The scrotum is a skin-covered sac that holds your testicles. It also contains the arteries and veins that deliver blood to the reproductive glands. A vein abnormality in the scrotum may result in a varicocele.A varicocele is an enlargement of the veins within the scrotum. These veins are called the pampiniform plexus.

A varicocele only occurs in the scrotum and is very similar to varicose veins that can occur in the leg.A varicocele can result in decreased sperm production and quality, which in some cases can lead to infertility. It can also shrink the testicles.

Varicoceles are common. They can be found in 15 percent of the adult male population and approximately 35 percent of men with primary infertility. They’re more common in males aged 15 to 25.

Varicoceles generally form during puberty and are more commonly found on the left side of your scrotum. The anatomy of the right and left side of your scrotum isn’t the same. Varicoceles can exist on both sides, but it’s extremely rare. Not all varicoceles affect sperm production.

You may have no symptoms associated with a varicocele. But you might experience:

A spermatic cord holds up each testicle. The cords also contain the veins, arteries, and nerves that support these glands. In healthy veins inside the scrotum, one-way valves move the blood from the testicles to the scrotum, which sends it back to the heart.

Sometimes the blood doesn’t move through the veins like it should and begins to pool in the vein, causing it to enlarge. A varicocele develops slowly over time.

There are no established risk factors for developing a varicocele, and the exact cause is unclear.

There are several ways that your doctor may diagnose a varicocele, including:

  • Physical exam. Because a varicocele can’t always be felt or seen when you’re lying down, your doctor will most likely examine your testicles while you’re standing up and lying down.
  • Valsalva maneuver. This technique is often used to diagnose smaller varicoceles. The Valsalva maneuver typically requires you to stand, take a deep breath, hold it, and bear down while the doctor examines your scrotum.
  • Scrotal ultrasound. In some cases, a scrotal ultrasound may be necessary. This helps measure the spermatic veins and allows your doctor to get a detailed, accurate picture of the condition.

Once the varicocele is diagnosed, your doctor will classify it with one of three clinical grades. They’re labeled grades 1 through 3, according to the size of the lump in your testicle. Grade 1 is the smallest, and grade 3 is the largest.

The size doesn’t necessarily affect the overall treatment because you may not require any. Treatment options are based on the degree of discomfort or infertility issues you have.

This condition can affect fertility. Varicocele is present in 35 to 44 percent of men with primary infertility and 45 to 81 percent of men with secondary infertility.

Primary infertility is generally used to refer to a couple that hasn’t conceived a child after at least 1 year of trying. Secondary infertilitydescribes couples that have conceived at least once but aren’t able to again.

It’s not always necessary to treat a varicocele. But you may want to consider treatment if the varicocele:

You may also want to consider treatment if you’re thinking about assisted reproductive techniques.

This condition can cause problems with testicular functioning in some people. The earlier you start treatment, the better your chances of improving sperm production.

Wearing tight underwear or a jockstrap can sometimes provide you with support that alleviates pain or discomfort. Additional treatment, like varicocelectomy and varicocele embolization, might be necessary if your symptoms get worse.


A varicocelectomy is a same-day surgery that’s performed in a hospital. A urologist will go in through your abdomen or pelvis and clamp or tie off the abnormal veins. Blood can then flow around the abnormal veins to the normal ones. Talk with your doctor about how to prepare for the surgery and what to expect after the operation.

Varicocele embolization

Varicocele embolization is a less invasive, same-day procedure. A small catheter is inserted into a groin or neck vein. A coil is then placed into the catheter and into the varicocele. This blocks blood from getting to the abnormal veins.

Varicoceles often cause no signs or symptoms and don’t usually require treatment. In fact, they’re often diagnosed during a routine physical exam or fertility assessment.

But if the varicocele is large, your testicles are too small, your sperm count is low, or you and your partner are having difficulty getting pregnant, your doctor may recommend treatment.

You should also talk with your doctor if you notice any of the following symptoms:

  • dull, aching, or throbbing pain in the scrotum, testicle, or groin
  • swelling of the scrotum
  • shrinkage of the affected testicle
  • a lump or bulge on the scrotum
  • changes in the size of one or both testicles
  • impaired fertility

Infertility is a common complication of a varicocele. Talk with your doctor about seeing a reproductive specialist if you and your partner are having problems getting pregnant.

Surgery is only necessary if the varicocele is causing you pain or if you’re trying to have a child. Talk with your doctor about which treatment is right for you.