Table of ContentsView AllTable of ContentsTypesSymptomsCausesDiagnosisTreatmentFAQs

Table of ContentsView All

View All

Table of Contents

Types

Symptoms

Causes

Diagnosis

Treatment

FAQs

A varicocele often causes no symptoms and, in such cases, usually requires no treatment. Even so, it can affect sperm production, leading toinfertilitydue to a low sperm count and/or poor sperm quality. A varicocele that causes symptoms (testicular pain),low testosterone(a sex hormone related to energy and libido), or infertility may be treated surgically.

This article looks at the symptoms, causes, diagnosis, and treatment of varicocele. It also describes the available surgical and non-surgical options when treatment is indicated.

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Close-up of healthcare provider noting symptoms on a clipboard in an examination room with a male person seeking care

Types of Varicoceles

A varicocele specifically involves a structure called thepampiniform venous plexus. This is a network of tiny veins—also known as spermatic veins—that transport oxygen-depleted blood from each of the testicles as part of normal blood circulation. There are right spermatic veins and left spermatic veins.

The right spermatic veins drain into the rightrenal vein(which receives oxygen-depleted blood from the kidneys). The left spermatic vein drain into the left renal vein (which receives oxygen-depleted blood from multiple organs, including the heart and intestines).

This is significant anatomically because the left spermatic veins bend at a 45-degree angle as they connect the left renal vein (unlike the right spermatic veins, which are relatively straight). This bend makes them vulnerable to blood flow restriction, rather like a cinch in a garden hose.

Left-Sided vs. Right-Sided VaricoceleBecause of the structural vulnerability of the left spermatic veins, a varicocele is more likely to be left-sided. An isolated right-sided varicocele is far less common, accounting for only around 2% of cases.

Left-Sided vs. Right-Sided Varicocele

Because of the structural vulnerability of the left spermatic veins, a varicocele is more likely to be left-sided. An isolated right-sided varicocele is far less common, accounting for only around 2% of cases.

Bilateral (two-sided) varicoceles can also occur, albeit less commonly than a left-sided varicocele.

Symptoms of a Varicocele

A varicocele is typicallyasymptomatic(meaning without symptoms). In fact, it is not uncommon for people to be entirely unaware of the condition until they are faced with unexplained infertility.

If symptoms do develop, they may involve:

A large varicocele can cause a prominent scrotal mass often described as a “bag of worms.”

Varicoceles and InfertilityA varicocele causes the pooling of blood in veins that service a testicle. The pooling increases the temperature within the scrotum, damaging not only sperm cells but alsoLeydig cellsin the testicles that producetestosterone(the sex hormone responsible for sperm production).

Varicoceles and Infertility

A varicocele causes the pooling of blood in veins that service a testicle. The pooling increases the temperature within the scrotum, damaging not only sperm cells but alsoLeydig cellsin the testicles that producetestosterone(the sex hormone responsible for sperm production).

Swollen Testicles

A varicocele is a relatively common condition, affecting 15% to 20% of males and between 30% and 40% of males with infertility. It tends to develop gradually over time.

And, while a varicocele may only be noticed in adulthood, it can start to develop in early adolescence. Studies have shown that roughly 8% of males between the ages of 11 and 14 and 14% of those between 15 and 19 have varicoceles.

How a Varicoceles Occurs

The cause of a varicocele is unclear, but there are a number of possible explanations:

The exam is done while you are standing. As the specialist palpates (manuallyexamines) the scrotum and testicles, you may be asked to perform theValsalva maneuver, during which you breathe out forcefully through your mouth while holding your nose shut. Doing so can help reveal the varicocele.

Based on how visible the varicocele is with or without the Valsalva maneuver, the urologist can classify the severity of the condition as follows:

Anultrasound(a non-invasive device that produces images using sound waves) is generally notneeded to confirm the diagnosis; a physical exam is usually enough.

However, an ultrasound may be useful in situations where a scrotal exam is difficult, such as when a person hasobesity, a small scrotum, or thick scrotal skin. In cases like these, acolor Doppler ultrasoundcan reveal the reversal of blood flow within the spermatic veins and vein diameter.

Once a varicocele is present, it will not go away on its own. This doesn’t mean that it is necessarily problematic or in need of treatment. If there are no symptoms and your fertility is not impaired, a varicocele is often left untreated.

If pain is the only concern, conservative treatment is recommended before more invasive procedures are considered. This includes limitation of physical activities, elevation of the scrotum, and the use ofnonsteroidal anti-inflammatory drugslikeAdvil (ibuprofen)orAleve (naproxen)to temporarily relieve the scrotal pain.

Indications for TreatmentMore invasive varicoceles treatments are reserved for people with infertility who are trying to or hoping to conceive. They may also be considered for people whose severe symptoms are not relieved with pain medications or for adolescents whose testicles are not developing due to a varicocele.

Indications for Treatment

More invasive varicoceles treatments are reserved for people with infertility who are trying to or hoping to conceive. They may also be considered for people whose severe symptoms are not relieved with pain medications or for adolescents whose testicles are not developing due to a varicocele.

There are three procedures commonly used to treat varicoceles:

By normalizing blood flow, these procedures may help improve both sperm count and sperm quality, as well as testosterone.They can also help reduce chronic scrotal pain or help an undeveloped testicle “catch up” in size.

Possible complications includehydrocele(the swelling of the scrotum due to fluid build-up) and the recurrence of a varicocele. These can occur with all three procedures but are less common with microsurgical varicocelectomy.

Some studies suggest that all three techniques are similarly effective in improving conception rates.

Summary

A varicocele is diagnosed with a physical exam and occasionally an ultrasound. Not all cases need to be treated, but those that cause infertility, chronic pain, low testosterone, or stunted testicular growth may benefit from surgical or embolization procedures.

Frequently Asked QuestionsNot really. Some early studies have suggested that micronized purified flavonoid fraction (MPFF), an oral therapy used for people with chronicvenous insufficiency, may help alleviate varicocele pain.Even so, there is no evidence that any drug can reverse or “cure” a varicocele.Based on a Cochrane review published in 2021 involving 48 studies and 5,384 participants, the investigators concluded that varicocele surgery or embolization “may improve the chances for pregnancy” compared to no treatment. Of the available treatment options, microscopic varicocelectomy may offer better results and lower rates of varicocele recurrence.Learn MoreVaricocele SurgeryVaricoceles affect roughly 8% of males between the ages of 11 and 14.At this age, varicoceles can cause delays in secondary male characteristics due totesticular atrophy (shrunken testicles). Muscle mass, sex drive, and sperm count may also be reduced in later life.Learn MoreIs It Normal for One Testicle to Be Smaller?

Frequently Asked Questions

Not really. Some early studies have suggested that micronized purified flavonoid fraction (MPFF), an oral therapy used for people with chronicvenous insufficiency, may help alleviate varicocele pain.Even so, there is no evidence that any drug can reverse or “cure” a varicocele.

Based on a Cochrane review published in 2021 involving 48 studies and 5,384 participants, the investigators concluded that varicocele surgery or embolization “may improve the chances for pregnancy” compared to no treatment. Of the available treatment options, microscopic varicocelectomy may offer better results and lower rates of varicocele recurrence.Learn MoreVaricocele Surgery

Based on a Cochrane review published in 2021 involving 48 studies and 5,384 participants, the investigators concluded that varicocele surgery or embolization “may improve the chances for pregnancy” compared to no treatment. Of the available treatment options, microscopic varicocelectomy may offer better results and lower rates of varicocele recurrence.

Learn MoreVaricocele Surgery

Varicoceles affect roughly 8% of males between the ages of 11 and 14.At this age, varicoceles can cause delays in secondary male characteristics due totesticular atrophy (shrunken testicles). Muscle mass, sex drive, and sperm count may also be reduced in later life.Learn MoreIs It Normal for One Testicle to Be Smaller?

Varicoceles affect roughly 8% of males between the ages of 11 and 14.At this age, varicoceles can cause delays in secondary male characteristics due totesticular atrophy (shrunken testicles). Muscle mass, sex drive, and sperm count may also be reduced in later life.

Learn MoreIs It Normal for One Testicle to Be Smaller?

11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Baigorri BF, Dixon RG:Varicocele: a review.Semin Intervent Radiol. 2016;33(3):170–176. doi:10.1055/s-0036-1586147Lomboy JR, Coward RM.The varicocele: clinical presentation, evaluation, and surgical management.Semin Intervent Radiol.2016;33(3):163–169. doi:10.1055/s-0036-1586143Cho CL, Esteves SC, Agarwal A.Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation.Asian J Androl.2016;18(2):186–193. doi:10.4103/1008-682X.170441American Urology Association.Varicocele.Paick S, Choi WS.Varicocele and testicular pain: a review.World J Mens Health.2019;37(1):4–11. doi:10.5534/wjmh.170010Kupis T, Dobronski PA, Radziszewski P.Varicocele as a source of male infertility – current treatment techniques.Cent European J Urol.2015;68(3):365–370. doi:10.5173/ceju.2015.642Alsaikhan B, Alrabeeah K, Delouya G, Zin A.Epidemiology of varicocele.Asian J Androl.2016;18(2):179–181. doi:10.4103/1008-682X.172640Alkhamees M, Hamri SB, Alhumaid T, et al.Factors associated with varicocele recurrence after microscopic sub-inguinal varicocelectomy.Res Rep Urol.2020;12:651–657. doi:10.2147/RRU.S281739Dabaja A, Wosnitzer M, Goldstein M.Varicocele and hypogonadism.Curr Urol Rep. 2013;14(4):309-314. doi:10.1007/s11934-013-0339-4Nasr EB, Binhazzaa M, Almont T, Rischmann P, Soulie M, Huyghe E.Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: prospective comparison of reproductive and functional outcomes,Basic Clin Androl.2017;27:11. doi:10.1186/s12610-017-0055-xPersad E, O’Loughlin CA, Kaur S, et al.Surgical or radiological treatment for varicoceles in subfertile men.Cochrane Database Syst Rev. 2021;4(4):CD000479. doi:10.1002/14651858.CD000479.pub6

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Baigorri BF, Dixon RG:Varicocele: a review.Semin Intervent Radiol. 2016;33(3):170–176. doi:10.1055/s-0036-1586147Lomboy JR, Coward RM.The varicocele: clinical presentation, evaluation, and surgical management.Semin Intervent Radiol.2016;33(3):163–169. doi:10.1055/s-0036-1586143Cho CL, Esteves SC, Agarwal A.Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation.Asian J Androl.2016;18(2):186–193. doi:10.4103/1008-682X.170441American Urology Association.Varicocele.Paick S, Choi WS.Varicocele and testicular pain: a review.World J Mens Health.2019;37(1):4–11. doi:10.5534/wjmh.170010Kupis T, Dobronski PA, Radziszewski P.Varicocele as a source of male infertility – current treatment techniques.Cent European J Urol.2015;68(3):365–370. doi:10.5173/ceju.2015.642Alsaikhan B, Alrabeeah K, Delouya G, Zin A.Epidemiology of varicocele.Asian J Androl.2016;18(2):179–181. doi:10.4103/1008-682X.172640Alkhamees M, Hamri SB, Alhumaid T, et al.Factors associated with varicocele recurrence after microscopic sub-inguinal varicocelectomy.Res Rep Urol.2020;12:651–657. doi:10.2147/RRU.S281739Dabaja A, Wosnitzer M, Goldstein M.Varicocele and hypogonadism.Curr Urol Rep. 2013;14(4):309-314. doi:10.1007/s11934-013-0339-4Nasr EB, Binhazzaa M, Almont T, Rischmann P, Soulie M, Huyghe E.Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: prospective comparison of reproductive and functional outcomes,Basic Clin Androl.2017;27:11. doi:10.1186/s12610-017-0055-xPersad E, O’Loughlin CA, Kaur S, et al.Surgical or radiological treatment for varicoceles in subfertile men.Cochrane Database Syst Rev. 2021;4(4):CD000479. doi:10.1002/14651858.CD000479.pub6

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Baigorri BF, Dixon RG:Varicocele: a review.Semin Intervent Radiol. 2016;33(3):170–176. doi:10.1055/s-0036-1586147Lomboy JR, Coward RM.The varicocele: clinical presentation, evaluation, and surgical management.Semin Intervent Radiol.2016;33(3):163–169. doi:10.1055/s-0036-1586143Cho CL, Esteves SC, Agarwal A.Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation.Asian J Androl.2016;18(2):186–193. doi:10.4103/1008-682X.170441American Urology Association.Varicocele.Paick S, Choi WS.Varicocele and testicular pain: a review.World J Mens Health.2019;37(1):4–11. doi:10.5534/wjmh.170010Kupis T, Dobronski PA, Radziszewski P.Varicocele as a source of male infertility – current treatment techniques.Cent European J Urol.2015;68(3):365–370. doi:10.5173/ceju.2015.642Alsaikhan B, Alrabeeah K, Delouya G, Zin A.Epidemiology of varicocele.Asian J Androl.2016;18(2):179–181. doi:10.4103/1008-682X.172640Alkhamees M, Hamri SB, Alhumaid T, et al.Factors associated with varicocele recurrence after microscopic sub-inguinal varicocelectomy.Res Rep Urol.2020;12:651–657. doi:10.2147/RRU.S281739Dabaja A, Wosnitzer M, Goldstein M.Varicocele and hypogonadism.Curr Urol Rep. 2013;14(4):309-314. doi:10.1007/s11934-013-0339-4Nasr EB, Binhazzaa M, Almont T, Rischmann P, Soulie M, Huyghe E.Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: prospective comparison of reproductive and functional outcomes,Basic Clin Androl.2017;27:11. doi:10.1186/s12610-017-0055-xPersad E, O’Loughlin CA, Kaur S, et al.Surgical or radiological treatment for varicoceles in subfertile men.Cochrane Database Syst Rev. 2021;4(4):CD000479. doi:10.1002/14651858.CD000479.pub6

Baigorri BF, Dixon RG:Varicocele: a review.Semin Intervent Radiol. 2016;33(3):170–176. doi:10.1055/s-0036-1586147

Lomboy JR, Coward RM.The varicocele: clinical presentation, evaluation, and surgical management.Semin Intervent Radiol.2016;33(3):163–169. doi:10.1055/s-0036-1586143

Cho CL, Esteves SC, Agarwal A.Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation.Asian J Androl.2016;18(2):186–193. doi:10.4103/1008-682X.170441

American Urology Association.Varicocele.

Paick S, Choi WS.Varicocele and testicular pain: a review.World J Mens Health.2019;37(1):4–11. doi:10.5534/wjmh.170010

Kupis T, Dobronski PA, Radziszewski P.Varicocele as a source of male infertility – current treatment techniques.Cent European J Urol.2015;68(3):365–370. doi:10.5173/ceju.2015.642

Alsaikhan B, Alrabeeah K, Delouya G, Zin A.Epidemiology of varicocele.Asian J Androl.2016;18(2):179–181. doi:10.4103/1008-682X.172640

Alkhamees M, Hamri SB, Alhumaid T, et al.Factors associated with varicocele recurrence after microscopic sub-inguinal varicocelectomy.Res Rep Urol.2020;12:651–657. doi:10.2147/RRU.S281739

Dabaja A, Wosnitzer M, Goldstein M.Varicocele and hypogonadism.Curr Urol Rep. 2013;14(4):309-314. doi:10.1007/s11934-013-0339-4

Nasr EB, Binhazzaa M, Almont T, Rischmann P, Soulie M, Huyghe E.Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: prospective comparison of reproductive and functional outcomes,Basic Clin Androl.2017;27:11. doi:10.1186/s12610-017-0055-x

Persad E, O’Loughlin CA, Kaur S, et al.Surgical or radiological treatment for varicoceles in subfertile men.Cochrane Database Syst Rev. 2021;4(4):CD000479. doi:10.1002/14651858.CD000479.pub6

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