Occupational hazard

Many men are oblivious of varicocele, an abnormal dilation of the veins in the scrotum, and only discover such problem when facing issues of male infertility.

It has been many years since I have been excited about celebrating the Chinese New Year. For the first time in years, the family decided to have the reunion dinner at home, instead of hotel outings, which resembled a wedding banquet with the absence of the ‘bride and groom’. 

The strange thing about festivity is the tantalising enticement to the built up of the occasion and the whole affair may not really meet up to expectations. This certainly has remained unchanged since my early memories of CNY and that usually makes all the past celebrations a blur. 

In the Lee household, the first day of the Lunar New Year is normally greeted with home-cooked noodles, followed by the morning prayers in the temple. This often feels like a townhall gathering of the local Chinese minorities, and I feel  embarrassed when greeted by friends whom I have not seen for years, and failed to recognise. 

After temple,  we are duty-bound to visit our senior relatives. And of course, kids will usually outdo each other in the Ang pow game during this time. The small  talk usually starts after the initial round of drinks and tidbits. I often wonder, after years of telling my relatives what I do for a living, one would think they would finally get it. Oh no! From tremor to headache, I am usually bombarded with unimaginable questions and in most instances, are trivial. 

As I was leaving, a young gentleman approached me in the quite corner of the dining room and whispered: “Uncle George, I have read year articles on your column on The Star Online, Ask Dr G, are they real?” Well, he has got my attention calling me uncle George (okay, he should call me uncle as he is my cousin’s 24-year-old son). What I was more astounded was someone had actually read my articles in Kota Baru. 

“I have this problem. I have been married for two years and we are having difficulties having babies”. Before I could respond, he enquired further. “And I also have this lump in the left testicle! Do you want to have a look?” 

Now, he has really gotten my attention. A 24-year-old man with the history of testicular lump and infertility can be a serious matter as the cancer of the testicle can be associated with infertility in younger men. What really alarmed and staggered me was how am I going to confirm the etiology of the lump. 

In the normal setting, I would have asked the patient to come to my clinic the following day. On this occasion, I was completely hesitant whether to inspect his scrotum in the privacy of the bathroom or bedroom, as I really didn’t want to be mistaken as “perverted uncle George”. 

I initially asked him to draw the scrotal defect on paper, which failed miserably, as the drawing more resembles Chinese Dim Sum than scrotal lump.

Out of desperation, I asked his dad to come along to chaperon the examination. To my relief, even before the touching of the testicle, the appearance resembles “a bag of worms”. That can only mean one thing, varicocele.

Varicocele is an abnormal dilation of the veins in the scrotum called pampiniform plexus. This is a very common condition affecting men and some studies have reviewed prevalence of 15-20% in the general population. 

The risk factors of having this condition include excessive gym activities, weight increase or straining. However, in most men, the cause is unknown.

Most men with this condition are symptom-free. Some complained of heavy, dragging sensation in the scrotum, commonly in the left. 

Others may complain of lumps in the testicle as the dilated vein often appear like a defect in the testicles that looks like “a bag of worms” especially in a prolong standing position, and disappear when supine.

Many men are completely oblivious of the varicocele and only discover such problem when facing issues of male infertility. This is believed to be associated with the increase of temperature in the testicle with the increase blood flow, impeding spermatogenesis. 

Most varicocele is managed conservatively, as the existence will not result in significant adversity. In the minority of sufferers, surgical intervention is advised to enhance sperm production or to relieve discomfort.

The surgical correction can be done with open keyhole, microscopic or even via radiologically. The results of such corrections are efficacious. 

I continued my journey of visiting my families on our “Chinese New Year Open House quests” after assuring my nephew the lump in the testicle is nothing serious, and the surgical correction may even bring him a baby in the year of the wooden horse. 

Most of the family members were unmindful of what had happened. Dr G was amused with his occupational hazard as a urologist and was overwhelmed of not being mistaken as “Perverted uncle George”. Gong Xi Fa Cai!!

> The views expressed are entirely the writer’s own. 


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