Varicocele

What is a varicocele?

A varicocele (VAIR-ick-oh-seal) is a common disorder that enlarges the veins in your scrotum. Your scrotum is the pouch of skin behind your penis that typically contains your testes (testicles). Varicoceles are similar to varicose veins. Varicose veins cause veins in your legs to swell and lose their shape.

Varicoceles are usually painless but can sometimes cause testicular pain, which may come and go. In some people, a varicocele may cause infertility. If a varicocele doesn’t bother you, you may not need treatment.

Is a varicocele serious?

Varicoceles aren’t life-threatening. However, a varicocele can be very serious if you’re trying to have a biological child.

Can varicoceles affect fertility?

Yes, varicoceles can affect fertility in some people. Varicoceles can contribute to about 40% of all cases of male infertility. However, many people with varicoceles have no problems achieving pregnancy.

Medical experts don’t understand what role varicoceles play in infertility. It’s possible that the temperature inside your scrotum increases due to the buildup of blood in the veins. The higher temperature affecting both testicles may affect sperm count or production.

Talk to a healthcare provider if you suspect you have infertility. Fertility concerns are the top reason why people receive varicocele treatment.

How common are varicoceles?

Varicoceles affect 15% to 20% of all men and people assigned male at birth (AMAB) in the United States — about 1 in 5. A varicocele is more likely to occur on the left side of your scrotum because of differences in how blood drains from your left testicle back into the major veins of the body. Less commonly, it can affect the right side or both sides.

What are the symptoms of a varicocele?

Varicoceles usually don’t have any symptoms. However, you may notice:

• Dull testicular pain or aching in your scrotum, which often gets better when you lie down.
• Swelling in your testicles or scrotum.
• Shrinking in your testicles (testicular atrophy).
• Inability to achieve pregnancy after at least a year of trying (infertility).
• A small lump above your affected testicle.

What does a varicocele feel like?

Larger varicoceles may feel or look like a bag of worms or spaghetti. They may cause mild discomfort, aches or pains. Smaller varicoceles may be too small to see or feel.

What is the main cause of a varicocele?

Healthcare providers and medical experts aren’t sure what causes varicoceles to develop. Some think that a faulty “switch” (valve) inside certain veins in the spermatic cord may cause them. The spermatic cord is a band of tissues that holds your testicles in place. These veins return blood from your testicles to your body. The valve acts as a sort of “on/off” switch. It has two flap-like structures that help blood move back toward your heart. When a valve doesn’t work the way it should, blood may build up inside the veins in your testicles. Over time, the veins swell.

Who do varicoceles affect?

Varicoceles can affect anyone with testicles at any age. Healthcare providers believe that many varicoceles are present at birth (congenital). People often notice a varicocele during their teenage years. Medical experts suspect this may have to do with puberty, when blood flow to your genitals increases. In some cases, the varicocele can prevent your testicle from growing properly.

Does a varicocele cause erectile dysfunction?

There isn’t enough research to definitively say that varicoceles cause erectile dysfunction (ED), but there may be a link. Some studies show that people who receive varicocele treatment may still sometimes fail to achieve an erection, but not as often.

Are there other complications of a varicocele?

Larger varicoceles may increase your risk of other complications, including:

• Low testosterone (male hypogonadism). People AMAB create testosterone in their testicles. Testosterone is a hormone that initiates male characteristics during puberty, enhances libido (sex drive) and helps strengthen bones and muscles. Low testosterone may shrink your testicles, reduce your sex drive, decrease your muscle mass and cause depression.
• Azoospermia. Azoospermia is when you don’t have any sperm in your ejaculate (semen). Sperm cells are reproductive cells that fertilize an egg cell (ovum or oocyte). This creates an embryo that later develops into a fetus. Azoospermia is one cause of male infertility.

How is a varicocele diagnosed?

A healthcare provider can diagnose a varicocele. They’ll review your medical history, ask questions about your symptoms and perform a physical examination.

During the physical exam, your provider may ask you to stand up, take a deep breath, hold your nose and mouth closed and strain to push air out. This is the Valsalva maneuver. They’ll feel your scrotum for enlarged veins as you’re holding your breath and straining.

They may also order the following tests to confirm their diagnosis:

• Pelvic ultrasound. A pelvic ultrasound is a noninvasive imaging test that gives your provider a detailed view of the veins in your testicles. It’s the most common imaging test that providers order to help diagnose varicoceles.
• Semen analysis. During a semen analysis, you’ll masturbate into a special container. Your provider will then send your semen sample to a lab, where technicians will look for the presence and overall health of sperm. A provider will order a semen analysis if there are concerns that a varicocele is impacting your fertility.
• Blood test. During a blood test, your provider will use a tiny needle to withdraw a small blood sample. They’ll send your blood sample to a lab, where technicians will check hormone levels, including follicle-stimulating hormone (FSH) and testosterone.

After confirming the presence of a varicocele, your provider will grade its severity.

What are the grades of a varicocele?

Healthcare providers use grades to detect and score varicoceles:

• Grade 0. This is the smallest type of varicocele. Your provider can’t feel it during a physical exam, but they can see it on an ultrasound.
• Grade I. Your provider can’t see the varicocele, and they can only feel it when you perform the Valsalva maneuver.
• Grade II. Your provider can feel the varicocele even when you’re not performing the Valsalva maneuver, but it’s still not visible.
• Grade III. This is the largest varicocele. Your provider can clearly see and feel it.

How do you get rid of a varicocele?

Varicocele treatment depends on the severity of your varicocele. For low-grade varicoceles, a healthcare provider may recommend at-home treatment options, including:

• No treatment. You may not need treatment if your varicocele doesn’t bother you or cause fertility issues.
• Changes to your daily routine. You may need to avoid certain activities that cause discomfort. Wearing tighter-fitting underwear (like spandex or elastane) or a jockstrap while exercising or standing for long periods can ease symptoms.
• Ice. Applying ice or cold packs to your scrotum may help relieve pain and discomfort. Don’t apply ice directly to your skin. Wrap ice or cold packs in a towel. Apply ice for no more than 15 minutes at a time.
• Over-the-counter (OTC) medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen and ibuprofen — can help relieve any aching or pain in your scrotum or testicles. Not everyone can take NSAIDs, so it’s a good idea to talk to a provider before you take them.

What is varicocele surgery?

A varicocelectomy is a surgical procedure that treats severe varicoceles that are painful or affect your fertility. A surgeon who specializes in conditions that affect your urinary system and reproductive system will cut your affected veins and seal off the ends. This redirects blood flow to other healthy veins in your scrotum.

How long does it take to recover from varicocele treatment?

Most people make a full recovery after a varicocelectomy within six weeks.

What happens if a varicocele is left untreated?

It depends on the varicocele grade. Your healthcare provider may not recommend treatment if you have a small varicocele that doesn’t bother you or cause fertility issues.

If you have a higher-grade varicocele and don’t get treatment, it can permanently damage your testicles.

Can a varicocele be prevented?

Medical experts aren’t sure what causes varicoceles to develop. As a result, they’re not sure how you can prevent them.

What can I expect if I have a varicocele?

Many people with varicoceles have no symptoms at all. Some people may experience mild discomfort during certain activities, but the varicoceles won’t cause serious or long-term health problems.

Some people who have varicoceles have fertility issues. If you have concerns about your ability to have a biological child, talk to a healthcare provider. They’ll help you understand your options.

When should I see a healthcare provider?

Talk to a healthcare provider if you have varicocele symptoms, including an inability to get your partner pregnant. They can diagnose a varicocele and recommend the best treatment for you.

If you receive treatment for a varicocele, schedule follow-up appointments with your provider. They’ll monitor your health and may order additional tests to make sure your treatment is effective.

What questions should I ask my healthcare provider?

• How do you know I have a varicocele?
• Do I need treatment for my varicocele?
• Will my symptoms get worse without treatment?
• Will my varicocele get larger?
• What steps can I take to improve my symptoms at home?
• Could a varicocele affect my fertility?
• What are my treatment options?
• Can a varicocelectomy improve my fertility?

What is the difference between a hydrocele and a varicocele?

A varicocele is an enlarged vein in your scrotum. A hydrocele is a fluid-filled sac surrounding a testicle in your scrotum. It commonly affects newborn boys or babies AMAB when the thin membrane tunnel (processus vaginalis) fails to close after the testicles descend during fetal development.

A note from Cleveland Clinic

A varicocele is a common condition that can affect people AMAB at different ages and stages of life. Most people experience mild or no symptoms. Deciding whether to treat a varicocele is up to you. Wearing supportive underwear or a jockstrap or taking over-the-counter pain medication may be enough to relieve minor symptoms. However, varicoceles can cause infertility. A varicocelectomy can repair a varicocele and sometimes improve your fertility. Talk to a healthcare provider about your treatment options, including how surgery may affect your fertility.