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What Is a Varicocele? Symptoms, Causes, Diagnosis and Treatment
Contents
- What Is a Varicocele?
- Which Side Is Usually Affected?
- What Are the Symptoms?
- What Causes a Varicocele?
- Can Varicocele Cause Infertility?
- How Is a Varicocele Diagnosed?
- How Is Varicocele Graded?
- Why Is Semen Analysis Performed?
- Does Every Varicocele Need Treatment?
- How Is Varicocele Treated?
- What Is Microsurgical Varicocelectomy?
- What Is Varicocele Embolisation?
- Recovery After Varicocele Surgery
- Varicocele in Adolescents
- Frequently Asked Questions
What Is a Varicocele?
A varicocele is an abnormal enlargement of the veins of the pampiniform plexus surrounding the testicle.
It develops when venous drainage and blood flow within the testicular veins become abnormal, allowing the veins to dilate.
Many varicoceles cause no symptoms. In some men they may be associated with scrotal discomfort, reduced testicular volume or abnormalities in sperm production and function.
Which Side Is Usually Affected?
Varicoceles occur more commonly on the left side because of differences in venous anatomy and drainage.
They may also occur on both sides. An isolated clinically significant right-sided varicocele is less common.
What Are the Symptoms of a Varicocele?
Many varicoceles are asymptomatic.
Possible symptoms or findings include:
- A dull ache in the scrotum or testicle
- A feeling of heaviness or dragging
- Discomfort that becomes more noticeable after prolonged standing or later in the day
- Visible or palpable enlarged scrotal veins
- Reduced testicular volume
- Abnormal semen parameters during an infertility evaluation
Not all testicular pain is caused by varicocele, so other causes of scrotal pain should also be considered.
What Causes a Varicocele?
Varicocele development is associated with abnormal venous drainage and increased pressure within the testicular veins.
The anatomy of the left testicular vein, its drainage into the left renal vein and venous valve dysfunction can contribute to the greater frequency of left-sided varicocele.
Can Varicocele Cause Infertility?
Varicoceles can adversely affect sperm production or function in some men.
Proposed mechanisms include increased scrotal temperature, oxidative stress, impaired testicular oxygenation and increased sperm DNA damage.
However, not every man with a varicocele develops abnormal semen parameters or infertility.
In couples experiencing infertility, the clinical significance of a varicocele should be assessed together with semen analysis, the duration of infertility and the reproductive status of the female partner.
How Is a Varicocele Diagnosed?
Physical examination is the primary method of diagnosing a clinical varicocele.
The examination is usually performed while the patient is standing, both at rest and during a Valsalva manoeuvre when required.
Doppler Ultrasound
Scrotal Doppler ultrasound is not mandatory in every patient.
It can be useful when:
- Physical examination is inconclusive
- Testicular volume needs to be assessed
- Another scrotal disorder is suspected
- Persistent or recurrent varicocele is suspected after treatment
How Is Varicocele Graded?
| Grade | Definition |
|---|---|
| Subclinical | Not palpable or visible on examination and detected only by imaging. |
| Grade 1 | Palpable only during the Valsalva manoeuvre. |
| Grade 2 | Palpable while standing without Valsalva. |
| Grade 3 | Visible and palpable while standing. |
Why Is Semen Analysis Performed?
Semen analysis is particularly important in men who are trying to conceive or undergoing infertility evaluation.
It assesses parameters such as sperm concentration, total sperm count, motility and morphology.
An abnormal result may need to be repeated under appropriate conditions, and male infertility should not automatically be attributed to varicocele alone.
Does Every Varicocele Need Treatment?
No. Many varicoceles do not require intervention.
Treatment can be considered in situations such as:
- A man attempting to conceive who has a palpable clinical varicocele, infertility and abnormal semen parameters
- Persistent pain considered to be related to varicocele after other causes have been assessed
- Persistent impairment of testicular growth in adolescents
- Other selected situations following specialist male-fertility assessment
How Is Varicocele Treated?
Treatment is individualised according to symptoms, reproductive plans, semen parameters, testicular volume and clinical examination.
Observation
Men without significant symptoms, fertility problems or evidence of testicular dysfunction may simply be monitored.
Symptom Management
For mild discomfort, scrotal support, temporary modification of aggravating activity and appropriate analgesic or anti-inflammatory medication may be considered.
These approaches do not eliminate the varicocele itself.
What Is Microsurgical Varicocelectomy?
Varicocelectomy is a procedure that interrupts abnormal venous drainage through the enlarged testicular veins.
During inguinal or subinguinal microsurgical varicocelectomy, magnification is used to identify the veins while preserving the testicular artery, lymphatic vessels and other important structures where possible.
Microsurgical approaches are commonly used because they can offer relatively low recurrence and complication rates.
In appropriately selected infertile men with clinical varicoceles and abnormal semen parameters, semen quality may improve after repair. However, surgery does not guarantee pregnancy.
What Is Varicocele Embolisation?
Varicocele embolisation is a minimally invasive endovascular procedure performed by interventional radiology.
A catheter is advanced into the abnormal testicular vein and venous reflux is blocked using coils or other appropriate embolisation materials.
The choice between surgery and embolisation depends on anatomy, previous treatment, recurrence and local expertise.
Recovery After Varicocele Surgery
Recovery varies according to technique and individual factors.
Mild pain, tenderness or swelling may occur during the first few days.
Postoperative advice may include pain control, scrotal support, wound care and temporary restriction of strenuous exercise or heavy lifting.
When surgery is performed for infertility, several months may be required before changes in semen parameters can be meaningfully assessed because sperm production takes time.
Varicocele in Adolescents
Varicocele can develop during puberty.
Not every adolescent with a varicocele requires surgery. Testicular growth should be monitored over time.
A persistent reduction in the size of the affected testis compared with the opposite testis is an important factor when considering treatment.
Current European guidance considers a persistent difference of more than approximately 2 mL or 20%, confirmed on follow-up examinations, clinically relevant.
Have Varicocele and Male Fertility Assessed
If you have testicular discomfort, enlarged scrotal veins or difficulty conceiving, urological assessment and semen analysis can be planned when appropriate.
Frequently Asked Questions
References
- Academic Hospital. Varicocele
- European Association of Urology. EAU Guidelines – Male Infertility: Varicocele
- American Urological Association / American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline
