ReproductiveICD-10: I86.1Common; found in a substantial proportion of adolescent and adult males, most without symptoms

Varicocele

Also known as: Varicose veins of the scrotum, Scrotal varices

A varicocele is an enlargement of the veins within the scrotum that drain the testicle, similar to varicose veins in the legs. It develops when valves inside these veins fail and blood pools, most often on the left side because of the way the left testicular vein drains. Varicoceles are common, usually develop during puberty, and are often painless, so many men never know they have one. They matter mainly because the pooled blood raises the temperature around the testicle, which can impair sperm production and, in some cases, testicle growth or testosterone output. Most need no treatment, but repair is considered when a varicocele causes pain, shrinks the testicle, or contributes to infertility.

At a Glance

Common symptoms
A soft lump or swelling above the testicle, often described as feeling like a bag of worms, A dull ache or heaviness in the scrotum, worse after standing, exercise, or at the end of the day, Swelling that is more obvious when standing and shrinks when lying down
Main treatments
Observation with periodic review for varicoceles that cause no pain or fertility concerns, Varicocelectomy, a surgical procedure to tie off the affected veins, most often done with a microsurgical approach through a small groin incision, Embolization, a less invasive radiology procedure that blocks the vein from inside using a catheter
Category
Reproductive · Common; found in a substantial proportion of adolescent and adult males, most without symptoms
See a doctor if
Any new lump or swelling in the scrotum, so other causes such as a hernia or tumor can be excluded

Symptoms

A soft lump or swelling above the testicle, often described as feeling like a bag of worms
A dull ache or heaviness in the scrotum, worse after standing, exercise, or at the end of the day
Swelling that is more obvious when standing and shrinks when lying down
One testicle, usually the left, being noticeably smaller
Reduced fertility discovered on semen analysis
Often no symptoms at all

Causes

  • Faulty valves in the testicular veins allowing blood to flow backward and pool
  • The anatomy of the left testicular vein, which drains at a right angle into the renal vein and is more prone to pressure
  • Rarely, a mass in the abdomen or kidney compressing the vein, particularly if a varicocele appears suddenly or on the right side

Risk Factors

  • Adolescence and young adulthood, when varicoceles most often develop
  • A tall, thin body build
  • A family history of varicocele
  • No clear lifestyle risk factors are established

Diagnosis

  • Physical examination of the scrotum while standing and while bearing down, which makes the veins more prominent
  • Scrotal ultrasound with Doppler to measure vein size and confirm backward blood flow
  • Measurement of testicle size, especially in adolescents, to check for a growth difference
  • Semen analysis and hormone tests in men being evaluated for infertility
  • Abdominal imaging if a right-sided or sudden-onset varicocele raises concern about a mass

Treatment

  • Observation with periodic review for varicoceles that cause no pain or fertility concerns
  • Varicocelectomy, a surgical procedure to tie off the affected veins, most often done with a microsurgical approach through a small groin incision
  • Embolization, a less invasive radiology procedure that blocks the vein from inside using a catheter
  • Repair in adolescents when the affected testicle is lagging in growth
  • Supportive: over-the-counter pain relief and supportive underwear or an athletic supporter to ease aching
  • Supportive: avoiding prolonged standing and heavy straining when the varicocele is uncomfortable

Prevention

  • Varicoceles cannot be prevented, as they arise from vein anatomy
  • Have any scrotal lump checked promptly
  • Adolescents with a varicocele should have testicle size monitored
  • Seek fertility evaluation early if conception is proving difficult, since repair may help in selected cases

When to See a Doctor

  • Any new lump or swelling in the scrotum, so other causes such as a hernia or tumor can be excluded
  • Scrotal pain or heaviness that persists or worsens
  • A varicocele that appears suddenly, is on the right side only, or does not shrink when lying down
  • One testicle noticeably smaller than the other, particularly in a teenager
  • Sudden severe testicular pain (emergency, possible torsion)

Frequently Asked Questions

Related Conditions

Infertility

Reproductive

Testicular Torsion

Urological

Low Testosterone

Endocrine

Varicose Veins

Cardiovascular

Hernia

Digestive

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