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.

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

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Varicoceles generally have no signs, says Craig Comiter, MD, a professor of urology at Stanford Health Care in California.

• 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.

“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.

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.

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.

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.

Embolization

Varicoceles aren’t preventable, Comiter says, and there are no screening tests for them.

• Avoid activities and sports that trigger symptoms.
• Apply ice to the affected area.
• Wear snug-fitting underwear.
• Wear a jockstrap during exercise.

While varicoceles are generally harmless, they can in some cases lead to complications, including:

• A lump or mass in the scrotum
• Testicular atrophy (one or both testicles shrink)
• Infertility
• Low testosterone

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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.

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  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.

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  But testicular atrophy in adults may not improve after surgery.

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• 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.

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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.