A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum). These veins transport oxygen-depleted blood from the testicles. A varicocele occurs when blood pools in the veins rather than circulating efficiently out of the scrotum.
Varicoceles usually form during puberty and develop over time. They may cause some discomfort or pain, but they often result in no symptoms or complications.
A varicocele may cause poor development of a testicle, low sperm production or other problems that may lead to infertility. Surgery to treat varicocele may be recommended to address these complications.
A varicocele usually occurs on the left side of the scrotum and often produces no signs or symptoms. Possible signs and symptoms may include:
Annual wellness visits for boys are important for monitoring the development and health of testicles. It's important to schedule and keep these appointments.
A number of conditions could contribute to pain, swelling or a mass in the scrotum. If you experience any of these, see your health care provider to get a timely and accurate diagnosis.
The testicles receive oxygen-rich blood from two testicular arteries — one artery for each side of the scrotum. Similarly, there are also two testicular veins that transport oxygen-depleted blood back toward the heart. Within each side of the scrotum, a network of small veins (pampiniform plexus) transport the oxygen-depleted blood from the testicle to the main testicular vein. A varicocele is the enlargement of the pampiniform plexus.
The exact cause of a varicocele is unknown. One contributing factor may be the malfunction of valves inside the veins that are intended to keep blood moving in the right direction. Also, the left testicular vein follows a slightly different path than the right vein — a path that makes a problem with blood flow more likely on the left.
When the oxygen-depleted blood gets backed up in the network of veins, they widen (dilate), creating the varicocele.
There don't appear to be any significant risk factors for developing a varicocele.
Having a varicocele can make it difficult for your body to regulate the temperature of the testicles. Oxidative stress and the buildup of toxins can result. These factors may contribute to the following complications:
Your health care provider can diagnose a varicocele by visual inspection of the scrotum and by touch. You'll likely be examined while lying down and standing up.
When you're standing, your health care provider may ask you to take a deep breath, hold it and bear down, similar to the pressure during a bowel movement. This technique (Valsalva maneuver) can make a varicocele easier to examine.
Your health care provider may want you to have an ultrasound exam. Ultrasound uses high-frequency sound waves to create images of structures inside your body. These images may be used to:
A varicocele often doesn't need to be treated. For a man experiencing infertility, surgery to correct the varicocele may be a part of the fertility treatment plan.
For teenagers or young adults — generally those not seeking fertility treatment — a health care provider may suggest annual checkups to monitor any changes. Surgery might be recommended in the following situations:
The purpose of surgery is to seal off the affected vein to redirect the blood flow into healthy veins. This is possible because two other artery-and-vein systems supply blood circulation to and from the scrotum.
Treatment outcomes may include the following:
Varicocele repair presents relatively few risks, which might include:
The balance between the benefits and risks of surgery shifts if the treatment is only for pain management. While varicoceles may cause pain, most do not. A person with a varicocele may have testicular pain, but the pain may be caused by something else — an unknown or not yet identified cause. When varicocele surgery is done primarily to treat pain, there is a risk that the pain may worsen, or the nature of the pain may change.
Your surgeon can stop the flow of blood through the testicular vein by stitching or clipping the vein shut (ligation). Two approaches are commonly used today. Both require general anesthesia and are outpatient procedures that usually allow you to go home the same day. The procedures include:
Pain from this surgery generally is mild but might continue for several days or weeks. Your doctor might prescribe pain medication for a limited period after surgery. After that, your doctor might advise you to take nonprescription pain medicine, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve discomfort.
You'll likely be able to return to work about a week after surgery and resume exercise about two weeks after surgery. Ask your surgeon about when you can safely return to daily activities or when you can have sex.
In this procedure, a vein is blocked by essentially creating a tiny dam. A doctor specializing in imaging (radiologist) inserts a tiny tube into a vein in your groin or neck. A local anesthetic is used at the insertion site, and you may be given a sedative to reduce discomfort and help you relax.
Using imaging on a monitor, the tube is guided to the treatment site in the groin. The radiologist releases coils or a solution that causes scarring to create a blockage in the testicular veins. The procedure lasts about an hour.
Recovery time is short with only mild pain. You'll likely be able to return to work in 1 to 2 days and resume exercise after about a week. Ask your radiologist when you can resume all activities.
If you have a varicocele that causes minor discomfort, but doesn't affect your fertility, you might try the following for pain relief:
A varicocele that doesn't cause pain or discomfort — which is common — may be diagnosed during a routine wellness exam. It may also be diagnosed during a more complex diagnostic process for fertility treatment.
If you're experiencing pain or discomfort in your scrotum or groin, you should be prepared to answer the following questions:
