Patient and family experiences toward fertility, self-esteem, and sexual function in adolescents with varicoceles: A qualitative study
Grace Elizabeth Sollender, MD, Allen Siapno, BA, Eduardo Piquieras, PhD, Jennifer S. Singer, MD, Sriram V. Eleswarapu, MD, PhD.
UCLA, Los Angeles, CA, USA.
BACKGROUND: Varicoceles affect 5% - 30% of postpubertal 12- to 18-year-old males. Although common in the general population and often asymptomatic, varicoceles can be associated with gonadal dysfunction including testicular atrophy, infertility, and hypogonadism for some adolescents in adulthood. The objective of this qualitative study was to explore first-person attitudes and concerns among adolescents and their parents regarding varicocele diagnosis and subsequent management.
Methods:Using an exploratory qualitative design, semi-structured interviews were separately conducted with English-speaking adolescents with varicoceles and their parents from 8/2022-1/2023. Purposive sampling identified eligible patients between the ages of 10-19 diagnosed with a varicocele and seen in the urology clinic between 10/2015-7/2022 who elected observation or microsurgical subinguinal varicocelectomy. Participants were interviewed using a standardized script which covered the following topics: potential long-term impacts of varicoceles on fertility and sexual function; varicocele-specific knowledge; family experiences with diagnosis; factors involved in decision-making; and level of parent involvement. Interviews were recorded, transcribed, and then coded to generate salient themes via thematic analysis.
Results:We interviewed 23 parents (17 mothers, 6 fathers) whose adolescent had a mean age of 16.3 (range 13-19) and 16 cis-gender male adolescents with a mean age of 17.5-years-old (range 14-19) at time of interview (Table 1). The mean time that had elapsed between the date the interview was conducted and the last urology appointment prior to interview was 10.3 months in the parent’s group (standard deviation 9.1, range 0.4 - 27.6 months) and 10.3 in the adolescent’s group (standard deviation 8.4, range 1.55 - 28.5 months).Two major themes were identified, each with associated subthemes. Analysis revealed that parents and adolescents have common concerns regarding fertility and the psychosocial impact of a varicocele on adolescent self-esteem and sexual function. Spanning all themes was the diversity of attitudes and care preferences among participants (Table 2). Qualitative analysis indicates: 1) future fertility is a critical factor for both parents and adolescents and 2) concerns regarding varicocele’s impact on self-esteem and sexual function are potential psychosocial drivers for seeking care.
Conclusions:This work represents the first study to utilize a qualitative approach to explore the patient and family experience of an adolescent varicocele diagnosis. Families identified common concerns related to fertility and the psychosocial impact of a varicocele on adolescent self-esteem and sexual function. Importantly, the study highlights the diversity of attitudes and care preferences among participants, underscoring the need for individualized care for varicocele patients. These perspectives can be used to guide family-centered education and informed decision-making by prioritizing uncomfortable but important discussions of adolescent varicocele treatment and care.
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