A varicocele is an enlarged vein in the scrotum.

While sometimes only a cosmetic concern, enlarged veins is this area can also contribute to a low sperm count and issues with sperm quality and fertility. Varicoceles often develop over time and typically do not require treatment. They’re also easy to diagnose during a normal physical exam.

It’s when enlarged scrotal veins are contributing to other problems that treatment usually becomes necessary.


Signs & Symptoms

Some men have varicoceles with no symptoms or discomfort. If there are symptoms, you may experience sharp or dull pain in the scrotum that’s more noticeable during physical exertion or when moving or standing. You might feel relief when lying down or resting while on your back. Enlarged veins in the scrotum may also contribute to:

  • Difficulty with pregnancy attempts
  • Testicle shrinkage (testicular atrophy)
  • Swollen or irregularly shaped testicles

What Causes Varicoceles?

Blood is carried to and from testicles via the spermatic cord. It’s believed varicoceles develop when valves within veins in the scrotum affect the normal flow of blood. The backed up blood causes veins to become swollen or enlarged. If the blockage is severe enough, it may damage the testicle the affected vein is linked to or contribute to fertility problems.

Diagnosis & Treatment

A urologist usually performs a physical exam to determine if varicoceles are present. If enlarged veins aren’t large enough to be seen, they may be felt through the scrotum. If it’s suspected that you may have a small varicocele contributing to issues with sperm quality, you may be asked to do the Valsalva maneuver, a breathing technique that sometimes make it easier to detect abnormalities. A scrotal ultrasound may be performed to make a positive diagnosis and rule out other possible issues, such as presence of a tumor.

If a varicocele isn’t causing any discomfort or fertility issues, periodic observation during routine physical exams may be all that’s necessary. When symptoms are present and it’s believed that varicoceles are affecting sperm quality or quantity, varicocele repair may be recommended. During the procedure, each affected vein is blocked and blood flow is redirected to healthy veins. Surgical repair options include:

  • Traditional open surgery
  • Laparoscopic surgery involving a small incision in the abdomen to repair the varicocele
  • Percutaneous embolization that involves the release of coils or a solution to block affected testicular veins by creating scar tissue
  • Microsurgical subinguinal varicocelectomy performed with special surgical instruments

You can’t do anything to prevent varicoceles from developing. However, you can be observant during routine self-exams and let your doctor know if you have concerns about enlarged scrotal veins. If issues with sperm quality or count are suspected, you may be referred to a urologist for further evaluation that may include a sperm analysis and diagnostic testing to check testicle size and determine if there are other abnormalities requiring attention.