Varicocele is when veins in your scrotum swell. It’s a lot like a varicose vein that you get in your leg. It might feel like a bag of worms.
It usually shows up above one of your testicles, most often the left one. You can usually see it when you stand up, but not when you lie down.
It should be harmless, but it can be uncomfortable or painful. And it might affect your fertility or cause your testicles to shrink.
This condition is fairly common and usually affects young people. About 10 to 15 of every 100 men have this problem. It’s not uncommon to have varicoceles as you move through puberty.
If a varicocele causes problems, your doctor may send you to a specialist called a urologist.
Varicocele vs hydrocele
A hydrocele is swelling in the scrotum caused by fluid building up in the sac surrounding the testicle. Newborns usually get the condition as they're developing in the womb.
Doctors aren’t sure what causes this condition. It could be a problem with blood flow in the spermatic cord, which carries blood to and from your testicles. If valves inside the veins in the cord don’t work as they should, the blood backs up, and the veins get wider.
Each testicle has a spermatic cord holding it up. The spermatic cord has veins, arteries, and nerves. The veins have valves that keep blood flowing in one direction – toward the heart. If a valve in the spermatic cord doesn’t close the way it should, blood backs up and causes a varicocele.
When varicoceles happen in teens, it’s often because of their quick growth during puberty. The testicles need more blood than normal as they develop, and any kind of problem in the veins can keep the blood from getting where it needs to go
Varicoceles rarely hurt. You may not even know you have one until you or the doctor sees it. Symptoms could include a mass in your scrotum and testicles that are different in size.
If your varicocele does cause pain, it might:
- Switch from dull to sharp
- Get worse when you stand or exert yourself, especially for a long time
- Become more intense as the day goes on
- Go away when you lie on your back
Varicocele and fertility
You may also have problems getting your partner pregnant. Varicoceles are one of the most common causes of infertility in men and people assigned male at birth. Treating your varicocele should improve your sperm and help with infertility issues.
You and the doctor may be able to feel the mass easily. If not, the doctor might ask you to stand, take a deep breath, and hold it while you bear down. They’ll call this the Valsalva maneuver. It helps them feel enlarged veins.
If the exam isn’t enough to be sure, they might take an ultrasound of your scrotum. A scrotal ultrasound uses sound waves to take pictures of the inside of your body. The pictures can tell your doctor how large the veins in your scrotum are, how large your testicles are, and in which direction the blood is flowing in your scrotal veins.
The size of the lump in your testicle helps your doctor classify your varicocele on a grading scale of 0-3:
- Grade 0 is the smallest, and it can be seen only with the help of an ultrasound.
- Grade 1 is when your varicocele isn't visible, and your doctor can only feel it when you perform the Valsalva maneuver.
- Grade 2 is when your doctor can feel the varicocele without the Valsalva maneuver, but they can't see it.
- Grade 3 is the largest, and means your varicocele is big enough that it changes the shape of your scrotum.
Not all varicoceles require treatment. It’s mostly done if:
- You’re in pain
- You have problems getting your partner pregnant
- You’re a child whose left testicle is smaller than the right
If you do need treatment, the goal will be to tie off or remove the veins that supply blood to your spermatic cord. You might have:
The doctor will make a 1-inch cut into your scrotum. They’ll use a magnifying glass or microscope to see small veins better. You might get local anesthesia to numb the area, or you may need general anesthesia to help you sleep through the procedure.
The doctor makes a much smaller cut and uses it to insert tubes that hold surgical tools and a special camera to help see inside you. You’ll get general anesthesia so you can sleep while it’s done.
Results from both of these treatments are similar because the cuts are small. It’s rare, but you may notice:
- The varicocele doesn’t go away or comes back.
- Fluid in the testicles (Your doctor will call this hydrocele.)
- Your testicular artery gets injured.
With this less common treatment, a doctor called a radiologist will cut into a vein in your groin or neck to insert a tube. They’ll use X-rays to guide them to the varicocele and insert a balloon or coil into it through the tube. This blocks the blood flow to the varicocele and shrinks it. You'll have this done with general anesthesia.
Problems that can follow this procedure include:
- The varicocele doesn’t go away or comes back.
- The coil moves.
- You get an infection where the doctor made the cut.
Varicocele treatment without surgery
There are no meds to prevent varicoceles. If yours hurts, the doctor may tell you to take ibuprofen or acetaminophen for pain. You can also wear an athletic supporter or snug briefs and lie on your back to help drain the varicocele and relieve pain.
With a larger varicocele, you have a higher chance of other health problems, including:
- Low testosterone. Testosterone is a hormone created in the testicles that triggers male traits during puberty, boosts sex drive, and helps make your bones and muscles stronger.
- Azoospermia. This is when you lack sperm in your semen, which fertilizes an egg cell. The condition can cause infertility.
You can probably go back to work a day or two after surgery. But you’ll need to take it easy – no exercise – for about 2 weeks.
Recovery after an embolization is a little quicker. You’ll still need a day or two off from work, but you can get back to the gym in a week to 10 days. Your varicocele may be more likely to come back after this treatment, but sometimes it’s the better choice.
If you have the procedure to help with fertility, the doctor will test you in 3-4 months. That’s how long it takes for new sperm to grow. You’ll probably see improvements in 6 months, but it could take a year. A little more than half of infertile men who have the procedure benefit from it. Surgery is also successful for most teens who have it to fix slow testicular growth.
If you have symptoms of a varicocele, talk to your doctor. They'll help figure out if you have the condition and will suggest a treatment plan. After treatment, be sure to go to all follow-up appointments. Your doctor will keep an eye on your health and may order tests to make sure your treatment has worked.