Varicoceles are enlarged veins inside the scrotum, similar to varicose veins you might see in the legs. They develop during puberty and are found in about 15 percent of adult men. Most varicoceles cause no symptoms at all, but some men experience pain, testicular shrinkage, or fertility problems. Treatment is not always needed, but surgery or a minimally invasive procedure can correct the issue when symptoms or fertility concerns exist.
What Exactly Is a Varicocele?
A varicocele happens when the valves inside the veins of the spermatic cord fail. The spermatic cord is the structure that holds the testicle and carries blood vessels to and from it. When those valves stop working properly, blood pools in the veins instead of flowing upward toward the heart.
This pooling causes the veins to stretch and widen. The result is a soft, sometimes painless lump above the testicle. It often feels like a “bag of worms.” The left testicle is affected most often because of how the left vein drains into the kidney vein at a sharper angle than the right side.
What Are the Symptoms of a Varicocele?
Most men with a varicocele have no symptoms at all. The condition is often found during a routine physical exam or a fertility workup. When symptoms do occur, they typically include a dull ache or heaviness in the scrotum that worsens after standing or physical exertion.
Pain from a varicocele usually improves when you lie down. This is because gravity stops pushing blood into the weakened veins. Some men also notice a visible or palpable lump above the testicle, and the affected testicle may be smaller than the other one.
Testicular atrophy is a real concern. The pooled blood raises the temperature inside the scrotum, which can interfere with normal testicular function and growth. This is why a varicocele can affect sperm production even when it causes no pain.
What Causes a Varicocele?
The exact cause is not always clear. The primary mechanism is faulty valves in the veins of the spermatic cord. These valves normally prevent blood from flowing backward. When they fail, blood backs up and the veins enlarge.
Anatomy plays a role. The left testicular vein drains into the left renal vein at a right angle, which creates more pressure than the right side. This is why roughly 80 to 90 percent of varicoceles occur on the left side. Bilateral varicoceles occur in a smaller percentage of men, and isolated right-sided varicoceles are rare.
Most varicoceles develop during puberty when the testicles grow rapidly and blood demand increases. A sudden onset of a varicocele in an older man, especially on the right side, warrants further evaluation because it can occasionally be linked to a tumor pressing on the veins.
How Is a Varicocele Diagnosed?
A doctor can often diagnose a varicocele during a physical exam. You will stand while the doctor examines your scrotum. The varicocele may be visible as a soft mass, and you may be asked to take a deep breath and bear down, which increases abdominal pressure and makes the varicocele more obvious.
An ultrasound is the most common imaging test used to confirm the diagnosis. It can measure the size of the veins, assess blood flow, and check the size of both testicles. An ultrasound is especially useful when the physical exam is inconclusive or when the varicocele is small.
If fertility is a concern, a semen analysis is typically recommended. This test evaluates sperm count, motility, and shape. A varicocele is found in about 40 percent of men with infertility, which is why it is considered a correctable cause of male infertility.
What Are the Treatment Options for a Varicocele?
Treatment is not automatically required. If the varicocele causes no pain and does not affect fertility, many doctors recommend watchful waiting. The condition is generally harmless in these cases and does not require intervention.
Treatment is considered when one or more of the following apply: significant pain, testicular atrophy, abnormal semen analysis, or fertility problems. The two main treatment approaches are surgical ligation and percutaneous embolization.
Surgical ligation is the most common procedure. The surgeon makes a small incision and ties off the affected veins to redirect blood flow through healthy veins. This can be done with open surgery or laparoscopically. The recovery time is usually about one to two weeks.
Percutaneous embolization is a less invasive option. A radiologist inserts a thin catheter through a vein in the groin or neck and guides it to the varicocele. Coils or a liquid agent are used to block blood flow. This procedure requires no surgical incision and recovery is faster.
Both procedures are effective, but the choice depends on your specific situation and your doctor’s expertise. Surgical ligation has a slightly higher success rate in some studies, while embolization offers a quicker recovery. Recurrence rates are low for both but not zero.
Does Treating a Varicocele Improve Fertility?
The evidence here is mixed. Some studies show that varicocele repair improves sperm count, motility, and morphology. Other research suggests that the improvement in pregnancy rates is modest and not guaranteed.
A large review of clinical trials found that varicocele treatment may improve fertility in couples who have been trying to conceive for more than a year and where the male partner has an abnormal semen analysis. However, the overall increase in pregnancy rates is not dramatic.
This is an important point to understand. Treating a varicocele does not guarantee pregnancy. It improves the odds for some men, but many other factors affect fertility, including female age, egg quality, and other male factors. A fertility specialist can help you weigh the evidence for your specific case.
The decision to treat a varicocele for fertility reasons should be made jointly with a urologist and a reproductive specialist. Do not assume that surgery will solve all fertility problems.
Can a Varicocele Cause Other Health Problems?
Beyond pain and fertility, varicoceles are generally not associated with serious health risks. They are not linked to testicular cancer. They do not cause erectile dysfunction or affect testosterone levels in most men.
Some research has investigated whether varicoceles cause a gradual decline in testicular function over time. The evidence suggests that untreated varicoceles may be associated with progressive testicular damage in some men, which is why pediatricians and urologists sometimes recommend repair in adolescents with testicular size discrepancy.
However, the long-term consequences of an untreated varicocele in an adult with no symptoms are not well defined. Many men live with a varicocele for decades without any health issues.
Frequently Asked Questions
Can a varicocele go away on its own?
No. A varicocele does not resolve without treatment. The veins remain enlarged once the valves have failed.
Is a varicocele dangerous?
Most varicoceles are harmless and require no treatment. The main concerns are pain, testicular shrinkage, and potential effects on fertility.
Does a varicocele always cause infertility?
No. Most men with a varicocele have normal fertility. Only a subset of men experience impaired sperm production that affects their ability to conceive.
Can I exercise with a varicocele?
Yes, but heavy lifting or prolonged standing may worsen discomfort. If exercise causes pain, talk to your doctor about whether treatment is appropriate.
