VARICOCELE means, simply speaking, varicose veins in the scrotum. In mild cases there is no special inconvenience, nor are any of the results likely to be of much consequence; but when the disorder is pronounced it may cause extreme sensitiveness and pain, and in an aggravated case there may be such an interference with the circulation in the testicles and adjacent parts as to cause the shrinking or atrophy of these glands. Like every other part of the body they depend upon a good blood supply. Of course, atrophy of the testicles may be largely the result of the same abuses that have produced the varicocele, but there is no question that impaired circulation would tend to produce this result. However, when the circulation has not been materially interfered with, the testicles and the degree of virility may be little affected by the varicocele. One should not allow himself to be alarmed by the quack literature about this complaint, in case minor symptoms of the trouble are experienced. As a rule it is very easily cured by simple, natural methods.
Varicocele is always very readily induced when there is much sexual excitement, with the resulting congestion of the generative organs. It is more likely to develop in those who are not athletic in their habits, for the circulation of such persons is generally not strong. Especially are those subject to it who have a tendency toward weakness of the veins or their valves, as when varicose veins are hereditary, but of course such an inheritance is rare.
Naturally, any relaxed or weakened condition of the tissues would favor the development of this disorder. Long standing aggravates it, but should not be regarded as a cause, for standing will not affect one who is vigorous.
Masturbation is, of course, a common cause of varicocele, but mental incontinence is just as likely to produce it. Ungratified sex excitement, frequently repeated, is almost certain to cause it to a greater or less degree. But if one is much debilitated, with tissues lacking in tone and circulation weak, one may possibly develop varicocele without any specific abuse. Tight clothing may have something to do with it. Constipation is a cause in many instances. The wearing of a truss, the presence of a tumor, or any other obstruction to the circulation, might cause it. Gonorrhea is sometimes an active cause because of the inflammation of the veins produced when this disease has penetrated to the remoter parts of the generative system. Injuries involving the veins concerned are the cause of some of the most serious cases of varicocele.
Varicocele is really a complaint affecting the spermatic cord and not the testicle, though the latter may suffer from it through impaired circulation. The spermatic cord is a sheathlike structure which supports the testicle, the latter being suspended from it in the scrotum. The spermatic cord contains the vas deferens, or duct by which the seminal fluid is carried from the testicle to the seminal vesicle or reservoir just under the bladder. It also shelters the spermatic artery, which supplies the testicle with blood and the veins for its return. The veins in this part take something of the form of a network, so that when congested and enlarged, as in varicocele, they will feel something like a “bunch of worms,” to which they have often been likened. Each testicle has its own spermatic cord, duct and blood supply, and either side may be affected without the other.
It should be understood that in some cases these veins are rather full and tortuous when in a healthy condition, so that the fact that one may be able to feel them plainly does not always indicate varicocele. Don’t be too easily frightened. Varicocele, in its troublesome or harmful stage, invariably takes the form of a tumor or lump that can be seen, but which on palpation is found to be a group of enlarged veins. Hydrocele and hernia may also cause the appearance of a tumor in the scrotum. Varicocele is most frequently found in young men, because it is among them that the extreme abuses that cause it are most prevalent. There are cases, however, in which it is brought on by the debility of advancing years, with their consequent enfeeblement of circulation and weakening of tissues.
As a rule the scrotum hangs very low in cases of varicocele, and there is likely to be a sensation of weight and dragging down. The parts may be extremely tender, with an aching sensation, and sometimes there is excruciating pain. In other cases, again, there may be no signs of trouble aside from the enlargement of the veins. Suitable treatment should be adopted in all cases, however, to restore the best possible circulation in the testicle.
The greater length of the spermatic cord on the left side is partly responsible for the fact that varicocele is usually found on the left side, or is almost invariably worse on that side, because there is naturally a larger network of veins in the longer cord. The circulation too, is more apt to be impaired on the left side because the left spermatic vein opens at right angles into the renal vein, a formation unfavorable to the return of the blood when the circulation is weak. Further-more, this left spermatic vein runs across in front of the sigmoid flexure, which is a fold of the lower part of the colon, and when there is constipation the pressure upon it interferes with the return of the blood and tends to cause varicocele. It is accordingly one’s first duty to overcome constipation, if present. Strains in heavy lifting, especially when constipation is already present to impede the movement of blood in this vein, may also have much to do with producing varicocele.
When there is extreme degeneration of the walls of the veins, and especially of the valves, it may take a little time to get completely satisfactory results. The ordinary case responds quickly to treatment, but one cannot expect that in all cases the veins will immediately be reduced to their former size. If the walls of the veins have become greatly thickened, as often happens, it may be a long time before they decrease materially in size, but at least the walls will be strengthened and the veins will do their work of conveying the blood satisfactorily which is all that is necessary. If a painful and tender condition of the veins can be overcome by a few days or weeks of treatment, the sufferer should be well satisfied, even if they remain abnormal as to size for a considerable time after.
Surgery is a popular form of treatment for this trouble, but it is rarely necessary. The usual surgical treatment consists in tying a ligature around the offending vein in such a way as to “put it out of business,” entirely shutting off the flow of blood from it. The result is that the venous blood has to find or make another channel for itself, which is often accomplished by the enlargement of small blood vessels or capillaries, while the former vein atrophies. It is undoubtedly better to continue to use the old veins if it is possible to improve them by treatment. It is true, however, that in exceptional instances in which the valves of the veins seem to have degenerated and the veins generally are much enlarged, and very tender and painful, surgery may be required. But don’t take the quack’s word for it. Go to a reputable member of the profession. And first of all give the physical-culture treatment a good trial.
The mental requirements of the treatment are important, as in other sexual disorders. There should be no harboring of lascivious fancies or exposure to other influences likely to cause sexual excitement and consequent congestion of the affected parts. There should be no fondling of the opposite sex, such as will arouse passion which cannot be gratified, No treatment will bring results if these precautions are neglected. Masturbation, if practiced, must be stopped.
The most important local treatment consists of the application of cold water, and the most important general treatment is bodily exercise.
Exercise has the two-fold effect of strengthening all tissues, muscular and other, and of greatly improving the circulation. ‘When the parts are not so tender and sensitive as to make active exercise painful the more vigorous it is the better. Temporary congestion can usually be overcome by an hour’s exercise, which keeps the blood circulating vigorously throughout the entire body. Even brisk walking, at perhaps four miles an hour or faster, would often be sufficient to over come trouble of this kind. Slow walking would be of no value. Be as athletic as possible. If you can, play games like tennis, handball, hockey, basket ball, and engage in any other sport that calls for running or much activity. Swimming is an ideal exercise for varicocele, for it combines the good effect of the cold water with the type of exercise for the legs that is best suited to this complaint. Also, by reason of the more or less horizontal position assumed in swimming there is relief from the blood pressure in the large veins in the lower. part of the body, making the return of the venous blood in the affected parts much easier.
Most of the special movements that I have de-scribed in the chapter on exercises for virility building will be useful in the treatment of varicocele, though for immediate relief from the pain of this disorder I would particularly recommend those in the up-side-down position, with the weight of the body on the shoulders and back of the neck, while the legs are extended upward. This position serves to reduce the blood pressure in the large veins of the lower body. Remember that the upright position assumed by the human race when standing necessitates a considerable column of blood in the large veins. This has to be forced upward to and by the heart, with some assistance from the’ valves of the veins, which help to support the weight of the blood and keep it moving in the right direction. When the walls of the veins have become weakened in any *ay there is likely to be a distended condition of the large veins in the abdomen which is relieved, together with the blood pressure, by the upside-down position mentioned, and the freer return of the blood from the spermatic vein is also favored. Exercises in a horizontal position, especially on the back, would have a similar but less marked effect, aside from their other benefits. There is a form of neurasthenia said to be due to such a distention of the large abdominal veins.
Local cold-water treatment seems to be sufficient in many cases of varicocele. The cold sitzbath each morning is the ideal form of this treatment, though it might hasten results to take it both morning and evening, or, if the bath is taken only in the morning,, to give the genital organs a cold sponging at any convenient time during the day and before going to bed. The colder the water the better.
When the veins are very painful quicker resuits will be secured by using a hot sitz-bath for a few minutes, or by local bathing with hot water, always following the hot water with ablutions of cold. Alternate hot and cold water may be desirable in such a case, the cold water being always used last. One must make the blood move freely through these veins. When there is pronounced atrophy of the testicles in connection with varicocele an extremely active circulation is to be de-sired, and a number of changes of hot and cold water, one after another at short intervals, would be advisable. When there is severe pain one should attempt no exercise.
A suspensory should never be used unless absolutely necessary to relieve marked tenderness or pain. In that case it may be advisable for a time, but make sure that the testicles are held well up against the abdomen, so that the veins will naturally drain downward. Don’t depend upon it too much however, and discard it just as soon as possible. Commence by leaving it off only a part of a day at a time, and gradually you will find that you can dispense with it altogether.
In all cases you should study the list of causes of the complaint given in this chapter, for the purpose of ascertaining if any exist in your own case. If there is constipation it should receive the very first attention, the other treatment being secondary.