What is Varicocele

Varicocele is a swelling of veins in the scrotum. The scrotum is the sac that contains the testicles. Varicoceles can occur on either side of the scrotum, but they are more common on the left side. They occur most often in teenage boys and young men.

In most cases, varicoceles are not a serious problem. They are usually small and painless and do not require treatment. Tests may be done to confirm the diagnosis. Treatment may be needed if:

• A varicocele is large, causes a lot of pain, or causes pain when exercising.
• Varicoceles are found on both sides of the scrotum.
• A varicocele causes a decrease in the size of the testicle in a growing adolescent.
• The person has fertility problems.

What are the causes?

This condition is the result of valves in the veins not working properly. Valves in the veins help to return blood from the scrotum and testicles to the heart. If these valves do not work well, blood flows backward and backs up into the veins, which causes the veins to swell. This is similar to what happens when varicose veins form in the leg.

What are the signs or symptoms?

Most varicoceles do not cause any symptoms. If symptoms do occur, they may include:

• Swelling on one side of the scrotum. The swelling may be more obvious when you are standing up.
• A lumpy feeling in the scrotum.
• A heavy feeling on one side of the scrotum.
• A dull ache in the scrotum, especially after exercise or prolonged standing or sitting.
• Slower growth or reduced size of the testicle on the side of the varicocele (in young males).
• Problems with fertility. This can occur if the testicle does not grow normally.

How is this diagnosed?

This condition may be diagnosed with a physical exam. You may also have an imaging test called an ultrasound to confirm the diagnosis and to help rule out other causes of the swelling.

How is this treated?

Treatment is usually not needed for this condition. If you have any pain, your health care provider may prescribe or recommend medicine to help relieve it. You may need regular exams so your health care provider can monitor the varicocele to ensure that it does not cause problems. When further treatment is needed, it may involve one of these options:

• Varicocelectomy. This is a surgery in which the swollen veins are tied off so that the flow of blood goes to other veins instead.
• Embolization. In this procedure, a small tube (catheter) is used to place metal coils or other blocking items in the veins. This cuts off the blood flow to the swollen veins.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Wear supportive underwear.
• Use an athletic supporter when participating in sports activities.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your pain is increasing.
• You have redness in the affected area.
• Your testicle becomes enlarged, swollen, or painful.
• You have swelling that does not decrease when you are lying down.
• One of your testicles is smaller than the other.

Summary

• Varicocele is a condition in which the veins in the scrotum are swollen or enlarged.
• In most cases, varicoceles do not require treatment.
• Treatment may be needed if you have pain, have problems with infertility, or have a smaller testicle associated with the varicocele.
• In some cases, the condition may be treated with a procedure to cut off the flow of blood to the swollen veins.