Varicocele

A varicocele is a swelling of the veins within the scrotum.

The scrotum is the skin sac below the penis that holds and protects the testicles.

With a varicocele, the veins in the scrotum become enlarged, similar to varicose veins found in the legs. This swelling is caused by faulty valves that prevent proper blood flow, leading to blood pooling and enlarged veins.

Varicoceles are common in adolescents and young adults. They typically happen on the left side of the scrotum. Varicoceles often cause no symptoms or complications, though they may cause pain or discomfort. In some cases, a varicocele can cause problems with the development of the testicles, low sperm production, or problems leading to infertility. For these problematic cases, there are options for treating the varicocele.

Learn more about varicocele, including its definition, causes, symptoms, diagnosis, treatment, and potential risks and complications.

What is a varicocele?

A varicocele is an abnormal dilation of the pampiniform plexus, a network of veins located in the spermatic cord that drains blood from the testicles. Varicoceles are similar to varicose veins and can affect one or both sides of the scrotum but are more commonly found on the left side due to anatomical differences. They are often discovered during evaluations for infertility or scrotal discomfort.

Are varicoceles common?

Varicoceles are a common problem in men. About 15% of men have varicoceles.

What causes a varicocele?

Arteries pump oxygen-rich blood to the testicles. Veins pump oxygen-depleted blood from the testicles back toward the heart. Usually, the blood flows to and from the testicles without issue.

In some cases, the small veins that should pump oxygen-depleted blood back toward the heart become enlarged. Blood gets backed up in these swollen veins, creating a varicocele.

Why these veins get swollen is unclear, but it may have something to do with the valves in the veins malfunctioning. The vein on the left side of the scrotum is different from the one on the right, and this difference makes it more common for a varicocele to form on the right side.

What are the symptoms of varicoceles?

Most people with varicoceles don’t have any symptoms.

You might notice visible, enlarged veins in the scrotum, which many men describe as looking like a “bag of worms.” You may be able to feel these veins through the skin of the scrotum.

Varicoceles can cause scrotal discomfort or pain. This can feel like a dull ache or feeling of heaviness in the scrotum. This feeling may become worse after prolonged periods of standing or physical activity.

In more serious cases, varicoceles may cause:

• Testicular pain: Pain that can range from mild discomfort to sharp, intense pain.
• Testicular atrophy: Shrinking of the affected testicle over time.
• Infertility: Varicoceles can cause impaired sperm production and function, leading to difficulties in conceiving.
• Hormonal changes: Potential impact on testosterone production.

How are varicoceles diagnosed?

You might notice varicoceles during a self-exam of your scrotum, by seeing or feeling the enlarged veins.

A urologist can check for varicoceles using a combination of methods and tests, which may include:

• Symptom assessment: Detailed inquiry about scrotal pain, discomfort, and any changes in testicular size.
• Medical history: Review of any family history of varicoceles or infertility issues.
• Physical examination: Examination of the scrotum while the patient is standing and lying down, including palpation and observation of the veins.
• Scrotal ultrasound: Imaging to confirm the presence of enlarged veins, assess blood flow, and evaluate the size and condition of the testicles.
• Doppler ultrasound: Helps measure the blood flow and detect abnormal venous reflux.
• Semen analysis: Evaluates sperm count, motility, and morphology, particularly in cases of infertility.

These tests can help determine if the varicoceles are an issue that may require treatment.

How are varicoceles treated?

In many cases, varicoceles do not require treatment. For varicoceles that cause discomfort, a health care provider may recommend lifestyle modifications to ease or decrease the discomfort, such as wearing supportive underwear.

Treatment may be necessary for men who have fertility problems, severe pain, abnormal semen analysis, or a left testicle growing more slowly than the right.

These treatment options may include:

• Pain management: Over-the-counter pain relievers like acetaminophen or ibuprofen to manage discomfort.
• Percutaneous embolization: A procedure where a radiologist inserts a catheter into the vein and places coils or a solution to block the dilated veins and redirect blood flow.
• Sclerotherapy: Injection of a sclerosing agent to collapse the enlarged veins.
• Varicocelectomy: Surgical ligation of the affected veins to redirect blood flow.
  • Open surgery: Performed through an inguinal or subinguinal incision.
  • Laparoscopic surgery: Minimally invasive approach using small incisions and a camera to guide the procedure.
  • Microsurgical varicocelectomy: Using a microscope for enhanced precision to preserve arteries and lymphatic vessels, reducing the risk of complications.

Follow-up care

• Regular check-ups: Routine follow-up appointments to monitor recovery, assess for recurrence, and evaluate fertility improvements.
• Semen analysis: Post-treatment evaluations to monitor sperm parameters and overall reproductive health.
• Monitoring for complications: Assessing testicular health and overall comfort after treatment.

Varicocele is a common condition that can affect men’s quality of life and fertility. Understanding the causes, symptoms, diagnostic methods, and treatment options is essential for effective management. If you or a loved one are experiencing symptoms of varicocele or concerns about fertility, consulting with a health care provider and a specialized urologist will help develop a comprehensive treatment plan tailored to your specific needs and circumstances.