Regular exams can detect varicoceles early.

Similar to varicose veins commonly seen in legs or on thighs, a varicocele is a condition characterized by enlarged veins within the pouch that holds the testicles (the scrotum). Sometimes described as having the appearance of a bag of worms, the condition isn’t always just a cosmetic concern.

  • Varicoceles may affect sperm count and contribute to issues with male infertility and the overall quality of sperm.
  • Easy to diagnose, it’s a problem that sometimes resolves itself. However, treatment may be necessary if the enlarged veins are contributing to other issues.

What Causes Varicoceles?

It’s not known what causes varicoceles. One possibility is that valves within veins in the tube-like spermatic cord, which transports blood to and from the testicles, become backed up or blocked. As a result, the veins widen and varicoceles develop.

Possible Symptoms

Varicoceles are more likely to develop during puberty, often on the left side because of a testicular vein that’s located there. Most men have no symptoms associated with varicoceles. If discomfort is experienced, it may be sharp or dull pain felt in the testicles. In some cases, physical exertion or standing for long periods of time may trigger noticeable pain. Other times, discomfort may go away when lying down. Possible complications include:

  • Swollen testicles, often on the left side
  • Shrinkage of the testicles (testicular atrophy)
  • Infertility

How Are Enlarged Testicle Veins Diagnosed?

Diagnosis of varicoceles typically starts with a physical exam. It may be possible to feel the affected testicle to get an idea of whether or not there are enlarged veins inside. If the abnormal testicular veins are smaller, the Valsalva maneuver may be done during the examination process. It’s a diagnostic breathing technique where a deep breath is taken while standing. If a positive diagnosis can’t be made with a physical exam alone, image testing that may include a scrotal ultrasound might be done to view the soft tissues and veins within the testicles.

What Are Treatment Options?

If treatment is necessary, varicocele repair surgery that involves sealing the testicular vein that’s blocked may be recommended. Blood flow is then redirected to a healthy vein. For men with related fertility issues, surgery may improve the response to treatments as sperm characteristics and levels return to normal. For most patients, surgery presents few risks. Specific surgical options include:

  • Traditional open surgery: The vein is reached with a standard incision made in the groin.
  • Microsurgical subinguinal varicocelectomy: Open surgery performed with a special surgical microscope.
  • Laparoscopic vein repair: A minimally invasive procedure performed with a small incision made in the lower abdomen.
  • Percutaneous embolization: A less common procedure involving the insertion of coils or the use of a special solution that purposely creates scar tissue to repair the damaged vein.

There are no common preventative measures that may prevent varicoceles from developing. What men can do is perform regular self-exams so the abnormal veins can be discovered early. If there are no significant issues with discomfort or the size and shape of the testicles, periodic observation during regular doctor visits may be all that’s necessary. Men with varicoceles may be advised to have a semen analysis done to determine if the condition has affected sperm quality and quantity.