Louise J Kaplan, the psychoanalyst and author who used a psychological lens and literary allusion to define and explain seemingly titillating topics in sex once said: “Adolescence is the conjugate of childhood and adulthood.”

In many sense, the conjugation from childhood to adulthood is also a source of self-doubt, confusion and embarrassment, as the body changes from a “dormant sexual being” to its reproductive maturity.

We all have our adolescent years that we look back with the moments of awkwardness and shame, such as the emergence of pubic hair, acne and enlargement of sexual organs. In male, these sexual maturations are driven by the surge of testosterone that will have life-long reproductive role.

During the process of conjugation of adolescent years, what constitute normal often are issues of discomfiture and humiliation for “peer-comparison” or open adult discussion. This week, we address a question from an adolescent reader who is having shameful awkwardness when he discovered some “worms in his pants”

Dear Dr. G,

I am 17-year-old and I really hope you can help me to address my problems, as I am too embarrassed to talk to my parents.

As most teenagers in my college, I am conscious about my body.

I have been going to the gym to build my “six packs” and it is going well.

The problem is, I recently was changing in the locker room and my friends saw my balls and thought I have a really weird looking scrotum.

The only way to describe it is as it I carry a bag of worms in the sac.

I often assume my body changes with puberty and this testicular enlargement is normal. Now, comparing with my peers, I realized this is far from normal.

The other strange this I observe is the worms (I mean swelling) disappears at night when I lie down.

Seriously, I am worried. You don’t think I have contracted any infections in my balls, do you? Truthfully, I have not started having sex yet. How did I contract any infection? Or worse, Can this be cancer?

I am embarrassed and worried.

Please help.


The abnormal enlargement of the vessels in the scrotum is called varicocele. The condition appears to look like a sagging bag of worms that hangs on the side or the upper part of the testicles. The varicocele is common and can occur in 15- 20% of all males, and the most frequent years of diagnosis is between the ages of 13 to 30 years old.

The exact cause of varicocele is largely unknown. The pampiniform venous plexus are the veins that return blood from the testicles to the main body. The return is usually be sustained by small one-way valves to ensure upwards flow of blood to the core body. Defective valves, or compression of the veins by pressures within the body will result in the dilation of the veins alongside the testicles, leading to the formation of varicocele.

The majority of varicocele is detected on the left side, as the left testicular vein travels to the vena cava via the left renal vein. This is believed to result in some turbulence in the blood flow dynamic. The dilation of the veins is generally progressing slowly and may not have any symptoms. However, the appearance of the enlarged sagging scrotum may cause embarrassment and shame, typically in the locker rooms.

Although varicocele is commonly symptomless, some men may experience dragging aching sensation and the feeling of heaviness in the testicles. In the more severe cases, the distension of the pampiniform plexus is also known to be associated with atrophy of the testicles causing impairment of the testicular functions, including alteration of testosterone and sperm counts. However, such complication is rather rare.

Lifestyle factors are well documented to be associated with varicocele; these include heavy lifting, gym activities, low fiber diet, bowel habit, excessive alcohol consumption and smoking. The exact mechanism of the etiology is unclear, but symptom relief and diminishing venous distensions are noted following the improvement of the lifestyle factors.

Varicocele may be embarrassingly unsightly and can be a complete nuisance with the discomfort. Most clinicians would agree the condition is overall harmless. Although, interventions such as open operations, keyhole surgery, microscope dissection and vascular embolization have been proposed to be the solution for varicocele; the vast majority of men will require absolutely no intervention for the bulge.

It is completely understandable for teenagers undergoing bodily changes to be completely freaked out when noticing the hideously unattractive “cohabiting worms” in their sacks. The fact is these “gruesome worms” in the pants are completely benign and innocent in nature, and the risk of cancer or other bodily harm is totally negligible. So, the advice from Dr. G to the teenagers with the trouble of varicocele is “Keep your pants on, and the worms will just remain a bulge in the pants that you keep with pride, with your six packs!”

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