What Is a Varicocele? Symptoms, Causes, Diagnosis, Treatment, Prevention
A varicocele (var-ih-koe-seel) is an enlarged vein in the scrotum, the sac of loose skin that holds the testicles.
The scrotum contains numerous veins that transport blood, but sometimes blood pools in these vessels rather than circulating the way it’s supposed to. When that happens, the vein might become swollen or dilated, forming a varicocele.
Varicoceles usually aren’t dangerous and may not have symptoms, but some cause discomfort or pain and may contribute to infertility or complications that require medical treatment.
Varicoceles mainly affect the network of small veins, or blood vessels, in the scrotum called the venous pampiniform plexus. But they sometimes affect the spermatic vein, which is the larger testicular vein where the small veins converge.
Varicoceles are more likely to occur in the left side of the scrotum, but they can happen in the right side or both sides, too.
These enlarged scrotal veins tend to form during or shortly after puberty and develop over time.
Healthcare providers usually grade or classify varicoceles by size: small, medium, or large.
There is also a grading system:
Grade 0 Physically undetectable but seen on an ultrasound
Grade I Detectable during a physical examination when the patient performs the valsalva maneuver (aka taking a deep breath and “bearing down” as if going to the bathroom)
Grade II Detectable during physical examination when the patient isn’t bearing down
Grade III Causes visible physical deformity of the scrotum
Varicoceles generally have no signs, says Craig Comiter, MD, a professor of urology at Stanford Health Care in California.
But some people may experience the following varicocele symptoms:
Pain: “A minority of men will complain of a dull ache in the scrotum, which is worsened by standing up and relieved by lying down,” Dr. Comiter says. The pain may intensify at night, he adds.
Mass or lump in the scrotum: Men with large varicoceles often say the vein cluster feels like a “bunch of worms” or “bag of worms,” Comiter says.
Testicular wasting or atrophy: The testicle (testes) near a varicocele may shrink.
Infertility: Varicoceles are a common cause of male infertility.
The exact cause of varicoceles is unknown, and there aren’t any significant risk factors beyond being male. But there are theories as to why they develop.
“Spermatic veins are long — they run from the testicles to the kidneys,” says John Christensen, MD, a urologist at Northwestern Medicine in Winfield, Illinois. “Normally, valves in these long spermatic veins prevent back pressure, but when the valves fail, this long column of blood from the kidney area down to the testicle can cause dilation [widening] of the veins in the scrotum.”
In rare cases, a kidney tumor can cause a varicocele, Dr. Christensen says. “A tumor in the kidney can block blood flow from the testes, which is more of a concern if the varicocele develops later in life, only on the right side, or does not decompress when lying flat,” he explains.
While any male can develop varicoceles, they’re more prevalent in adolescents of reproductive age and young adults.
Older men can develop varicoceles, though it is uncommon. “An older man who develops a new varicocele should see a provider right away to be checked for a kidney tumor,” Christensen says.
There isn’t a standard preventive screening for varicoceles because they usually aren’t harmful. But health professionals evaluating a man for infertility or trying to determine why a couple is having trouble conceiving may find varicoceles incidentally.
If you’re experiencing symptoms, it’s best to see a healthcare professional, such as a urologist, for an exam and diagnosis.
Healthcare professionals will conduct a visual and physical examination of the scrotum, Comiter says. They may ask you to sit or stand for the exam as well as take a deep breath, hold it, and bear down, which can make a varicocele more detectable.
Your provider may also order an ultrasound exam to confirm the diagnosis, rule out other possible conditions, and detect lesions or obstructions.
Varicoceles are treatable, Comiter says, adding that in some cases, leaving it alone is an option. “If a varicocele is found during an examination, but it’s not bothersome nor impacting fertility, then it does not need to be repaired,” he explains. “It can be left alone and is unlikely to cause any significant harm.”
If the only symptom of a varicocele is different size testicles in adult males, this alone does not warrant a medical intervention, Christensen adds.
But there are rare times when varicoceles can cause more serious issues if left untreated, such as severely low testosterone.
If you find a mass in the scrotum, you should see a doctor, Comiter says. Any mass in the scrotum could indicate a serious condition.
Medication
There are no prescription medications for varicoceles, but over-the-counter pain relievers — nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or medications like acetaminophen — may help alleviate any mild discomfort.
If varicocele pain persists, ask your healthcare provider about other treatment options.
Surgery
Surgery is the main and often best treatment for varicoceles, Comiter says. Surgical repair of varicoceles, also known as varicocelectomy, is recommended when the condition is causing pain or male infertility.
The surgery, which is an outpatient procedure, seals off the affected vein, which redirects blood flow into healthy veins. Removing varicoceles can increase the chance of achieving pregnancy by up to 70 percent.
Varicocelectomy, while relatively safe, may have complications. Some of the risks include hydrocele (buildup of fluid around the testicles, causing scrotal swelling), tenderness, scarring, and injury to a testicular artery. There are also general risks that come with any type of surgery, such as a negative reaction to anesthesia, blood clots, and infection.
Embolization
Embolization is a nonsurgical option in which a specialist called an interventional radiologist injects a substance into the affected blood vessel to block it off. It’s a quick, minimally invasive procedure.
Varicoceles aren’t preventable, Comiter says, and there are no screening tests for them.
But since they usually form during or shortly after puberty, it’s recommended that adolescent boys see a doctor for regular annual checkups to monitor their testicular health.
If varicoceles are causing discomfort, there may be some basic steps to get relief. Consider the following tips:
Avoid activities and sports that trigger symptoms.
Apply ice to the affected area.
Wear snug-fitting underwear.
Wear a jockstrap during exercise.
Varicoceles rarely go away on their own. There’s a small rate of recurrence even after surgery.
While varicoceles are generally harmless, they can in some cases lead to complications, including:
Varicoceles contribute to about 40 percent of cases of male infertility, though researchers don’t fully understand why.
Varicoceles have been linked to the following conditions.
Male Infertility Varicoceles are heavily associated with fertility issues in men, such as low sperm count, abnormal semen analysis, and decreased sperm motility. Infertile men may have higher rates of pregnancy following a varicocelectomy.
Testicular Hypotrophy Varicoceles can cause one testicle to appear smaller than the other. In adolescent boys going through puberty, a varicocele can inhibit testicle growth. Following surgery in adolescents, the smaller testicle may have “catch-up” growth, correcting the issue of different size testicles. But testicular atrophy in adults may not improve after surgery.
Heart Disease The research is limited, but varicoceles has been linked to certain heart-related issues. Some research suggests that men with varicoceles have a higher risk of developing cardiovascular disease than men who undergo varicocelectomy.
The Takeaway
Varicoceles form in the scrotum when blood pools in veins there, causing them to become swollen and enlarged.
Most varicoceles don’t cause symptoms or health issues and can likely be left alone.
In rare cases varicoceles may lead to pain and discomfort or complications like male infertility, for which there are treatments such as surgery.
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