Ask Dr. H: Varicoceles and cancer risk

Question:

For the last few months, I've had a swelling of my left testicle that's occasionally painful. My doctor sent me for a sonogram of my testicles that found a "varicocele." I have lingering concerns about the possibility that I may have testicular cancer. What would you suggest?

Answer: A varicocele is a varicose vein problem that can occur in a man's scrotum. On average, 10 percent to 15 percent of men will develop this dilation and engorgement of the internal spermatic veins that drain the testicle.

Just like the varicose veins that can develop in the legs, a varicocele develops because of a defect in tiny one-way valves that help to pump blood against gravity, away from the testicle and toward the abdomen and heart. If those valves are weak or ineffective, blood will tend to stagnate and pool in the spermatic veins, causing further stretching and engorgement.

Your ultrasound did not show a solid mass, so you do not have testicular cancer.

Just like varicose veins in the legs, most varicoceles do not cause much pain. Since you are experiencing pain, I'd advise seeing a urologist.

One important consequence of a varicocele is male infertility. Studies show that about 40 percent of all cases of male infertility are due to the presence of a varicocele.

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Q:

One girl in my daughter's preschool class came down with the chicken pox even though she was vaccinated against it. Can you explain why her vaccine didn't work?

A: The two-dose chicken pox vaccine is very effective, with published efficacy data of 79 percent after one dose and about 99 percent efficacy after receiving the recommended two-dose vaccine given 4 to 8 weeks apart. That means that roughly 1 to 2 percent of those immunized will still get a bout of chicken pox. The vaccine can fail when the individual fails to mount an adequate immune response or in an active case of shingles (the chicken pox virus reactivates, causing a rash of fluid-filled sacs on the skin).

This little girl likely had a much milder bout of chicken pox than she would have had if she had not received any vaccination. The vaccination almost always protects against serious disease. For those who received the two-dose chicken pox vaccine, an added benefit is a "markedly reduced" risk of developing shingles (the precise amount of future risk is hard to ascertain since the current chicken pox vaccine started in 1995).