Will varicocele cause the left testicle to be smaller and the right testicle to be larger?

Author: Zhang Xing, chief physician of Yangzhou Traditional Chinese Medicine Hospital

Reviewer: Chen Yun, Chief Physician, Jiangsu Provincial Hospital of Traditional Chinese Medicine

Some men find that their left testicles are smaller than their right testicles, and they think that this is caused by improper living habits or wearing inappropriate underwear. In fact, this is most likely caused by varicocele.

So, why does varicocele cause the left testicle to become smaller and the right testicle to become larger?

1. Will varicocele cause testicular atrophy?

Many people think that varicocele is just a minor disease that causes scrotal discomfort. But in fact, varicocele can cause many serious harms to patients, such as changes in local blood flow, temperature rise, and damage to the supporting cells in the testicles, which may cause spermatogenic dysfunction and infertility in severe cases; reduce the testicular function of androgen secretion, causing androgen deficiency, and even testicular atrophy in severe cases, etc.

Studies have shown that patients with varicocele may have varying degrees of testicular atrophy regardless of whether they have normal fertility. A study performed a bilateral testicular biopsy on patients with unilateral varicocele and found that even in unilateral varicocele, both testicles are affected, and the degree of testicular damage is not proportional to the severity of the varicocele.

Figure 1 Copyright image, no permission to reprint

In addition, clinical practice has found that most patients with varicocele have a smaller left testicle and a larger right testicle. What is going on?

2. Why is the left varicocele more likely to become varicose?

According to relevant literature statistics, the incidence of left-sided varicocele is higher than that of right-sided varicocele, accounting for about 90% of all varicocele in clinical practice. The main reasons for the higher incidence of left-sided varicocele are:

The left spermatic vein is 8 to 10 cm longer than the right spermatic vein, which causes the left spermatic vein pressure to be greater than the right one. The rate of deficiency of the left spermatic vein valve in men is also higher than that on the right side (about 40% on the left and about 23% on the right), which can also cause the left spermatic vein pressure to increase and blood return to be obstructed, making varicocele more likely to occur. In addition, the lower segment of the left spermatic vein is located behind the sigmoid colon, which also makes the left spermatic vein more susceptible to compression, thereby increasing the resistance of venous return.

These factors make the left varicocele prone to increased venous pressure, so the incidence of left varicocele is higher than that of right varicocele. Left varicocele leads to left testicular atrophy. Over time, the patient's left testicle is smaller than the right one.

If the patient is diagnosed and undergoes surgical treatment, can the testicular volume return to normal?

3. Can the testicular volume return to normal after surgery?

One of the important criteria for judging whether varicocele requires surgical treatment is whether varicocele causes progressive damage to the testicles. The most intuitive way is to observe whether there is any abnormality in the patient's testicular volume.

If a young man is diagnosed with unilateral or bilateral varicocele and there is an abnormality in the testicular volume, the doctor will consider surgery; if there is no obvious abnormality in the testicular volume, the doctor will closely observe the patient's testicular volume or semen changes for one year. If the difference in testicular volume increases or the semen quality decreases, surgery will be considered.

If an adolescent boy is diagnosed with varicocele and testicular shrinkage, doctors will often recommend surgery as soon as possible; or follow up and detect changes in the patient's testicular volume or semen parameters. Once abnormalities are found, surgery is also recommended as soon as possible, because testicular shrinkage may indicate a decline in semen quality.

A study found that after surgery, the difference between the volume of the affected and contralateral testicles of patients with varicocele was significantly reduced, with an average improvement rate of 76.4%. In other words, surgery has a certain probability of improving testicular volume.

In summary, varicocele is one of the common diseases in men. In life, any disease is "three parts treatment and seven parts care", and daily prevention and treatment is very important. Therefore, men should pay attention to the prevention and treatment of varicocele in daily life, and can start from the following aspects:

First of all, avoid smoking, drinking and spicy food, drink plenty of water, and eat more fresh vegetables and fruits.

Next, avoid wearing tight pants.

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Finally, men should have a correct understanding of varicocele. They should have a regular life and keep a good mood; avoid strenuous exercise, heavy physical labor and standing for a long time; avoid exercise that increases abdominal pressure, such as sit-ups, weightlifting, etc.; and avoid crossing your legs to prevent obstruction of blood return to the lower limbs.

If a man finds that his left testicle is smaller than his right, he should go to the hospital for medical treatment immediately.