Q: My 12-year-old son recently had a sports physical and was told he had a varicocele. Our doctor told him not to worry about it, but I don't understand what this is.
A: About 10 percent to 20 percent of teen-age males have a varicocele, usually felt as a "bag of worms" in the scrotum on the left side.
Varicoceles are the result of weakened valves in veins that would normally allow the blood to flow in only one direction -- back to the heart. When these valves weaken, blood pools in the veins and these dilated veins form the varicocele.
Typically, a small varicocele does not cause any problems. A larger one can cause vague pain in the scrotum, especially in young men who exercise regularly. Use of an athletic supporter (jock strap) during exercise will usually eliminate this problem. Some young men who may feel the varicocele mistakenly confuse it with testicular cancer.
The main concern about large varicoceles is whether they are linked to an increased risk of infertility in adulthood. In one study varicoceles were found more commonly among men attending an infertility clinic than in the general male population. But there are conflicting data about whether surgical repair of the varicocele improves fertility.
Current evidence suggests repair in adulthood has no effect on fertility. Whether earlier repair, during adolescence, would have any beneficial effect is unknown. Some physicians suggest varicoceles should be repaired at the time of diagnosis if the testicle on the same side as the varicocele is smaller than on the opposite side. Others do not agree.
As you can see, the decision about what to do is complicated, and if you have any questions, you and your son should talk with his doctor.
Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.