagnosed with varicocele should not experience undue psychological stress. Spouses should offer mutual encouragement rather than blame or criticism. A relaxed and optimistic mental state significantly facilitates recovery.

The above outlines the etiology of varicocele. We hope this information proves helpful.