Varicocele

A varicocele is a collection of widened veins, like varicose veins, that occurs on the outside of a testicle. Varicocele is a common cause of a lump in the scrotum, affecting about 15 per cent of men and teenage boys.

A varicocele affects only the left testicle in 90 per cent of cases. In 10 per cent of cases, both testicles are affected. It is rare to have a varicocele on the right testicle alone.

Treatment is available for varicoceles that are causing symptoms or complications.

What are the symptoms?

Usually the varicocele causes no symptoms, apart from a swelling on the outside of the testicle that may be more noticeable when standing. It is sometimes described as feeling like a bag of worms.

Occasionally it may cause an aching discomfort or a feeling of fullness in the testicle. The discomfort may be worse after standing for a long time, and may feel better when you lie down.

Complications

Some men with varicoceles have complications, including:

  • fertility problems, which many experts believe is due to blood pooling in the varicocele, raising the temperature in the scrotum and leading to abnormalities such as a low sperm count and poor sperm quality;
  • restricted growth of the affected testicle in teenage boys with a varicocele; and
  • a reduced production of testosterone, although this is uncommon.

What causes a varicocele?

A varicocele occurs when the veins that drain the testicle become widened. This is thought to be due to a number of factors, including incompetent (damaged or not functioning) valves in the veins.

Varicoceles usually occur on the left side because of anatomical differences that increase the pressure in the veins draining the left testicle. These include the increased length of the left spermatic vein (compared with the right) and the angle at which the left-sided vein inserts into the kidney vein.

These factors, combined with the downward force of gravity, can result in blood pooling in the small veins draining the left testicle, widening them and forming the swelling that is the varicocele.

Risk factors for varicocele

Varicoceles tend to be more common in men who have a family history of the condition, especially if they have brothers who have had a varicocele.

Being tall may also increase your risk of developing a varicocele.

How is a varicocele diagnosed?

To diagnose a varicocele, your doctor will need to look at and feel the testicles. The varicocele can be felt through the scrotum as a swelling on the outside of the testicle — the so-called bag of worms. Often the varicocele can only be felt when a man is standing, and disappears when he is lying down as the blood pressure to it falls.

Your doctor may recommend tests such as an ultrasound of the scrotum to confirm the diagnosis.

Additional tests may be recommended if you have suspected complications related to the varicocele. These may include hormone blood tests (including testosterone levels) or semen analysis (to check sperm numbers and quality).

Your doctor may refer you to a urologist (a specialist in conditions affecting the male reproductive system and the urinary system) for further assessment and treatment of your varicocele.

Treatment for varicoceles

If a man has a varicocele but has no discomfort and no fertility problems, then treatment may not be necessary. However, if there is ongoing discomfort or fertility problems, then a procedure to correct the varicocele may be offered. Treating a varicocele can help improve the chances of pregnancy in couples with otherwise unexplained fertility problems.

In a teenage boy diagnosed with a varicocele, treatment is usually recommended if the affected testicle is considerably smaller than the other testicle, or he is experiencing scrotal pain. In cases where the affected testicle is smaller that the other testicle, catch-up testicular growth is often seen after repair of the varicocele, but it may take up to 6 months.

Procedures used to repair a varicocele include:

  • minor surgery to ligate (‘tie off’) the swollen veins, done through a small cut in the groin or through laparoscopic (keyhole) surgery; or
  • an embolisation procedure, where a tube is inserted through a vein in the groin and threaded through to the problem vein, which is then blocked with a wire coil or chemicals that cause the vein to scar.

Self-care measures to help relieve aching in the affected testicle include wearing an athletic support and taking simple pain relievers.

When to see the doctor

If you have any pain or swelling of your testicles, or your testicles are different sizes, it is important to have it checked by a doctor straight away. Any change in the usual look or feel of your testicles or scrotum should be checked, because some causes of lumps or swellings need immediate treatment.

In most cases, your GP (general practitioner) is the best person to consult. Your GP may refer you to a urologist for an expert opinion, further tests or treatment.

Last Reviewed: 26 June 2017
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References

1. Andrology Australia. Scrotal lumps and inflammation (reviewed Feb 2015). https://www.andrologyaustralia.org/testes-problems/scrotal-lumps-and-inflammation/ (accessed Jun 2017).
2. Mayo Clinic. Varicocele (updated 7 Dec 2014). http://www.mayoclinic.org/diseases-conditions/varicocele/basics/definition/con-20024164 (accessed Jun 2017).
3. BMJ Best Practice. Varicocele (updated 8 Dec 2016). http://bestpractice.bmj.com/best-practice/monograph/1103.html (accessed Jun 2017).
4. Kroese ACJ, de Lange NM, Collins J, Evers JLH. Surgery or embolization for varicoceles in subfertile men. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD000479. DOI: 10.1002/14651858.CD000479.pub5. http://www.cochrane.org/CD000479/MENSTR_surgery-or-embolization-for-varicoceles-in-subfertile-men (accessed Jun 2017).
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