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Male Infertility and A Discussion of Spermophlebectasia, or Varicosity of the Spermatic Cord Vein

By J. Min Fan, L.Ac.

In Traditional Chinese Medicine, most cases of male infertility are related with kidney deficiency; thus, most TCM treatments of infertility concentrate on the kidneys and have good results. Yet some cases of male infertility have only indirect, or in some cases no relationship to the kidneys, and one such malady is spermophlebectasia, or varicose vein of the spermatic cord.

Spermophlebectasia can cause male infertility for two reasons. First, increased blood in the vein of the spermatic cord can increase testicle temperature, making the testicle a less hospitable environment for sperm production and decreasing or eliminating live sperm count and activity. Second, prolonged presence of the varicosity can result in poor blood circulation to the area and eventual shrinkage and dysfunction of the testicle, thus making it unable to produce healthy sperm.

Spermophlebectasia can be either a secondary or primary condition. A secondary type, such as one that might occur in a patient with a tumor in the abdomen, generally requires treatment of the major problem. In this article, we will focus on primary spermophlebectasia.

Spermophlebectasia most frequently occurs in the left testicle. In Western medicine, the cause of primary spermophlebectasia is unclear, but there are four main explanations which fall into two theoretical categories: anatomy and hemodynamics.

  1. The left side vein of the spermatic cord connects to the left kidney vein at a 90 degree angle, while the right side vein of the spermatic cord connects directly to the vena cava. One suggestion is that the tight angle on the left side increases the pressure on the left side vein, resulting in the varicosity.
  2. The vein inside the spermatic cord has many valves. Some may have congenital defects which can result in blood flowing backwards from the kidney. Over time, the conflicting forces may cause other valves to dysfunction, resulting in the varicosity.
  3. The left kidney vein has to cross the spine to get to the vena cava. Compared to the right kidney vein, the left has a longer pathway, and it also has to weave through more arteries, which can increase the pressure on the left side.
  4. When spermophlebectasia occurs in both testicles, the explanation is that since the left and right testicle veins are connected via the veniplex, increased blood pressure in the left can sometimes affect the right side as well.

Symptoms

Spermophlebectasia is most frequent in males age 20 to 30, because this is usually the age of greatest activity, both sexual and physical. Usually the chief complaint is pain, but patients with mild cases may only experience pain during a physical exam. More pronounced cases may have pain including heaviness in the scrotum and generalized pain around the testicles, groin, and lower abdomen. The pain is aggravated by prolonged standing and walking and unusually frequent sexual activity. Resting in supine position alleviates pain.

Other symptoms include insomnia, emotional disorder, irritability, Anxiety, decreased libido, impotence, premature ejaculation, etc.

Signs

Upon physical examination, the scrotum appears very loose and enlarged. The vein is enlarged, purple, and meandering, and the veniplex is visible. In some cases varicose veins are also present in the groin and inner thigh.

By palpation, the vein feels tangled and spongy. If you press into the vein, it temporarily shrinks or disappears. In a supine position the vein will appear smaller and straighter.

In Western medicine, treatment in mild cases is considered unnecessary. If the scrotum feels heavy, tight underwear may be recommended to provide support. But if pain is severe or the condition is causing infertility, then the condition must be treated by surgery.

In traditional Chinese medicine, the condition is first diagnosed as belonging to a particular syndrome, such as liver/kidney deficiency, sinking central qi, stagnation of qi and blood, and dampness and heat accumulation in the lower burner. A combination of acupuncture and Chinese herbal medicine is highly effective in treating spermophlebectasia.

Male infertility can be a very complex condition; spermophlebectasia is only one of may possible causes. For more information on treatment of male infertility, contact Dr. Fan at the Pacific College Clinic, (619) 574-6932

Dr. Fan is currently a professor and clinical supervisor at the Pacific College of Oriental Medicine. He is a former professor of the Nanjing University of Traditional Chinese Medicine and physician at the Jiangsu Province Hospital of Traditional Chinese Medicine.


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