Varicocele

Overview

What is a varicocele?

Varicoceles (VAIR-ick-oh-seals) are a common disorder of the veins inside the scrotum, the protective sac that protects and holds the testicles (balls). If you have a varicocele, it means veins inside the scrotum are enlarged (wider than they should be).

Varicoceles are similar to varicose veins, a common condition that causes veins in the leg to swell and lose their shape.

Varicoceles are usually painless but can sometimes cause aching testicles or pain that may come and go. In some people, a varicocele can affect fertility. If a varicocele doesn’t bother you, you may not need treatment.

How common are varicoceles?

Varicoceles affect 15% to 20% of all men and people assigned male at birth in the U.S. — about 1 in 5. In most people who have a varicocele, it occurs on the left side. Less commonly, it can sometimes affect the right-sided scrotum or both sides.

Who gets varicoceles?

Varicoceles can happen to anyone with testicles, at any age. Healthcare providers believe many cases are congenital (present at birth). Often, people notice a varicocele during the teenage years. Medical experts suspect this timing has to do with puberty, when blood flow to the genitals increases. Sometimes the varicocele can prevent the testicle from growing properly.

Symptoms and Causes

What causes varicoceles?

Much remains unknown about why varicoceles develop. It may be that varicoceles occur due to a faulty “switch” (or valve) inside certain veins in the spermatic cord, a band of tissues that holds the testicles in place.

These veins move blood from the testicles to the rest of the body. The valve acts as an “on/off switch.” When a valve doesn’t work the way it should, excess blood may build up inside testicular veins. Over time, this malfunction causes veins to swell.

What are the symptoms of varicoceles?

A varicocele often causes no symptoms. You may notice:

What does a varicocele feel like?

Varicoceles may cause mild discomfort, aches or pain, usually in the left testicle. Larger, swollen veins in the scrotal sac often feel or look like a bag of worms (or spaghetti). A small varicocele may be too small to see or feel.

Can varicoceles affect male infertility?

The short answer is yes: Varicoceles affect male fertility in some people. However, many people with varicoceles experience no reproductive obstacles.

Medical experts don’t understand exactly what role varicoceles play in male infertility. It’s possible that temperature changes inside the scrotum due to blood buildup in veins. This higher temperature may affect sperm count or production.

If you suspect infertility might be an issue for you, talk to your healthcare provider. Fertility concerns are the top reason people get treated for varicoceles. Almost half of couples who seek medical care for male infertility have a varicocele.

Diagnosis and Tests

How is a varicocele diagnosed?

Your healthcare provider may diagnose a varicocele after examining your symptoms during a physical exam. To confirm a diagnosis, you might have an ultrasound test, which can provide more detail of the testicular veins.

Your provider may recommend semen tests or blood tests if you are concerned that a varicocele may affect your fertility. Some insurance providers cover semen tests, but others might not.

Management and Treatment

How can I treat a varicocele at home?

At-home treatment options for varicoceles include:

  • No treatment: If a varicocele doesn’t bother you or cause fertility problems, you may not need treatment.
  • Routine changes: You may choose to avoid certain activities that trigger discomfort. Wearing tighter fitting underwear (like spandex) or a jockstrap can ease symptoms due to exercise or long periods of standing.
  • Ice: Applying cold packs to the scrotum may help you feel better. To protect your skin, don’t apply ice directly to skin. Wrap ice packs or cold gel packs in a towel and use it for about 15 minutes at a time.
  • Over-the-counter medication: Acetaminophen or ibuprofen may take the edge off any minor scrotal or testicle aching that becomes distracting.

What is varicocele surgery?

Your provider may recommend surgery if the condition is painful or negatively impacts your life. In varicocele surgery, a urologist (a doctor specializing in male reproductive organs) clips or ties off the veins that are causing symptoms. The clips stop blood from flowing through those veins.

The surgery is an outpatient procedure, meaning you go home the same day. Most people can return to work about three days after surgery and resume exercise and sexual activity in a week or two. You might still be able to feel a varicocele after surgery, but the veins will no longer be connected to the rest of the body and will no longer cause pain or harm to sperm production.

Many men choose to have surgery to improve fertility. Several studies have found that sperm numbers and motility (sperm’s ability to reach the egg) improve after varicocele surgery. Couples who have the varicocele fixed may be 40% to 50% more likely to get pregnant than couples who don’t.

Prevention

Can I prevent varicoceles?

The medical community is unsure what causes a varicocele to develop. For this reason, you can’t prevent it.

Outlook / Prognosis

What is the prognosis (outlook) for people with varicoceles?

Many people with a varicocele have no symptoms at all. While some people with a varicocele experience mild discomfort during certain activities, it doesn’t cause serious or long-term health problems.

If you are concerned about your fertility, talk to your healthcare provider about whether surgery to treat a varicocele may improve your chances of having a child.

Living With

What questions should I ask my doctor?

If you have a varicocele, you may want to ask your healthcare provider:

  • Do I need to be treated?
  • Are my symptoms likely to get worse without treatment?
  • What steps can I take to improve my symptoms at home?
  • Could the varicocele affect my fertility?
  • What are my treatment options?
  • Can surgery improve my fertility?

A note from Cleveland Clinic

A varicocele is a common condition that can affect men of different ages and stages of life. Most people experience mild or no symptoms. Deciding whether to treat a varicocele is up to you. Wearing a supportive jockstrap or over-the-counter pain medication may be enough to resolve minor symptoms. Varicoceles can cause male infertility. Surgery to repair a varicocele can sometimes improve fertility. Talk with your healthcare provider about your treatment options, including how surgery may impact your reproductive future.

Last reviewed by a Cleveland Clinic medical professional on 10/08/2020.

References

  • American Society for Reproductive Medicine. Varicocele. (https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/varicocele_factsheet.pdf) Accessed 10/9/2020.
  • Leslie SW, Sajjad H, Siref LE. Varicocele. (https://www.ncbi.nlm.nih.gov/books/NBK448113/) [Updated July 21, 2020.] Treasure Island (FL): StatPearls Publishing; 2020 Jan. Accessed 10/9/2020.
  • National Infertility Association. How Varicocele Repair Can Be an Effective Treatment. (https://resolve.org/infertility-101/medical-conditions/male-factor/varicocele-repair/) Accessed 10/9/2020.

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