Understanding Varicocele: Symptoms And Surgery

Varicocele is an enlargement of the veins within the scrotum that commonly affects men. It is not life‑threatening but can cause discomfort and is a recognized risk factor for infertility — it is found in up to about 40% of men evaluated for infertility (citation needed). If you have scrotal swelling, pain, or concerns about fertility, consider seeing a urologist for evaluation and testing.

What is Varicocele?

A varicocele is an enlargement of the veins within the scrotum — similar to varicose veins that occur in the leg. It results from abnormal blood flow in the veins of the spermatic cord, most often in the pampiniform plexus, and can affect one or both testicles. Many men have a varicocele and never know it; others may notice discomfort, swelling, or changes in testicular size.

To understand how varicoceles affect sperm production, it helps to review basic anatomy: the testicles (testes) produce sperm and testosterone and sit inside the scrotum. Sperm matures in the epididymis, then travels through the vas deferens during ejaculation. The prostate, which surrounds the urethra just below the bladder (anterior to the rectum), contributes fluid to semen. For optimal sperm production, the testicles need to be slightly cooler than core body temperature. The pampiniform plexus — a network of veins that wraps around the testicular artery — normally helps cool arterial blood before it reaches the testis through a countercurrent heat exchange mechanism.

When those scrotal veins become dilated (a varicocele), the cooling function can be impaired. The resulting rise in local temperature and altered blood flow may reduce sperm production and lower semen quality (count, motility, and morphology). While many men with varicoceles remain fertile, varicoceles are commonly found in men evaluated for infertility and can be a contributing condition to decreased sperm production (citation needed).

What are the Symptoms of Varicocele?

Many varicoceles cause no symptoms and are found incidentally during fertility evaluation. When symptoms do occur, they are usually mild but can affect comfort and fertility. Men with unexplained infertility are often evaluated for varicoceles because this condition is commonly associated with abnormal semen results.

Visible or palpable swelling: A soft, worm-like cluster of enlarged veins is most often felt or seen above the left testicle, since varicoceles are more common on the left side.
Dull ache or heaviness: Persistent, aching pain or a sensation of heaviness in the testicle, scrotum, or groin that often improves when lying down.
Symptoms worsen with heat or exertion: Discomfort may increase after exercise, prolonged standing, or in hot weather.
Testicular changes: Shrinkage (atrophy) of the affected testicle can occur in some cases and may be noticed by a clinician during examination.

How varicocele is evaluated

Physical exam: A urologist inspects and palpates the scrotum, often asking the patient to perform the Valsalva maneuver (take a deep breath and bear down) to reveal veins that enlarge with increased abdominal pressure.
Scrotal ultrasound: Doppler ultrasound evaluates venous dilation and blood flow in the pampiniform plexus and can detect grade 0 or subclinical varicoceles not found on exam.
Semen analysis: Because varicoceles can affect sperm count, motility, and morphology, semen testing is recommended for men with fertility concerns (repeat testing may be advised).
Blood tests: Hormone testing (FSH, testosterone) may be ordered when infertility or testicular atrophy is present to assess overall testicular function.

Clinical grading

Grade 0 (subclinical): Vein enlargement seen on ultrasound only, not felt on exam.
Grade 1: Small varicocele felt only during the Valsalva maneuver.
Grade 2: Varicocele palpable at rest but not easily visible.
Grade 3: Large varicocele visible through the scrotal skin and easily felt on examination.

If you have persistent scrotal pain, noticeable swelling, or concerns about fertility, schedule an evaluation with a urologist. Semen analysis and scrotal ultrasound are typical first steps to determine whether a varicocele is contributing to infertility or affecting testicular health (citation needed).

What Causes Varicocele?

Most varicoceles result from abnormal blood flow in the veins of the spermatic cord. Healthy veins have one-way valves that move blood back toward the heart; when those valves fail, blood can pool and the veins dilate, forming a varicocele. This process is similar to how varicose veins develop in the leg.

Anatomic drainage differences: The left testicular vein drains into the left renal vein at a right angle, which partly explains why varicoceles more commonly occur on the left side (venous pressure and reflux are greater).
Valve dysfunction: Incompetent venous valves within the pampiniform plexus or spermatic cord allow retrograde flow and progressive dilation of the veins.
External compression or lesions: Masses, scarring, or compression from nearby structures can obstruct venous outflow and contribute to varicocele formation.
Nutcracker phenomenon: Compression of the left renal vein between the aorta and superior mesenteric artery (the so-called Nutcracker Syndrome) can increase pressure in the left testicular vein and lead to varicoceles in some cases.

Varicoceles may be congenital (present with a predisposition from birth) but often become noticeable during puberty when testicular growth and increased blood flow reveal the dilation. If a varicocele is first detected in an older man or appears suddenly, additional evaluation is recommended to rule out other causes such as a mass obstructing venous drainage (citation needed).

How is Varicocele Treated?

Treatment for a varicocele depends on symptoms, testicular changes, and fertility goals. Not all varicoceles need intervention — many men have a varicocele without pain or abnormal semen and can be observed. When treatment is indicated, options range from conservative measures for symptom relief to invasive procedures aimed at improving blood flow and testicular function.

When to consider treatment

Persistent testicular pain that affects daily life
Testicular atrophy (shrinkage) of the affected testicle
Abnormal semen analysis in men concerned about fertility or with a partner trying to conceive

Conservative (non-surgical) measures

Observation with periodic exam and semen analysis when fertility is a concern (many varicoceles do not progress).
Supportive garments or snug underwear to relieve discomfort during activity.
Short-term measures such as cold packs for pain relief; note these approaches address symptoms rather than correcting the underlying venous dilation.

Procedural treatments

Varicocelectomy (surgical ligation): microsurgical subinguinal varicocelectomy is commonly used and aims to close dilated veins so blood is redirected through healthy vessels.
Percutaneous embolization: an interventional radiology procedure that blocks the enlarged veins using coils or embolic agents via a catheter (less invasive, but with different success and recurrence profiles).

Expected outcomes: many men experience improved semen parameters (count, motility, morphology) within 3–6 months after successful repair, though results vary and are not guaranteed (citation needed). If fertility remains an issue after treatment, assisted reproductive technologies may be discussed with a specialist.

Talk with a urologist about treatment varicocele options that fit your symptoms and fertility goals. If you pursue repair, plan a follow-up semen analysis about 3 months after the procedure to assess response (citation needed).

How is Varicocele Surgery Performed?

Varicocele repair can be performed surgically (varicocelectomy) or by a minimally invasive radiologic procedure (embolization). The choice of procedure depends on the patient’s symptoms, anatomy, prior treatments, and fertility goals. Below are the commonly used approaches, with typical indications and recovery notes.

Microsurgical subinguinal varicocelectomy: Performed by a urologist using an operating microscope through a small incision above the scrotum. The surgeon identifies and ligates the dilated veins while preserving arteries, lymphatics, and the vas deferens. This technique has low recurrence and complication rates. Typical recovery: short activity restriction, return to work in about 1–2 weeks depending on the job.
Inguinal or laparoscopic varicocelectomy: The surgeon accesses the veins via an inguinal incision or laparoscopy. Laparoscopic approaches may be used for bilateral cases or in conjunction with other abdominal procedures. Recovery and outcomes vary by approach.
Percutaneous embolization: An interventional radiologist threads a catheter (commonly from the femoral or jugular vein) to the testicular vein under fluoroscopic guidance and blocks the problematic veins using coils, plugs, or sclerosant agents. Embolization is less invasive, performed under local anesthesia with sedation, and may have quicker initial recovery; recurrence rates and success profiles differ from surgical options.

What to expect: all procedures aim to stop abnormal venous blood flow so blood redirects through healthy vessels. Success is measured by symptom relief and improvement in semen parameters; improvements in sperm count and motility are often seen within 3–6 months after a successful repair (citation needed). Discuss risks, benefits, and expected recovery times with your urologist or interventional radiologist to choose the best procedure for your situation.

What Should Be Considered After Varicocele Surgery?

Recovery after varicocele repair varies by procedure and individual, but most patients can follow a general timeline and precautions to support healing. Your surgeon will give specific instructions, but the guidance below summarizes common recommendations and what to watch for during recovery.

First week: Rest at home, avoid heavy lifting and strenuous activity, protect the surgical site from impact, and follow wound care instructions. Many surgeons advise delaying baths or showers until dressings are removed—follow your provider’s timing.
Weeks 2–4: Gradually increase light activities as tolerated. Avoid heavy exercise and heavy lifting for at least 2–4 weeks (timing depends on the procedure and your job).
Sexual activity and work: Most men can resume sexual activity and return to desk work within 1–2 weeks, but strenuous labor or intense sports may require a longer pause—follow your surgeon’s advice.
Swelling and hydrocele: Mild swelling of one or both testicles is common in the first few days. In some cases, fluid around the testicle (a hydrocele) can develop and may require further treatment if symptomatic.

Follow-up and fertility checks

Schedule a post-op visit as directed to check wound healing and testicular size (monitor for testicular atrophy).
If fertility was a concern, plan semen analysis about 3 months after repair and again at 6 months to assess changes in sperm count, motility, and morphology (improvements, if they occur, often appear in this timeframe).

When to seek urgent care

High fever, increasing or severe pain not helped by prescribed medications, heavy bleeding, spreading redness at the incision, or sudden significant swelling—contact your surgeon or go to the emergency room.

Most men recover without serious issues and may see improved fertility outcomes, though results vary and are not guaranteed. Discuss realistic expectations about how a successful repair may affect fertility and pregnancy chances with your urologist; if semen parameters do not improve, assisted reproductive options can be considered. Regular follow-up protects long-term testicular and sexual health—seek specialist evaluation promptly for persistent symptoms or new concerns.