Varicocele

What is a varicocele?

A varicocele is an enlargement of the veins in your scrotum. The scrotum is the loose pouch of skin that holds the testicles. There are veins in your scrotum that carry oxygen-depleted blood away from the testicles. A varicocele develops when blood backs up in the veins instead of circulating out of the scrotum.

Varicocele symptoms are usually mild and may include pain in the testicle. Often, they are painless. They can affect testicular growth during puberty and may cause fertility problems.

What are the symptoms of a varicocele?

Varicoceles often have no symptoms, but they may cause:

• Pain or an ache in the testicle
• Swelling in the testicle or scrotum
• A mass or lump in the testicle
• Infertility.

If a varicocele is large, you may be able to feel a cluster of enlarged veins. In some cases, a varicocele can stop the testicle from growing properly.

What causes a varicocele?

There are two arteries that supply the testicles with oxygen-rich blood, one for each side of the scrotum, and two veins that take oxygen-depleted blood away from the testicle. Inside the scrotum, a network of smaller veins takes oxygen-depleted blood from the testicles to the main veins. A varicocele is an enlargement of these smaller veins.

The exact cause of a varicocele isn’t fully understood, but it may be due to a malfunction of the valves within the testicular veins that ensure blood moves in the right direction.

Who is affected by varicoceles?

A varicocele can happen at any age. Some males are born with them, while others develop during adolescence. Doctors believe this may be because of the increased blood flow to the testicles during puberty.

What are the complications of a varicocele?

If a varicocele becomes large, it may increase the risk of complications, including:

• Low testosterone levels
• Testicular growth or shrinkage
• Fertility problems

There may also be a link between varicoceles and erectile dysfunction, but this isn’t fully understood.

How is a varicocele diagnosed?

Your doctor will diagnose a varicocele by performing a physical examination and asking about your symptoms and medical history. During the examination, you may be asked to stand up, hold your breath and strain, which makes a varicocele easier to examine. They may also perform an ultrasound to confirm the diagnosis or rule out other medical conditions.

If there are concerns about fertility, your doctor may also request a semen analysis.

Varicoceles are then graded:

• Grade 0: The varicocele can’t be felt but is visible on an ultrasound.
• Grade 1: The varicocele can’t be seen but can be felt when you hold your breath and strain.
• Grade 2: The varicocele can’t be seen but can be felt without holding your breath and straining.
• Grade 3: The varicocele can be seen and felt.

How are varicoceles treated?

Often, a varicocele doesn’t require treatment if it is not causing pain or fertility problems. Your doctor may recommend monitoring it for any changes. If it causes mild discomfort, you may be advised to take over-the-counter pain relief and wear underwear that supports the scrotum.

Treatment may be recommended if:

• The varicocele causes ongoing pain
• A testicle’s development is delayed
• The varicocele is causing infertility or other sperm irregularities.

In these cases, a surgical procedure called a varicocelectomy may be recommended. This involves cutting or sealing the affected veins to redirect blood flow to healthy veins.

When should I see a doctor about a varicocele?

A varicocele is a common condition that often causes mild or no symptoms. If you have a varicocele that is causing pain or fertility problems, talk to your doctor about treatment options. In some cases, a varicocele can affect testicular growth or function if left untreated. Your doctor will advise whether monitoring or treatment is appropriate.