What is a varicocele?
A varicocele occurs when the veins in the scrotum that drain blood from the testis (testicle) become abnormally dilated and large.
Varicoceles may look or feel like ‘a bag of worms’ within the scrotum. The way they look or feel depends on their size:
• Grade 1 varicoceles are small and can only be felt if you’re standing and bearing down, coughing or straining
• Grade 2 varicoceles are a moderate size and can be felt when you’re standing normally
• Grade 3 varicoceles are large and can be seen within the scrotum when you’re standing.
Varicoceles become increasingly common with age. The incidence is very low (less than 1%) under 1. years of age, increasing to around 15% in healthy young men . Varicoceles affect around 75% men aged 80-89 years1.
A varicocele occurs most commonly on the left side. About half of men with a varicocele only have it on the left side; in the other half, most have varicoceles on both sides. Varicocele on only the right side occurs in fewer than 1 in 50 men with a varicocele2.
Symptoms of a varicocele
Varicoceles cause pain in 2-10% of men who have them, but usually there are no symptoms3. In a minority of men, varicoceles can impact fertility.
Men who seek help for treating varicoceles describe a heavy dragging feeling towards the end of the day or on standing for prolonged periods. The discomfort is not sharp or very intense and usually resolves when they lie down.
Causes of a varicocele
Varicoceles are caused by a backup of blood in the veins within the scrotum2.
There are some differences in anatomy between the right and left sides of the body that make varicocele more common on the left.
Varicoceles are more likely to occur in men with varicose veins in their legs, or those whose fathers or brothers have a varicocele.
Diagnosis of a varicocele
Your doctor can diagnose varicocele by performing an examination.
They may examine the size and firmness of your testes (testicles) to see if your varicocele is causing possible problems with your testicular function.
Sometimes, varicoceles are diagnosed during an examination to investigate possible causes of infertility.
Usually, there are no additional tests needed to diagnose varicoceles, unless there are concerns about fertility. In these cases, a semen analysis might be performed. Some doctors might suggest measuring your testosterone levels, but this is not a standard test.
In some men it can be difficult to perform a thorough examination of the scrotum, so an ultrasound scan might be necessary. If a varicocele is seen using ultrasound but is very small, in the vast majority of cases no treatment will be necessary.
Treatment of a varicocele
There are several surgical procedures that can be used to treat a varicocele, but treatment is not always necessary4.
In most cases, surgery to repair a varicocele is only performed in the following circumstances:
• When the varicocele is causing discomfort
• If infertility is likely
• To reverse or prevent the testis becoming smaller.
Health effects of a varicocele
Varicoceles may inhibit development of sperm by the testes. Whether or not testosterone production by the testes is affected is not known for sure, but if it is the effect is likely to be very small. Surgical correction of varicocele can reverse these problems5.
What to do about a varicocele
If you have genital pain or notice any change in the appearance of your genitals, you should see your doctor.
Varicoceles may not pose a threat to your health, but it’s worth asking your doctor to help you keep an eye on it.
Questions to ask your doctor about a varicocele
• Do I need any tests to make sure my varicocele isn’t causing any problems?
• What should I do if my varicocele gets bigger?
• Does having a varicocele on one side mean I’m more likely to get one on the other side?
 Alsaikhan et al., 2016. Epidemiology of Varicocele. Asian Journal of Andrology
 Besiroglu et al., 2019. The prevalence and severity of varicocele in adult population over the age of forty years old: a cross-sectional study. The Aging Male
 Leslie et al., 2021. Varicocele. StatPearls. Available from: https://www.statpearls.com/ArticleLibrary/viewarticle/30986
 Masson & Brannigan, 2014. The Varicocele. Urological Clinics of Northern America
 Johnson & Sandlow, J., 2017. Treatment of varicoceles: techniques and outcomes. Fertility and Sterility