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Varicocele

What Is Varicocele in Men?

When functioning properly, veins in the pampiniform plexus of the scrotum are responsible for draining blood from around the testicles. This helps keep the testicles cool to promote healthy sperm production. However, sometimes these veins can become dilated, leading to slower blood flow and/or reflux. This is called varicocele.

Varicocele is fairly common among men, occurring in about 15% of the male population. The risk of varicocele is lower during childhood, but increases during puberty. About 40% of men with fertility issues have varicoceles, making it the most common diagnosis associated with male subfertility.1

varicocele

Common Varicocele Symptoms

Many instances of varicocele are asymptomatic; in these cases, the condition is usually discovered during an annual physical exam or fertility testing. However, some symptoms can help both patients and doctors identify a varicocele:

  • Testicular varicocele veins may feel like a “bag of worms.”
  • Lying down can reduce the presence and feeling of a varicocele, since this position lowers the effect of gravity on the veins.
  • Many men with varicocele will have testicular asymmetry, in which one testicle is significantly larger than the other.
  • Pain and/or swelling of the scrotum may be indicative of a varicocele.
  • Inability to conceive naturally may also point to a varicocele, especially when female reproductive issues have been ruled out.

Related Conditions

Symptoms of varicocele can overlap with signs of other conditions. Before seeking varicocele treatment, make sure to consult your physician to rule out other causes of scrotal swelling, groin pain, and infertility.

  • Hydrocele: A collection of fluid in the scrotal sac, causing swelling and a “heaviness” that is usually painless.
  • Spermatocele: Cysts that appear in the epididymis, the tube responsible for storing sperm.
  • Inguinal Hernia: An improper opening in the abdominals allowing organs, fat, or muscle to push through into the groin region, including the scrotum.
  • Testicular Torsion: A medical emergency wherein the spermatic cord twists and cuts off blood flow from the testicle, resulting in intense acute pain.
  • Testicular Cancer: Malignant cells in the testicle creating a solid mass and interfering with testicular function; renal cell carcinoma can also appear as a mass in the testicles.
  • Epididymitis: Inflammation of the epididymis, usually caused by a urinary tract infection, sexually transmitted infection, or other bacterial infection.

The Connection Between Varicocele and Infertility

Varicoceles are more highly reported in men with fertility problems than the general population, and may contribute to lower sperm count, impaired sperm mobility, and abnormal testosterone levels. Treatments like varicocele embolization can have a positive impact on fertility for men.2

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Testicular Varicocele Diagnosis

Diagnosing varicocele starts with a physical examination. During the exam, your doctor may look for visibly dilated veins and palpate the scrotum to see how your case aligns with varicocele grading standards.

The most severe varicocele (Grade 3) is visually present. Grade 2 varicoceles are able to be felt with ease. The lowest grade of varicocele, Grade 1, can only be felt while the patient performs a specific movement known as a Valsalva maneuver.

Additional tests that can help assess varicocele and rule out other conditions include:

  • Semen analysis
  • Scrotal ultrasound
  • Doppler examination
  • Spermatic venography

How To Treat Varicocele

Boys, young men, and adult men who are asymptomatic and are not trying to conceive are often treated with a “watch and wait” approach. Patients who present with symptoms such as pain and subfertility may require intervention.3 There are two main treatment options for symptomatic varicoceles: surgery and embolization.

  • Percutaneous varicocele embolization is performed by an interventional radiologist, who uses a small incision to access enlarged veins. The procedure places body-safe materials or chemical agents in the affected veins, cutting them off from the rest of the circulatory system so that they shrink.
  • A varicocelectomy is performed by a surgeon to disconnect the dilated veins and redirect blood flow to healthy vessels. These varicocele repairs may be performed using open or laparotic surgical techniques.

Don’t Delay Varicocele Treatment

Some men avoid discussing varicocele symptoms with their doctor due to embarrassment or stigma. But delaying treatment can impact testicular development and function as well as hormone levels. If you are having scrotal pain, swelling, or fertility challenges, the best thing you can do is schedule a consultation with your doctor.

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Varicocele Embolization

Varicocele Questions & Answers

Varicoceles are fairly common and occur in about 15% of men, though only some men have clinical symptoms of varicocele.

Varicoceles usually require intervention and do not resolve spontaneously.

Yes, varicocele can affect testosterone levels as well as other fertility factors.

Men with varicoceles are more likely to experience erectile dysfunction, but it’s not clear if varicoceles are the cause of the condition.

Men with a family history of varicocele are significantly more likely to develop them.4

Varicoceles have not been found to have any direct correlation with testicular or renal cancer in men.5

References

  1. Practice Committee of the American Society for Reproductive Medicine; Society for Male Reproduction and Urology. Report on varicocele and infertility: a committee opinion. Fertil Steril. 2014;102(6):1556-1560. doi:10.1016/j.fertnstert.2014.10.007
  2. Kyaw Tun J, Le Tat T, Hakime A. Percutaneous Anterograde Varicocele Embolization: Technique and Clinical Outcomes. J Vasc Interv Radiol. 2025;36(3):467-471. doi:10.1016/j.jvir.2024.11.013
  3. Cannarella R, Calogero AE, Condorelli RA, Giacone F, Aversa A, La Vignera S. Management and Treatment of Varicocele in Children and Adolescents: An Endocrinologic Perspective. J Clin Med. 2019;8(9):1410. Published 2019 Sep 8. doi:10.3390/jcm8091410
  4. Gökçe A, Davarci M, Yalçinkaya FR, et al. Hereditary behavior of varicocele. J Androl. 2010;31(3):288-290. doi:10.2164/jandrol.109.008698
  5. Elmer DeWitt M, Greene DJ, Gill B, Nyame Y, Haywood S, Sabanegh E Jr. Isolated Right Varicocele and Incidence of Associated Cancer. Urology. 2018;117:82-85. doi:10.1016/j.urology.2018.03.047