AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
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The text above is a follow-up to ...
does a varicocele get larger with an increase in activity?-----Question-----
I have in both sides of my scrotum a mass that is located basicly on top. When I am very active at work the nass will become larger and when I am resting at home it goe sdown in size. It is painless. I hav eno bleeding or redness. The mass is very soft. I liv ein the US and I am 49 years old. At present I am not taking any medication for any thing.
-----Answer-----
Kenneth, In evaluating lumps in the scrotum, is important to differentiate those that are extra-testicular, (originating from the contents of the scrotum but not actually from the testicle) from those that are originating from the testicle per se. The former are very common and almost always benign. Such examples would include hernia, varicocele, epididymal cyst, spermatocele, hydrocele, etc. Your brief description suggest one of these lesions, the most common being a varicocele. There also exists a small embryonic remnant on the upper pole and the testicle and another on the head of the epididymis. These are called the appendix testis (also know as the hydatid of Morgagni) and the appendix epididymis respectively. None of the requires treatment and they are generally painless. The one exception is that occasionally the appendix can twist (torsion) and shut off its blood supply. This produces a painful nodule that gradually disappears in a week or so. Sometimes they are removed surgically if one cannot differentiate them from torsion of the testicle.
Testicular lesions can also be benign, the most common of these being a tunica albuginea cyst which characteristically is smooth, round, painless and rarely more than 5 mm in size. All other masses of the testicle are to be considered tumor until proven otherwise. A urologist can usually differentiate between the various lesions on physical examination. An ultrasound of the scrotum will generally be done if the diagnosis is not obvious or there is concern about tumor. If a lesion is testicular or you can't be sure, it is my advice to consult with a urologist.
To follow is some general information on varicoceles as this is the most common condition that fits your description. A varicocele is a collection of varicose veins of the spermatic cord (the rope-like structure that suspends each testicle). They occur in about 15% of the population. More than 90% occur on the left, 5% on the right and the rest are bilateral. Varicoceles are due to a defective valve in the vein that drains blood from the testicle. They fill by gravity and therefore are not detectable while recumbent but apparent when upright. On examination, the lesion feels like a bag of worms. Small varicoceles may only be detected by imaging studies such as ultrasound. A varicocele that does not disappear when lying down may indicate a tumor in the abdomen (but this is quite unusual). Varicoceles are generally painless. Often men present to the doctor with pain in the testicle and the varicocele is discovered at that time. In my experience, the pain is very rarely due to the vairicoele and usually due to prostatitis (an inflammation of the prostate gland). In other words, the varicocele is an incidental and unrelated condition. Varcioceles may cause an infertility problem manifest by lower sperm counts and increased numbers of immature sperm in the semen on analysis. However, the majority of men with varicoceles do NOT have infertility. Of men who have abnormal semen analyses and varicoceles, in about 70% of them, the 2 are related and fixing the varicolele often will improve their fertility. If a teenager or young man with a varicocele has a smaller than normal testicles on that side, there is an increase risk of infertility and many urologists consider this an indication to fix the varicocele surgically.
Good luck!
Answer Kenneth, as mentioned, a varicocele is basically empty when you lie down and fills with blood when you stand because of the force of gravity. It may enlarge some more with physical activity especially those associated with a valsalva maneuver. The latter is any action that causes you to take in a deep breath, push down and contract the abdominal muscles. This action pushes the diaphragm down toward your abdomen and forces more blood into the veins of your body below this point. Such a phenomenon might occur for example in weight lifting. That being said, a hernia, however, would be more likely to show increase in size with physical activity than a varicocele.
