Varicocele

Overview

Varicocele is an enlargement of the veins inside the scrotum, the pouch of skin that holds the testicles. These veins are part of the spermatic cord, which carries blood to and from the testicles. A varicocele is similar to a varicose vein that may occur in the leg.

Varicoceles are relatively common and often develop gradually. They are more frequently found on the left side, although they can occur on both sides. Many people with a varicocele have no symptoms and may only discover it during a routine examination or fertility evaluation.

In some cases, a varicocele can affect testicular growth, comfort, or sperm production. However, not every varicocele causes problems or requires treatment. The need for care depends on symptoms, testicular size, fertility concerns, and examination findings.

Symptoms

Many varicoceles do not cause noticeable symptoms. When symptoms occur, they may vary from mild discomfort to a feeling of heaviness in the scrotum.

• A dull ache or discomfort in the testicle or scrotum
• A heavy or dragging sensation, especially after standing for a long time
• Discomfort that may improve when lying down
• Visible or palpable enlarged veins in the scrotum, sometimes described as feeling like a “bag of worms”
• Difference in testicle size, especially in adolescents
• Concerns related to fertility, such as abnormal semen test results

Sudden, severe testicular pain is not typical of a varicocele and should be assessed urgently, as it may indicate another condition requiring prompt medical attention.

Causes and Risk Factors

A varicocele develops when blood pools in the veins of the spermatic cord. This usually happens because the valves inside the veins, which normally help blood flow in the right direction, do not work properly. As a result, blood can collect and cause the veins to enlarge.

The left side is more commonly affected due to the way the veins from the left testicle drain into the larger veins of the body. This difference in anatomy can make blood flow less efficient on that side.

Varicoceles often appear during puberty, when the testicles grow and blood flow to the area increases. They may become more noticeable over time. While there may not be a clear preventable cause, certain factors can be associated with varicocele development or detection.

• Adolescence or young adulthood
• Increased pressure in the veins around the testicle
• Family history of vein-related conditions, in some cases
• Evaluation for male infertility

Most varicoceles are not caused by lifestyle habits. Rarely, a new varicocele appearing suddenly, especially on the right side or in an older adult, may require further evaluation to rule out other causes of blocked blood flow.

Diagnosis

Diagnosis usually begins with a medical history and a physical examination by a urologist. The doctor may examine the scrotum while the patient is standing and lying down. Sometimes the patient may be asked to gently bear down, which can make the enlarged veins easier to feel.

If the examination is unclear or if more information is needed, an ultrasound of the scrotum may be recommended. Ultrasound uses sound waves to create images of the testicles and surrounding structures. It can help assess vein size, blood flow, testicular size, and whether another condition is present.

For patients being evaluated for fertility, a semen analysis may be requested. This test assesses sperm count, movement, and shape. Hormonal tests may also be considered in selected cases. The choice of tests depends on age, symptoms, fertility goals, and examination findings.

Treatment Options

Not all varicoceles require treatment. If there are no symptoms, testicular growth is normal, and there are no fertility concerns, the doctor may recommend observation with periodic check-ups.

Treatment may be considered when a varicocele is associated with persistent discomfort, reduced testicular size in an adolescent, or fertility problems with abnormal semen findings. The decision is individualized and should be discussed with a urology specialist.

Common treatment approaches aim to redirect blood flow away from the enlarged veins. Surgical repair is one option and may be performed through different techniques, depending on the patient’s situation and the surgeon’s assessment. Another option is a minimally invasive procedure performed through a blood vessel to block the affected veins. Each approach has potential benefits and risks, including recurrence, fluid collection around the testicle, infection, bleeding, or discomfort.

After treatment, follow-up is important to assess healing, symptoms, testicular size when relevant, and fertility-related results if applicable. Improvement, when it occurs, may take time, especially when fertility is being evaluated. No treatment can guarantee a specific outcome, so expectations should be reviewed carefully with the healthcare team.

When to See a Doctor

A medical evaluation is recommended if you notice swelling, enlarged veins, or a persistent ache in the scrotum. It is also important to seek advice if there is a difference in testicle size, concerns about fertility, or a known varicocele that seems to be changing.

• Scrotal discomfort that continues or affects daily activities
• A lump, swelling, or visible enlarged veins in the scrotum
• One testicle appearing smaller than the other, especially in adolescents
• Difficulty achieving pregnancy with a partner after appropriate time trying
• A newly noticed varicocele, particularly if sudden or on the right side

Seek urgent medical care for sudden severe testicular pain, rapid swelling, fever with scrotal pain, nausea, vomiting, or a testicle that sits unusually high. These symptoms may be related to conditions other than varicocele and require prompt assessment.