Ask Dr. H: Are varicose veins in scrotum a problem?

Question:

For several months, I've had a swelling in my scrotum that's starting to get uncomfortable. I had an ultrasound of my testicles that said I have a varicocele. The doctor said we can just keep an eye on it. Is that good advice?

Answer: A varicocele is essentially a varicose vein problem that can occur in a man's scrotum. About 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 forms because of a defect in tiny one-way valves that help to pump blood against gravity. If those valves are weak or ineffective, blood will tend to stagnate and pool in the internal spermatic veins, causing further stretching and engorgement.

Most varicoceles do not cause much pain. Since you are experiencing pain, I'd advise that you see a urologist.

One important consequence of having a varicocele is male infertility. Studies indicate that about 40 percent of all cases of male infertility are varicocele-related. This may be due to increased testicular temperature and decreased sperm count as a result of abnormal blood flow in the veins draining the testicle. It may also be due to increased levels of metabolic waste products caused by impaired veins. This decreases the availability of oxygen and nutrients required for sperm production.

The dull pain and heaviness of a varicocele could eventually limit physical activity and impair your quality of life.

Q: I had a vasectomy in September, but as of the last semen analysis two months ago, there are still dead sperm in the ejaculate. Why is this still occurring? Was my vasectomy a failure?

A: While you haven't yet been given the "all clear" sign, there have been no live, viable sperm reported five months after your vasectomy.

Although your urologist is being cautious about declaring the procedure a success, and he is probably advising the continued use of a contraception method such as a condom, the odds are that it worked.

Persistent dead or nonmotile sperm are not an uncommon finding. It takes months for the small tubules to clear out all the dead sperm. The likely explanation is that your seminal vesicles, which store the semen fluid, are large but the exiting ducts are narrow. The sperm contained inside is dead; it's just taking a while to clear out the system.

In a 2004 study published in the journal Urology, researchers found that soon after vasectomy, 40 percent of men had rare dead sperm in the ejaculate; at 6 to 12 months following vasectomy, 24 percent had persistent rare dead sperm (1 percent had live sperm, and the other 75 percent had none). The researchers noted in their study that 96 percent of men with rare dead sperm ultimately cleared all sperm.

Other research has shown that there is no increased risk of pregnancy with three readings of dead sperm on three consecutive sperm tests compared to readings with no sperm at all. The chance of a live sperm passing through the blockage in the sperm tube, known as vas deferens, is extremely small, especially once the tube has been cut and cauterized.

But failure is always possible - roughly a 1-in-1,000 chance.