Varicocele

Each testicle is drained by a network of small veins called the pampiniform plexus, which join into a longer vein, the testicular vein (also called the gonadal vein). That vein has one-way valves that keep blood moving up toward the heart. When the valves fail, blood flows backward and pools. The veins in the scrotum swell and twist, just like varicose veins in the legs. That swelling is a varicocele.

Varicoceles are common, found in about 15 in 100 men. They usually appear during puberty and are much more common on the left, because the left testicular vein is longer and joins the kidney vein at a right angle, which makes backward flow easier.

The pooled blood keeps the testicle warmer than it should be. Sperm production needs a slightly cooler temperature, which is one reason varicoceles can affect fertility.

Most varicoceles cause no symptoms and are found during a routine exam or a fertility workup.

Varicoceles are found in about 35 to 40 in 100 men being evaluated for infertility. They can lower sperm count, movement and shape. Not every man with a varicocele has fertility problems, though. Many father children without any treatment.

A doctor can often feel a varicocele while you stand, especially when you bear down as if having a bowel movement (the Valsalva maneuver). Varicoceles are graded from small (felt only when bearing down) to large (visible through the skin).

A scrotal ultrasound with Doppler confirms the diagnosis. It measures the size of the veins, shows backward flow and compares the size of the testicles. It is painless and uses no radiation. If fertility is a concern, a semen analysis checks sperm count, movement and shape, and some men have hormone blood tests.

On Doppler ultrasound, the veins above the testicle look like a cluster of dark tubes. When you bear down, color flashes inside them as blood flows backward, confirming reflux.

For mild ache, supportive underwear or an athletic supporter and anti-inflammatory pain relievers such as ibuprofen can help. If fertility is the goal, we coordinate with your urologist or fertility specialist, and your partner's evaluation matters too.

Both main treatments close the faulty veins so blood drains through healthy ones. Success rates for pain relief and fertility improvement are broadly similar. The main differences are how they are done and the recovery.

Both options have a small chance, roughly 5 to 10 in 100, that the varicocele comes back or is not fully fixed. If one method does not work, the other can usually be tried. Learn more about how embolization is done on our varicocele embolization page.

Many men come to me after being told surgery is their only option. I explain that embolization reaches the same veins from the inside, through a small nick in the skin, and most men are back at their desk in a day or two. When I study the venogram, I look for every small side branch that could let the varicocele come back, because closing those is what makes the result last.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

1. First 1–2 days
   Mild ache in the scrotum or back is common after either treatment. Rest and use over-the-counter pain relievers.
2. About a week
   Most men return to exercise and heavy lifting after about a week following embolization, and after a few weeks following surgery.
3. Weeks
   Scrotal ache usually improves within weeks. The veins may take months to shrink fully.
4. 3–6 months
   A repeat semen analysis, if fertility was the reason. Sperm take about 2 to 3 months to develop, so changes are not seen sooner.

Varicocele treatment does not affect erections or ejaculation. It is not a form of birth control.