Varicocele: Symptoms, Causes & Treatment

A varicocele is a common condition consisting of dilation and enlargement of the veins inside the scrotum that drain blood from the testicle. It occurs when the valves inside these veins do not work properly, so blood pools and causes the veins to dilate and become tortuous, just as happens in leg varicose veins. A varicocele appears on the left side much more than the right for anatomical reasons, and is common among young men and adolescents.

Many varicocele cases cause no symptoms and are found incidentally during a routine examination. When symptoms appear, they include: a feeling of heaviness, discomfort, or dull radiating pain in the scrotum, usually increasing with prolonged standing, exertion, or at the end of the day and easing when lying down, the presence of a lump or swelling in the scrotum whose texture may be described as resembling a bag of worms, and sometimes a difference in the size of the testicles. The most important thing a varicocele may be associated with is its possible effect on fertility, as it is thought it may raise the testicle's temperature and affect sperm production and quality in some men, so it is among the common treatable causes of male fertility weakness. It may also affect the growth of the affected testicle in adolescents.

The doctor diagnoses a varicocele by clinical examination (sometimes while standing and exerting effort), and may confirm it with ultrasound that assesses the veins and testicle size. Importantly, the presence of a varicocele does not necessarily mean a need for treatment; many cases are symptomless, do not affect fertility, and can be only monitored. Intervention (a procedure that closes or ties the dilated veins) is advised in certain cases, such as: persistent bothersome pain that does not improve with simple measures, an effect on fertility (abnormal semen tests with a desire to have children), or poor testicular growth in adolescents. It is important to see a urologist to assess the condition and determine whether it needs treatment, especially with persistent pain or delayed conception.

• Heaviness, discomfort, or dull pain in the scrotum increasing with standing and easing when lying down.
• A lump or swelling with a texture resembling a bag of worms.
• Sometimes a difference in testicle size.
• Many cases are symptomless, and it may affect fertility.

• The valves inside the scrotal veins not working properly so blood pools.
• More common on the left side for anatomical reasons.
• Common among young men and adolescents.

• Clinical examination (sometimes while standing and exerting effort).
• Ultrasound to assess the veins and testicle size.
• Semen tests when assessing fertility.

Monitoring

• Many cases are symptomless, do not affect fertility, and are only monitored.

Intervention (closing or tying the veins)

• For persistent bothersome pain that does not improve.
• For affected fertility (abnormal tests with a desire to have children).
• For poor testicular growth in adolescents.

This content is educational and does not replace consulting a urologist.

• A possible effect on fertility and sperm quality.
• Poor testicular growth in adolescents.
• Chronic pain or bothersome heaviness in some cases.

• There is no proven prevention, but early follow-up detects the effect on fertility or testicular growth.
• Evaluating adolescents when a difference in testicle size is noticed.
• Not neglecting persistent pain or delayed conception and seeing a doctor.