Varicocele
A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins in the legs. It commonly affects the left side and can cause a heavy or dragging feeling, swelling, or discomfort, particularly after standing for long periods. Varicoceles are a common cause of reduced sperm quality and can sometimes affect fertility, but many people experience no symptoms and require no treatment.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
What is a Varicocele?
The testes are two oval-shaped organs located in the scrotum. They produce sperm and the hormone testosterone, which is important for male reproductive health. Each testis is connected to a network of veins, arteries, and the spermatic cord, which carries blood, lymph, and the vas deferens.
A varicocele is an enlargement or swelling of the veins within the spermatic cord, similar to varicose veins that can occur in the legs. This happens when the small valves in the veins that normally help blood flow toward the heart stop working properly, causing blood to pool and the veins to enlarge. Varicoceles are usually more common on the left side and can sometimes affect both sides.
Most varicoceles are harmless, but in some cases, they can be associated with reduced fertility or discomfort. They are more likely to develop during puberty and often become noticeable when standing or with increased intra-abdominal pressure.
Understanding Varicoceles
Many varicoceles do not cause any noticeable symptoms and are discovered during a routine examination. When symptoms do occur, they can include:
- A dull, aching pain or discomfort in the scrotum, often described as a heaviness, which may worsen with standing, physical activity, or at the end of the day.
- Visible or palpable enlarged veins above the testicle, sometimes described as a “bag of worms.”
- Testicular shrinkage (atrophy) in some cases, usually affecting the testicle on the same side as the varicocele.
- Fertility issues may occasionally be noted, as varicoceles can impact sperm production and quality.
Symptoms are usually mild and often don’t require urgent attention. However, any new lump, sudden pain, or swelling in the scrotum should always be checked by a healthcare professional.
Causes & Risk Factors
A varicocele occurs when the veins within the scrotum (the pampiniform plexus) become enlarged due to faulty valves that normally help blood flow toward the heart. When these valves fail, blood can pool, causing the veins to dilate. Factors that can increase the likelihood of developing a varicocele include:
| Age | Varicoceles most commonly develop during puberty and early adulthood when veins and blood flow in the scrotum increase. |
| Anatomy | Differences in vein structure, particularly on the left side, make left-sided varicoceles more frequent due to the angle at which the testicular vein enters the larger vein in the abdomen. |
| Increased pressure in the abdomen | Activities or conditions that raise pressure in the abdomen, such as heavy lifting, chronic constipation, or prolonged straining, can contribute to vein enlargement. |
| Underlying conditions | Rarely, a varicocele can be caused by a blockage or compression of abdominal veins, such as by a mass or kidney tumor, which requires further medical investigation. |
Diagnosing a Varicocele
A varicocele is usually suspected based on physical examination, but imaging can help confirm the diagnosis and assess severity.
| Clinical Examination | The clinician feels the scrotum while you are standing, sometimes asking you to gently strain. Enlarged, twisted veins may be felt, often described as a “bag of worms.” |
| Ultrasound | Measures vein size, evaluates blood flow, and helps identify any other testicular conditions. Useful when the varicocele is not obvious or for fertility assessment. |
Treatment Options
Not all varicoceles need treatment. Many are harmless and may not cause symptoms or fertility issues. Treatment is usually considered if there is pain, testicular atrophy, or concerns about fertility.
| Conservative management | If the varicocele is small and not causing problems, monitoring may be all that is needed. Wearing supportive underwear or a scrotal support can sometimes relieve discomfort. |
| Surgical repair (varicocelectomy) | This is an operation to tie off the enlarged veins, redirecting blood flow to healthier veins. It is typically recommended for varicoceles that cause pain, testicular shrinkage, or infertility. The surgery is usually performed under general or local anesthesia and may be done through a small incision in the groin or abdomen. Recovery often involves a few days of rest and gradual return to normal activity. |
| Percutaneous embolization | This is a minimally invasive procedure performed by an interventional radiologist. A small catheter is inserted into a vein, and the affected veins are blocked using coils or a special fluid. This redirects blood flow away from the varicocele. It is an option for patients who prefer a non-surgical approach or when surgery is not suitable. Recovery is generally quick, with most people resuming normal activities within a few days. |
Each treatment option has its own benefits and potential risks, so your healthcare provider will discuss what is most appropriate for you.
How can Lanthorn help?
Testes & Scrotum Ultrasound - only £150
A painless imaging scan to confirm the presence of a varicocele, assess its size, and check blood flow in the testicular veins. Ultrasound also helps rule out other causes of scrotal lumps or discomfort.
Male Hormone Blood Test - £99
For patients concerned about fertility or general testicular function, blood tests can assess levels of testosterone and other hormones, helping guide further management.
Onwards referral and follow-up planning
If the varicocele is large, causing symptoms, or affecting fertility, Lanthorn can arrange a referral to a urologist for further assessment and consideration of surgical or interventional treatment.
