Expert: Arthur Goldstein, M.D. - 4/30/2007

Question
I am 50, have just been told I have a varicocele of the left testicle, in the last 7-8 months my sex drive has gone to practically zip. also frequently have the sensation of "worms" crawling under my skin in the groin area. are these problems related to the varicocele?

Answer
Jerry, 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 varicocele 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.   Rarely, a varicocele may lower the testosterone level.  In this instance, the testes are usually smaller than normal.  Such a circumstance may decrease the libido.  Evaluation of the serum free testosterone level can detect this.

There are many causes of a decreased libido or sex drive.  It varies greatly from person to person and in some men, a low drive is normal for them.   One cause is  hormonal imbalance (the most common being a deficiency of testosterone or over production of a pituitary hormone called prolactin).  Also, if a man ejaculates too frequently, the prostate gland may become inflamed.  This may cause him to have difficulty with erections and perhaps to be less “horny”.   If this individual avoids sexual arousal and ejaculation for 7-10 days and the problem resolves, the cause was sexual activity that exceeded the tolerance of his prostate gland.  Other etiologies include anemia, chronic fatigue syndrome, diabetes, and just about any debilitating illness.   Certain medications may also lower the libido.  There are a number of men who have decreased libido on a purely emotional basis, such as might occur in anxiety, depression, bipolar disorder, etc.  Initially, one should go to their family physician for a routine history and physical examination and appropriate screening blood tests.  The latter might include a complete blood count, metabolic chemistry screen, a serum prolactin level and serum free and total testosterone levels.  Further consultation with a urologist, endocrinologist and possibly an emotional counselor may be necessary.  There really is no reliable medication yet available that one can take for this problem but drug research is going on in this area.  

The unusual sensation you notice in the groin area is not related to the varicocele and I have no specific explanation for it.  Good luck.