ASK THE DOCTOR: Can varicoceles cause impotence?

Although I have a four-year-old son, I have been told I suffer from varicoceles and advised to cut off my scrotum. However, I would like to have more children. Is there another way to treat the disease and is the child mine? Lazaro

Dear Lazaro,
In humans, testes hang out in a sac called a scrotum. The scrotum has testes which have blood vessels called arteries that take blood to the testes and veins that take blood away from the testes.
To ensure blood does not fail to climb out of the testes and run backwards, the veins have valves, which if damaged, blood does not flow away properly and the resulting backup causes the testicular veins to widen forming varicoceles.
The varicoceles cause blood to pool in the veins, resulting in heating up of the testes risking infertility (decreased sperm production and quality) and accumulation of toxins leading to testicular damage and shrinkage. Unfortunately, even if you have a varicocele only on one side, both testicles can be warmed by the increased amount of blood pooled in the enlarged veins risking infertility.
Varicoceles usually form during puberty but do not always lead to infertility in every sufferer, the reason some people may have varicoceles without symptoms or infertility. Apart from infertility and shrinkage of testes, symptoms may include, testicular discomfort which worsens with standing or physical activity but relieved by lying on the back.
Without symptoms, you require no treatment but if you have progressive testicular shrinkage, testicular pain or abnormal semen analysis results, surgery on the veins but not testes themselves may be done. Semen analyses may require to be done every three to four months after the procedure though improvement might take as long as a year.
Because you have not had a child in two years, you require to see a doctor for fertility tests and likely varicocele treatment if the seminal analysis shows that this is likely to be having an effect on your fertility. However, please take your wife for checkup as well because she may also be having fertility issues the reason she has failed to get pregnant after her first child.
If you suspect the child might not be yours, please do a DNA test to rest your mind but make sure you do not cause the child psychological issues.