A varicocele (pronounced VAR-ih-koe-seel) is an enlargement of the veins within the scrotum, the loose bag of skin that holds your testicles. It is very similar to a varicose vein you might see in a person’s leg.
About 15% of men have a varicocele, and they most commonly develop during puberty. While they are usually harmless, they are a leading cause of low sperm production and decreased sperm quality, which can cause infertility.
## Symptoms
Most men with a varicocele have no symptoms at all. However, when symptoms do occur, they may include:
A “Bag of Worms” Feeling: You may feel or see twisted, swollen veins in the scrotum.
Dull Aching Pain: A heavy or aching sensation that often gets worse with standing or physical exertion and is relieved when lying down.
Testicular Atrophy: The affected testicle may appear smaller than the other.
Fertility Issues: Difficulty conceiving a child due to reduced sperm count or quality.
## Causes & Anatomy
The exact cause is not always clear, but most experts believe they form when the valves inside the veins of the spermatic cord (which carry blood away from the testicles) don’t work properly.
Blood Pooling: If the valves fail, blood pools in the veins instead of flowing back to the heart, causing them to stretch and widen.
Temperature: This pooling of blood raises the temperature of the testicles, which can damage sperm and interfere with testosterone production.
Left Side Prevalence: About 85-90% of varicoceles occur on the left side because of the way the left testicular vein is positioned relative to the kidney.
## Grading System
Doctors categorize varicoceles based on their size and visibility: | Grade | Description | | :— | :— | | Grade 0 (Subclinical) | Not visible or felt; only detected via ultrasound. | | Grade 1 (Small) | Only felt when performing the “Valsalva maneuver” (bearing down). | | Grade 2 (Medium) | Can be felt by the doctor without bearing down, but not visible. | | Grade 3 (Large) | Easily visible through the skin (the “bag of worms” look). |
## Treatment Options
Treatment is usually only necessary if the varicocele causes pain, leads to infertility, or causes the testicle to shrink.
Conservative Care: Wearing snug-fitting underwear or a jockstrap to provide support and taking over-the-counter pain relievers (like ibuprofen).
Varicocelectomy (Surgery): A urologist ties off the affected vein to redirect blood flow through healthy veins. This is usually an outpatient procedure done microsurgically or laparoscopically.
Varicocele Embolization: A minimally invasive procedure where a radiologist inserts a tiny coil or fluid into the vein to block it, effectively “turning off” the varicocele without surgery.