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Overview
What Is a Varicocele?
A varicocele is a group of enlarged veins in the scrotum, the skin sac that holds the testicles. It often develops on the left side because of differences in how the veins drain blood. A varicocele may occur without symptoms and is sometimes found during a routine examination or fertility evaluation. The term is pronounced “VAR-ih-koh-seel.”
Symptoms
Varicocele Symptoms and Clinical Features
Many varicoceles cause no noticeable symptoms and are discovered during a routine examination or fertility evaluation. When symptoms occur, they may be mild and more noticeable after standing, physical activity or later in the day.
- Dull aching discomfort in the scrotum.
- A feeling of heaviness in the scrotum.
- Visible enlarged veins under the scrotal skin.
- A soft, cord-like lump that may feel like a “bag of worms.”
- A smaller testicle (testicular size difference).
- Difficulty conceiving (infertility).
Seek prompt care
Sudden testicular pain is not typical
Typical varicocele discomfort is usually dull or aching rather than sudden and severe. Sudden intense testicular pain needs prompt medical assessment because conditions such as testicular torsion require urgent treatment.
Causes
What Causes a Varicocele?
A varicocele develops when valves in the veins that carry blood away from the testicle are weak or do not work properly. Blood can then flow backward and pool in the veins of the spermatic cord, causing them to widen. This is the basic mechanism behind most varicocele causes.
Why Is It More Common on the Left?
Risk Factors
Varicocele Risk Factors
- Adolescence is a common time for a varicocele to develop as the testicles grow.
- Male reproductive anatomy is a non-modifiable factor associated with varicocele.
- A family history of varicocele may be associated with increased likelihood.
- A personal history of varicocele can increase the chance of having another affected area or recurrence after treatment.
- Evaluation for infertility may identify a previously unnoticed testicular varicocele.
- Factors affecting testicular growth or sperm production may make a varicocele more clinically important.
Most risk factors cannot be changed, and there is no established lifestyle action that reliably prevents a varicocele from forming. Regular evaluation is useful when there is pain, a difference in testicle size or concern about fertility.
Complications
Varicocele Complications
- Chronic scrotal discomfort may persist or gradually affect daily activities.
- Reduced testicular growth may occur in some adolescents.
- Impaired sperm production may affect semen quality.
- Infertility may occur in some people, especially when other fertility factors are present.
- Testosterone production may be affected in some cases.
What to know
Not every varicocele causes problems
The presence of a varicocele does not automatically mean infertility or another complication. Clinical importance depends on symptoms, examination findings, testicular size, semen results and reproductive goals.
Diagnosis
How Is a Varicocele Diagnosed?
A clinician usually examines the scrotum while you are standing and lying down. The examination may include looking for enlarged veins and gently feeling the area while you briefly bear down, when appropriate. The clinician may compare both testicles and assess whether the veins become less prominent when you lie down.
- Doppler scrotal ultrasound can show enlarged veins and blood flow, especially when the examination is unclear.
- Semen analysis measures sperm count, movement and shape when fertility is a concern.
- Testicular size measurements help assess growth and differences between the testicles.
- Selected hormone or fertility tests may be used when symptoms or reproductive concerns suggest they are needed.
Distinguishing Other Scrotal Conditions
Treatment & Management
Varicocele Treatment and Management
| Approach | When it may be considered | What it involves | Important considerations |
|---|---|---|---|
| Observation | No significant symptoms, testicular growth problems or fertility concerns | Periodic examinations and monitoring of symptoms, testicular size or semen results | A varicocele may remain stable, but follow-up is important if circumstances change |
| Supportive care | Mild discomfort that does not require a procedure | Supportive underwear, activity adjustments and clinician-approved pain relief | This may ease symptoms but does not remove the enlarged veins |
| Surgical varicocelectomy | Persistent pain, impaired testicular development or selected fertility concerns | A surgeon closes or redirects the affected veins, often using microsurgical techniques | Risks include recurrence, hydrocele, infection, bleeding and injury to nearby structures |
| Catheter-based embolization | A suitable alternative to surgery for selected patients | A specialist guides a catheter through a blood vessel and blocks the affected veins | Technical failure, recurrence or persistent pain can occur, and suitability varies |
Varicocele treatment is not always needed. Clinicians weigh pain, testicular development, semen analysis, fertility plans and whether another condition could explain the symptoms before recommending management or a procedure.
Before treatment
Discuss benefits and risks with a specialist
Procedures may involve recurrence, hydrocele, infection, bleeding, injury to nearby structures or persistent pain. A urologist or fertility specialist can explain the likely benefits and individualized risks of varicocele surgery or embolization.
Outlook and Prognosis
Varicocele Outlook and Prognosis
Many varicoceles remain stable and cause no major problems. Others require monitoring for pain, changes in testicular growth, semen changes or fertility concerns. The outlook is often favorable when the condition is appropriately assessed and followed.
- Follow-up after treatment helps check symptom improvement, healing and possible recurrence.
- Repeat semen analysis may be recommended when fertility is relevant or when earlier results were abnormal.
- Adolescents may need monitoring of testicular growth and size differences over time.
- A persistent or recurrent varicocele may require further examination and discussion of additional management.
When Should You See a Doctor
When Should You See a Doctor?
- Arrange an evaluation for a new scrotal lump, even if it is not painful.
- Arrange an evaluation for persistent scrotal aching or heaviness.
- Seek assessment for a visibly enlarged scrotum or enlarged veins.
- Ask for medical review if one testicle appears smaller than the other.
- Discuss fertility concerns or difficulty conceiving with a clinician.
- A newly noticed right-sided or sudden-onset varicocele should be medically evaluated.
Get urgent help
Urgent testicular symptoms
Go to emergency care for sudden severe testicular pain, rapid swelling, nausea with testicular pain, fever or a testicle that appears abnormally positioned. These symptoms may indicate another urgent condition rather than a typical varicocele.
Branches
1 topic
Varicocele
Urology
