Symptoms of a varicocele can include aching, swelling, or shrinkage in the testicles, as well as fertility issues. While many cases don’t require treatment, non-surgical options like embolization can relieve discomfort and restore healthy blood flow.Varicocele is one of the most common vascular conditions affecting the male reproductive system–and the most common reversible cause of male infertility. Although many men have no symptoms, this condition can become bothersome and affect your reproductive health over time.Keep reading to explore:
- The symptoms of varicocele
- What you can do about it without going under the knife
- When surgery might be your best option
What is a varicocele?
Varicocele is a common condition in which the veins inside the scrotum become enlarged, much like varicose veins in the legs. It happens when the valves in these veins fail, allowing blood to pool, causing the veins to stretch and twist. Varicoceles typically develop on the left side due to anatomical differences in how the left testicular vein drains into the kidney vein.While often harmless, varicoceles are a leading reversible cause of reduced sperm quality. They affect about:
- 10-15% of men in the general population
- Up to 35-40% of those evaluated for infertility
Symptoms of varicocele
Most varicoceles don’t cause noticeable symptoms. In fact, many men only discover they have one during a routine exam or fertility evaluation. Those who do experience symptoms may notice:
- A dull ache or feeling of heaviness in the scrotum
- Visible or palpable enlarged veins (the hallmark varicocele “bag of worms”)
- Swelling or shrinkage on one side of the scrotum
- Discomfort that worsens with standing, exercise, or throughout the day
- Fertility challenges or abnormal semen analysis
It’s important to see your healthcare provider if you notice:
- New swelling
- Persistent pain
- Any changes in testicular size or texture
What causes a varicocele?
Experts don’t fully understand why varicoceles develop, but they recognize several contributing factors:
Faulty vein valves
The veins in the scrotum contain small valves that help keep blood flowing in the right direction. When those valves don’t work properly–or are missing–blood can flow backward and start pooling, which causes the veins around the testicle to swell.
Increased venous pressure and left-sided anatomy
The vein on the left side of the scrotum takes a longer, steeper path to drain into the kidney vein. That setup increases pressure and makes the left side more likely to develop a varicocele. In some cases, nearby arteries can press on the kidney vein, which raises pressure even more.
Backup from nearby veins
As pressure builds, other small veins around the testicle–such as the cremasteric and deferential veins–can also stretch and swell. These collateral veins try to assist with drainage but often perpetuate high pressure and blood pooling instead.Over time, this chronic pressure leads to more vein dilation and can trigger the previously mentioned symptoms.
How doctors diagnose varicoceles
Most diagnoses start with a physical exam. A doctor may feel enlarged veins–especially when you stand or perform what’s called the Valsalva maneuver. This involves bearing down as if exhaling forcefully. In many cases, doctors then use an ultrasound to:
- Confirm the diagnosis
- Measure vein diameter
- Evaluate blood flow
Varicocele treatment without surgery
Embolization
If you’re seeking an effective treatment that doesn’t involve open surgery, varicocele embolization is a less invasive option with a speedy recovery.During this image-guided procedure, a doctor inserts a small catheter into a vein–usually through the groin or neck–and guides it to the faulty vein. The doctor then places tiny coils or a sclerosing agent (a substance that irritates, collapses, and seals the vein lining) inside the vein to block abnormal blood flow and reroute circulation through healthy vessels.Some benefits of embolization include:
- No general anesthesia
- No incisions or stitches
- Outpatient procedure
- Minimal downtime–most men return to normal activities in 1-2 days
- High success rate (about 90-97%), which is comparable to open surgery
Natural ways to manage symptoms
If you’re not ready for embolization, a few natural strategies may help ease discomfort and support your reproductive health. These options won’t fix the varicocele but can improve symptoms:
- Supportive underwear: Tight briefs or a jockstrap can reduce heaviness and strain, especially during long periods of standing or physical activity.
- Ice therapy: Applying a wrapped ice pack for up to 15 minutes may ease pain or swelling.
- Horse chestnut extract: This supplement may help with vein-related discomfort, although most studies have examined its effects on varicose veins in the legs.
- Antioxidants (vitamins C and E, coenzyme Q10, L-carnitine): These supplements may improve sperm quality in some men.
When surgery may be necessary
Many men choose non-surgical options like embolization, but some situations call for surgery. In these cases, surgeons often perform microsurgical subinguinal varicocelectomy, a procedure that uses magnification to tie off faulty veins while preserving nearby arteries and lymphatic vessels.Doctors might recommend surgery when:
- Pain is severe or persistent
- The testicle has shrunk or shows signs of growth arrest, especially in adolescents
- Semen analysis shows abnormalities and you’re trying to conceive
- Embolization isn’t an option due to anatomical complications or prior treatment
In situations like these, surgery can resolve the issue more reliably, since the surgeon can directly see and repair all the veins causing the varicocele.
Final thoughts
Varicoceles are common and often symptom-free, but they can lead to pain, swelling, or fertility issues. Minimally invasive treatments like embolization, along with symptom-relief strategies and–when necessary–open surgery give you a range of options for improving your reproductive health.If you’re experiencing symptoms or have concerns about fertility, talk with your healthcare provider to determine the best next step.
References:Varicocele – StatPearls – NCBI BookshelfVaricocele and Testicular Pain: A Review – PMCVaricocele surgery or embolization: Which is better? – PMCRecurrent Varicoceles: Causes and Treatment Using Angiography and Magnification Assisted Subinguinal Varicocelectomy – PMCPathophysiology and treatment options of varicocele: An overview – Su – 2021 – Andrologia – Wiley Online LibraryMolecular mechanisms involved in varicocele-associated infertility – PMCThe Varicocele: Clinical Presentation, Evaluation, and Surgical Management – PMCA fifteen-year retrospective analysis of varicocele embolization: evaluating success, recurrence rates and embolic agents
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