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Varicocele | Symptoms & Diagnosis

Varicocele: symptoms, causes and diagnosis

A varicocele is an enlargement of the veins around the testicle, similar to varicose veins in the legs. Many varicoceles cause no symptoms, but they can sometimes cause discomfort, affect testicular function or be associated with fertility concerns. Diagnosis usually involves a clinical examination and, when appropriate, an ultrasound.
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varicocele illustration

What are the symptoms of a varicocele?

Many varicoceles cause no symptoms and are found during a physical examination or investigation for fertility concerns. When symptoms do occur, they may include:
  • A dull ache, discomfort or feeling of heaviness in the scrotum, often worse after prolonged standing or physical activity.
  • Enlarged veins in the scrotum, sometimes described as feeling like a “bag of worms”.
  • Swelling or a difference in size between the testicles.
  • Symptoms that become more noticeable later in the day or improve when lying down.
  • Fertility concerns or changes in semen analysis in some men.
 The severity of a varicocele does not always correspond with symptoms. Some larger varicoceles cause little or no discomfort, while smaller varicoceles may still be symptomatic.
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Clinical analysis

What causes a varicocele?

A varicocele develops when blood flows backwards, or refluxes, through the veins that drain the testicle. Normally, small valves within these veins help blood flow upwards towards the heart. When these valves are absent or do not function effectively, blood can flow backwards and pool within the veins of the pampiniform plexus, causing them to enlarge. Varicoceles occur much more commonly on the left side because of the anatomy of the left testicular vein. The left testicular vein is longer and drains into the left renal vein, creating higher venous pressure and making reflux more likely. Less commonly, increased pressure or compression of veins higher in the abdomen can contribute to the development of a varicocele.
Varicocele cause diagram
Clinical evaluation

How is a varicocele diagnosed?

A varicocele can often be diagnosed during a physical examination. The scrotum is examined while standing and lying down, and you may be asked to bear down (Valsalva manoeuvre), which can make enlarged veins more apparent. A scrotal ultrasound with Doppler may also be performed to assess the veins around the testicle and look for abnormal backward blood flow (venous reflux). Ultrasound can also assess the testicles and help exclude other causes of scrotal symptoms.
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Physical examination

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Valsalva manoeuvre

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Doppler ultrasound

Clinical impact

Can a varicocele affect fertility?

A varicocele can affect fertility in some men, although many men with a varicocele have normal fertility. Varicoceles are commonly identified during the investigation of male infertility. The exact way a varicocele affects fertility is not completely understood. Increased temperature around the testicle, altered blood flow and oxidative stress may affect sperm production and function. In some men, a varicocele may be associated with changes in sperm concentration, movement (motility) or shape (morphology). The presence of a varicocele does not necessarily mean that fertility will be affected, and its significance should be considered alongside semen analysis and other fertility investigations.
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Clinical guidance

Does a varicocele need treatment?

Many varicoceles do not require treatment, particularly when they are not causing symptoms or fertility concerns. Treatment may be considered when a varicocele is associated with persistent pain or discomfort, reduced testicular size or function, or fertility concerns with an abnormal semen analysis. The decision to treat depends on your symptoms, examination findings, ultrasound results where relevant, and individual circumstances.
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Specialist consultation

Discuss your findings with Dr McConnell

Your consultation provides an opportunity to discuss your symptoms, fertility concerns and any previous investigations. Dr Ryan McConnell will review your clinical history and relevant imaging or test results and discuss whether treatment may be appropriate. If treatment is being considered, the available options, expected recovery, potential benefits and risks can be discussed so you can make an informed decision about your care.
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Dr Ryan McConnell
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Speak with Dr Ryan McConnell about your varicocele

If you have symptoms, fertility concerns or have been diagnosed with a varicocele, a consultation can help determine whether treatment is appropriate for you. Dr Ryan McConnell can review your symptoms and investigations, discuss the available treatment options and answer any questions you may have.
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Frequently asked questions about varicoceles

Can a varicocele go away on its own?
A varicocele usually does not go away on its own. However, many varicoceles cause no significant symptoms or fertility concerns and do not require treatment. Whether treatment should be considered depends on your symptoms, examination findings and individual circumstances.

Is a varicocele dangerous?
A varicocele is usually not dangerous. Many men have a varicocele without significant problems. In some men, however, a varicocele may be associated with persistent discomfort, changes in testicular size or function, or fertility concerns.

Can a varicocele affect fertility?
Yes. A varicocele can affect fertility in some men, although many men with a varicocele have normal fertility. Varicoceles may be associated with changes in sperm concentration, movement (motility) or shape (morphology), and are commonly identified during the investigation of male infertility.

Can a varicocele cause pain?
Yes. Some varicoceles cause a dull ache, discomfort or feeling of heaviness in the scrotum. Symptoms may become more noticeable after prolonged standing or physical activity and may improve when lying down. Many varicoceles, however, cause no pain.