Varicocele: Symptoms, Diagnosis & When Surgery Is Needed

A varicocele is an enlargement of the veins inside the scrotum — essentially a varicose vein, but in a part of the body most men never think to check. It's common: roughly 15% of all men have one, and it shows up in closer to 40% of men being evaluated for infertility. Most varicoceles cause no problems at all. Some quietly affect fertility for years before anyone notices. The trick is knowing which kind you have.

What a Varicocele Feels Like

Many men have no symptoms whatsoever — a varicocele is often found incidentally during a physical exam or a fertility workup, not because anything hurt. When symptoms do show up, they tend to be:

• A dull, aching discomfort that builds over the course of a day, especially after standing or physical activity, and eases when lying down
• A feeling of heaviness or dragging in the scrotum
• A visible or palpable cluster of veins, sometimes described as feeling like a 'bag of worms'
• Visible shrinkage of the testicle on the affected side over time, in more advanced cases

Varicoceles occur on the left side in the large majority of cases, due to the anatomy of how the left testicular vein drains — this is normal and doesn't necessarily mean anything more serious is going on.

Varicocele vs. Hydrocele — They're Not the Same Thing

These two get confused often because both cause scrotal swelling. A hydrocele is a fluid-filled sac and generally feels smooth and fluid-like; a varicocele is a cluster of dilated veins and has that characteristic 'bag of worms' texture. A hydrocele also typically transilluminates (lights up when a light is held behind it) while a varicocele does not. Getting the two mixed up is common enough that it's a large part of why an in-person exam matters more than trying to self-diagnose from a symptom list.

How We Diagnose It

Diagnosis starts with a physical exam, often including a Valsalva maneuver (bearing down, similar to a mild strain) which makes a varicocele more prominent and easier to feel. If a varicocele is suspected but not obvious on exam, or if we need to grade its severity, we follow up with a scrotal ultrasound — the same imaging that frequently surfaces a varicocele incidentally during a broader fertility workup.

When Surgery Is Actually Needed

This is the part most men searching for information on this topic actually want answered, and the honest answer is: not always. A varicocele that isn't causing pain, isn't affecting fertility, and isn't causing visible testicular shrinkage can often just be monitored. Surgical correction (varicocelectomy) is generally recommended when:

• There's persistent pain or discomfort that affects daily activity
• Semen analysis shows abnormal count, motility, or morphology and the varicocele is a likely contributing factor
• There's measurable testicular size discrepancy suggesting the varicocele is affecting testicular function over time
• You and your partner are actively trying to conceive and male factors are part of the picture

What the Procedure Involves

Varicocelectomy is a microsurgical procedure that ties off the affected veins while preserving the artery and lymphatic vessels that need to stay intact. It's performed on an outpatient basis. Most men take a few days off from strenuous activity and see gradual improvement in semen parameters over the following 3-6 months, since sperm production takes about that long to reflect a physical change.

Varicocelectomy is available at our Memorial location.