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by Lyons S
(Varicose Veins—Scrotum)

Definition

A varicocele is swelling in the scrotum associated with the backup of blood in the testicular veins.

Varicocele
testicle varices
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Causes

A varicocele is caused by a problem in the main vein of the testicle. Blood normally leaves the testicle through this vein. When blood flow through the vein is slowed, the blood backs up into smaller veins. This causes bulging of blood vessels in the scrotum.

Risk Factors

Varicoceles typically develop in men 15-25 years old. There are no specific factors that increase your risk of getting varicoceles.

Symptoms

Varicoceles may not always have symptoms. When they do appear, symptoms may include:

  • Feeling of heaviness or soreness in the scrotum.
  • Feeling enlarged, or twisted veins in the scrotum. They can feel like worms or spaghetti.
  • Veins typically change in size and are larger when standing or straining.

Varicoceles may cause the testicle to be smaller. They may also contribute to male infertility by reducing sperm quality and/or quantity.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Varicoceles are usually easily diagnosed by exam. Your doctor may recommend tests to confirm varicoceles or rule out other conditions.

Tests may include:

  • Ultrasound
  • Semen tests
  • Blood tests to look for testicular injury in adolescents

Treatment

Treatment is not required for all varicoceles. Treatment is generally recommended if a varicocele is causing infertility, change in testicle size, or pain.

Options may include one or more of the following:

Home Care

To help ease discomfort, your doctor may recommend over-the-counter pain relievers. In some cases, you may need to wear supportive or athletic underwear.

Surgery

Surgical treatment options include:

  • Open surgery—the veins are surgically cut and tied off through an incision in the groin
  • Catheter ablation—heat is applied through a catheter to destroy the vein
  • Catheter embolization—a substance is placed in the vein(s) to block it
  • Laparoscopic varicocelectomy —involves the use of a thin, lighted tube inserted into the abdomen to view the vessels in the body as they lead to the testicle and block them

Prevention

There are no current guidelines to prevent varicoceles.

RESOURCES

Reproductive Facts—American Society for Reproductive Medicine  http://www.reproductivefacts.org 

Urology Care Foundation  http://urologyhealth.org 

CANADIAN RESOURCES

Health Canada  https://www.canada.ca 

The College of Family Physicians of Canada  http://www.cfpc.ca 

References

Khera M, Lipshultz LI. Evolving approach to the varicocele. Urol Clin North Am. 2008;35(2):183-189.

Robinson SP, Hampton LJ, Koo HP. Treatment strategy for the adolescent varicocele. Urol Clin North Am. 2010;37(2):269-278.

Practice Committee of the American Society for Reproductive Medicine. Report on vericocele and infertility: A committee opinion. Fertil Steril. 2014;102(6):1556-1560.

Varicocele in adults. EBSCO DynaMed website. Available at:  http://www.dynamed.com/topics/dmp~AN~T909425/Varicocele-in-adults  . Accessed January 29, 2021.

Varicocele. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/teens/varicocele.html. Accessed January 29, 2021.

Varicoceles. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/varicoceles?article=116. Accessed January 29, 2021.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37(3):613-629.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
  • Review Date: 03/2020
  • Update Date: 01/29/2021