Varicocele, Male infertility, Infertility in Nigeria, Men’s reproductive health, Hidden causes of infertility, Stigma and infertility, Urology and men’s health, Fertility solutions Nigeria
ABUJA, Nigeria – In Nigeria, where family lineage and children are central to social identity, infertility remains one of the most stigmatised health issues. Yet, when a couple struggles to conceive, suspicion almost always falls on the woman. Across neighbourhoods, villages, and even city churches, whispers of “barrenness” shadow wives, while men often escape scrutiny. But hidden behind this silence is an uncomfortable truth: male infertility contributes to nearly half of all cases, with conditions like varicocele playing a significant role.
Varicocele, an often overlooked yet common medical condition, silently sabotages male fertility in thousands of Nigerian homes. The tragedy lies not just in its prevalence but in the culture of silence, denial, and misplaced blame that prevents men from seeking help. Juliet Jacob writes.
What Exactly is Varicocele?
A varicocele is an abnormal enlargement of the veins within the scrotum, similar to varicose veins that appear in the legs. This venous swelling disrupts the cooling system of the testes, raising temperatures and impairing sperm production and quality. Doctors liken it to a “short circuit” in the male reproductive system.
Symptoms may include a heavy, dragging pain in the scrotum, swelling or visible enlarged veins (“bag of worms” appearance), and reduced testicular size.
Infertility, often discovered after years of trying for a child
While some men live with it unknowingly, urologists estimate that up to 15% of all men and around 40% of men evaluated for infertility have a varicocele.
The Causes: Why Varicoceles Form
Experts explain that varicoceles occur when faulty valves in the testicular veins allow blood to pool, increasing scrotal temperature. Genetics, lifestyle, and even occupational strain (long hours of standing, heavy lifting) may worsen the condition. Left untreated, varicoceles can reduce sperm count, impair motility, and in severe cases, lead to testicular atrophy.
Numbers That Tell the Story
Globally, the World Health Organisation (WHO) recognises varicocele as a leading cause of male infertility. In Nigeria, available studies suggest that up to one in five men presenting at fertility clinics are diagnosed with it. Yet, experts warn this figure is likely higher, as most men never seek evaluation.
A 2021 study at the Lagos University Teaching Hospital reported that nearly 42% of male infertility cases involved varicocele, underscoring its silent yet significant burden.
The Human Experience: A Story Untold
Emeka (surname withheld), a 38-year-old welder in Abuja, though a father of one out of concern for his secondary infertility situation, took a bold step for a medical checkup and discovered he was suffering from varicocele shared his ordeal:
“My wife and I had been married for seven years without a child and after our son who is six years now, a series of trials to get another child proved negative and everyone blamed her and some believed it wasn’t normal, including my own mother.
“She went through endless tests and treatments, some painful, some humiliating. But nothing worked. Finally, at her insistence, I got tested. That’s when the doctors found I had a varicocele. I felt shocked, ashamed… almost less of a man. But at the same time, guilty for all the pain she had carried out, what was my problem.”
His experience mirrors countless silent stories across Nigeria, where women bear social condemnation for infertility, even when the root cause lies with the man.
The Gendered Burden: Why Women Take the Blame
Infertility is seen through a gendered lens in Nigeria. Cultural narratives often cast women as the “carriers” of fertility, while masculinity is equated with virility. As such, male infertility challenges not only health but identity, making men less likely to admit or confront the possibility.
In one interview with Africa Health Report, a Medical Laboratory Scientist, Victor Ekoche Ali, detailed varicocele’s dual assault on fertility and well-being, causing pain and atrophy if ignored. He pinpointed stigma as the core barrier, tying it to masculinity myths, alongside awareness gaps, high costs, and rural healthcare shortages.
Ali calls for education via campaigns and leader involvement, plus routine screenings and empathetic care to encourage men to seek help without shame. His rallying cry: treat infertility as a team effort, with early specialist consultations key to success.
Another public health expert, Dr. Ahmadi based in Abuja, described varicocele as a treatable but often overlooked cause of infertility, hidden under layers of stigma and the widespread belief that infertility is solely a woman’s burden.
He called for a cultural reorientation toward shared responsibility, stressing the need for early diagnosis and affordable treatment options.
Dr. Ahmadi further emphasized integrating male reproductive health screenings into primary healthcare policies and rolling out community-based awareness campaigns to dismantle ridicule and encourage men to seek help with confidence.
Barriers to Breakthrough: Systemic Challenges and Policy Imperatives
Despite signs of progress, significant hurdles persist. The World Health Organization highlights diagnostic inconsistencies fuelled by bias and variations in testing methods, while Nigeria continues to struggle with shortages of specialised facilities. Economic constraints and deep urban–rural divides leave many men without access to proper care, turning otherwise treatable conditions into lifelong burdens.
Addressing these challenges requires a decisive policy shift: integrating male reproductive health into national health strategies, subsidising diagnostic services, and expanding the pool of trained specialists. Community-driven initiatives must also play a central role, ensuring that awareness and support reach even the most marginalised communities.
This report lays out a pathway for meaningful change: Amplify Awareness: Launch nationwide campaigns through traditional media, social platforms, and community leaders to normalise conversations about male infertility, with an emphasis on varicocele as a treatable condition.
Enhance Access: Invest in affordable diagnostic tools, surgeries, and rural health facilities to make reproductive healthcare more equitable.
Foster Partnerships: Encourage couples’ joint evaluations and counselling, promoting a culture of shared responsibility and resilience.
Drive Cultural Evolution: Collaborate with respected figures and influencers to challenge stereotypes of masculinity, reframing openness and vulnerability as strengths.
Expert Views: The Cost of Ignoring Male Infertility
Medical professionals warn that ignoring conditions like varicocele has serious consequences:
Medical Consequences: “If untreated, varicocele can lead to permanent infertility,” notes Dr. Abdulrahman Musa, urologist at Aminu Kano Teaching Hospital.
Psychological Toll: Psychiatrist Dr. Maymunah Kadiri explains: “Men diagnosed with infertility often develop depression, anxiety and low self-worth. For couples, the constant blame game fuels marital breakdown.”
Cultural Blind Spots: Sociologist Prof. Abayomi stresses: “By focusing blame solely on women, society not only deepens gender injustice but also undermines efforts to treat infertility holistically.”
Possible Solutions: Breaking the Cycle of Silence
Experts agree that solutions must combine medical, cultural, and policy interventions:
- Awareness Campaigns – Normalising male reproductive health check-ups, including varicocele screening.
- Counselling Services – Providing psychosocial support for men and couples.
- Access to Care – Expanding fertility clinics beyond urban centres, subsidising tests and surgery.
- Policy Reforms – Including male infertility in national reproductive health strategies.
- Community Engagement – Religious and traditional leaders encouraging men to seek care.
Treatment for varicocele ranges from non-surgical management to procedures like varicocelectomy, a minor surgery with high success rates in improving fertility outcomes.
A Call to Action: Shifting the Conversation
Male infertility, especially varicocele, is not just a medical condition—it is a social justice issue. It highlights the inequities women face in taking all the blame, while men suffer in silence. Breaking this cycle requires honesty, education, and systemic reform.
As Emeka reflects on his journey “I wish I had gone for tests earlier. Maybe we would have saved years of pain. Men must stop seeing fertility checks as an attack on their manhood—it is a responsibility.”
The future of Nigeria’s families depends on breaking the silence around male infertility. It is time for men to step forward, for health systems to respond, and for society to shift its gaze from blame to solutions.
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