Varicocele: Seek help for that persistent groin pain

Gay is pain free for the first time in more than two years. At 30, the American sprinter is trying to resurrect his career after hip, groin and hamstring injuries. [File, Standard]

Groin discomfort is something many men brush off. It can feel like a pulled muscle, the stiffness after a long day on one’s feet, or a passing ache that does not seem worth attention.

Some shrug it off, others bottle it up, or scroll past it during a quick online search and move on.

Yet beneath that dull ache or heaviness in the scrotum, there can be a condition that is common but often overlooked. Varicocele is a problem of the veins above the testicle, and it can affect not only comfort but also fertility and hormonal balance.

Naushad Karim, a consultant Interventional Radiologist at Aga Khan University Hospital, Nairobi, says a varicocele is an abnormality in the veins of the testis.

“The veins, which normally carry blood from the testicles back to the heart, contain small one-way valves that prevent backward flow. When these valves fail, blood pools in the scrotum instead of flowing out, creating a tangle of swollen veins that resemble varicose veins in the legs,” Dr Karim says.

This pooling of blood raises the temperature around the testicles.

Karim explains that “this rise in temperature affects the male reproductive system by lowering sperm quality and reducing testosterone levels.”

Over time, he adds, it can lead to a reduction in testicular size and affect fertility.

In medical terms, varicocele refers to the abnormal enlargement of the pampiniform venous plexus, a network of veins that drains blood from the testes. These veins pass through the inguinal canal and back toward the heart. When their valves fail, blood flows backward and collects instead of circulating normally.

The condition is more commonly found on the left side because of how veins connect to larger blood vessels in the body. Some men notice no symptoms at all. Others experience a dull, aching pain in the scrotum that worsens after long periods of standing, sitting, or physical exertion. Swelling, a feeling of heaviness, or visibly enlarged veins that feel like a soft bag of worms may also occur.

Despite these signs, many men delay seeking care.

“It is not unusual for patients to come in only when they and their partners are struggling with fertility,” Karim notes. In many cases, the condition is discovered during routine ultrasound scans or fertility evaluations rather than because of pain.

According to clinical research cited by the National Library of Medicine, about 15 to 20 per cent of men and adolescent boys globally have a varicocele. Many remain unaware of it because the condition can be asymptomatic. The prevalence is higher among men with fertility problems, where varicoceles are found in about 30 to 40 per cent of those with primary infertility and up to 80 per cent of men with secondary infertility.

Overall, varicocele is widely recognised as the most common correctable cause of male infertility.

Diagnosis is usually straightforward. Larger varicoceles may be detected during physical examination, but smaller or less obvious ones require imaging.

“An ultrasound scan remains the most accurate diagnostic tool,” Karim says. “It allows doctors to visualise the dilated veins and assess whether blood is flowing backward, which is a key indicator of valve failure.”

For decades, open surgery was the standard treatment. This involved making an incision and tying off the faulty vein to stop the backflow of blood. While effective, it required general anaesthesia, hospital admission, and weeks of recovery.

Today, a less invasive option is available. Varicocele embolisation is a minimally invasive procedure performed under local anaesthesia.

“We perform the procedure while the patient is awake,” Karim explains. “A tiny wire and catheter are inserted through a vein in the neck or arm, just like placing an IV line. Using live X-ray imaging, we guide the catheter to the affected testicular vein and seal it with small metal coils.”

These coils block the abnormal vein and allow blood to reroute through healthy veins.

“There are no large cuts, no general anaesthesia, and recovery is almost immediate,” he says. The procedure takes less than an hour and is done on a day-care basis, with most patients resuming normal activities within 24 hours.

Follow-up care may include ultrasound scans to confirm that blood flow has normalised. For men with fertility concerns, semen analysis after a few months can show improvements in sperm count, motility, and quality.

Most patients experience relief from pain within days.