Varicocele: Symptoms, Causes, Diagnosis and Treatment
A varicocele is an enlargement of the veins inside the scrotum, similar to varicose veins that can develop in the legs. The affected veins belong to the pampiniform plexus, a network that helps carry blood away from the testicle. Varicoceles are common and often develop during puberty. They occur more frequently on the left side because of differences in the anatomy of the testicular veins.
What are the symptoms of varicocele?
Many men with a varicocele have no symptoms and may discover it during a routine examination or fertility evaluation. When symptoms occur, they may include:
- dull or aching pain in the scrotum, especially after prolonged standing or later in the day;
- enlarged or twisted veins that may feel like a “bag of worms”;
- a difference in testicle size;
- problems with sperm production or fertility.
Discomfort may improve when lying down. Importantly, having a varicocele does not necessarily mean that a man will experience infertility.
How is varicocele diagnosed?
Diagnosis usually begins with a physical examination. The urologist may examine the patient while standing and lying down and may ask him to perform the Valsalva maneuver—taking a breath, holding it and bearing down—to make enlarged veins easier to detect.
A scrotal ultrasound may be recommended to confirm the diagnosis, assess blood flow and testicular size, or rule out another cause of the symptoms.
Does varicocele require treatment?
Not every varicocele needs treatment. Observation may be appropriate when it causes no significant symptoms or complications.
Treatment may be considered when a varicocele is associated with persistent pain, abnormal semen parameters or fertility problems, or impaired development of the affected testicle in adolescents. Options include surgical varicocele repair and percutaneous embolization. The choice depends on the patient's condition and should be discussed with a urologist.
FAQ
Can varicocele cause infertility?It can affect sperm production and fertility in some men, but most men with a varicocele do not necessarily have fertility problems.
Can varicocele disappear on its own?A clinically significant varicocele generally does not simply disappear. However, if it causes no problems, treatment may not be necessary.
When should I see a urologist?Medical evaluation is recommended if you notice scrotal pain, swelling, a lump or a change in testicle size. These symptoms can have causes other than varicocele and require proper diagnosis.
Medical disclaimer: This article is intended for general informational purposes only and does not replace professional medical advice, diagnosis or treatment. Consult a qualified healthcare professional regarding symptoms, diagnosis and treatment options.