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A varicocele is enlarged veins in the scrotum, the loose pouch of skin that contains the testicles. This is a surgically correctable condition. Similar to varicose veins in the legs, varicoceles are caused when valves controlling blood flow along the testicular cord fail to operate normally, causing a backflow of blood and swollen veins. This causes elevated temperatures that are thought to interfere with normal sperm production and inhibit the production of testosterone.

Affecting about 20% of men aged 15 to 25, varicoceles usually develop above the left testicle and occasionally in both testicles.

elderly man in green shirt with buttons

Symptoms of Varicocele

Most men with varicoceles often have no symptoms and most varicoceles often go unnoticed until a physical exam or a fertility work-up. Symptoms may include:

  • Aching or feeling of heaviness in the testicle, especially after standing for a long time
  • Atrophy (shrinkage) of the testicle
  • Visible or palpable enlarged veins that may look like “a bag of worms”
  • Infertility
  • A mass in the scrotum


In most cases, your doctor can detect the varicocele through a physical exam. He may ask you to take a deep breath and bear down (called the valsalva maneuver) to improve detection. If the exam is not conclusive, he may order an ultrasound of the testicles to provide a painless view of their internal structures.

Varicocele Repair: Treatment Options

Most varicoceles don’t require treatment. If you experience pain or atrophy of the testicle or if you are infertile, you may wish to undergo one of several treatments:

Microsurgical Varicocelectomy

Microsurgical varicocelectomy is usually considered to be the best treatment for relieving pain caused by the varicocele, and also to improve semen parameters, testicular function, and pregnancy rates in couples with male factor infertility associated with varicocele. A microsurgical varicocelectomy is performed on an outpatient basis under general anesthesia. A small incision (2cm) is made just above the pubic bone. The veins are then isolated and tied off so that the varicose veins are permanently closed and blood flow is redirected to the unaffected veins.


This procedure is performed less often because it can present more risks. Laparoscopy may have the advantage of identifying veins higher up, where your surgeon likely will need to tie off fewer veins. The urologist makes several tiny incisions in your abdomen, using tiny instruments under general anesthesia to repair the varicocele.

Percutaneous Embolization

Percutaneous embolization is usually performed when other approaches have failed. A radiologist passes a tube through a vein in your groin to the affected area and releases a coil or balloon to block off the affected vein.

You cannot expect to restore fertility for at least three to four months after the procedure, as sperm take about eight weeks to generate. These procedures do not guarantee fertility; talk with your doctor to fully understand your potential risks and benefits.

Varicoceles and Male Infertility

Varicoceles are a common cause of male infertility and the most common cause of sperm production problems that can lead to male infertility. Some 40% of infertile men have a varicocele and about 80% of those who have already fathered a child but are now infertile, have one. Doctors suspect that varicoceles can cause infertility in some men by raising the temperature in the testes, which may damage or destroy sperm.

Fortunately, the specialists at Urology Associates have a deep understanding of varicoceles and the tie-in with male infertility and have several treatment options available to men.