Introduction

Varicoceles are varicose veins in the scrotum (the sac that holds the testicles).

They form in the veins that run along the spermatic cord. Blood from the testicles flows back into the body through those veins. Like varicose veins in the legs, varicoceles form when blood builds up in the veins and they become permanently enlarged.

Symptoms

Varicoceles don't normally cause any symptoms. But they can sometimes lead to swelling, a feeling of tightness or a dull, “dragging” pain in the testicle.

Causes and risk factors

There are probably a number of reasons why veins in the scrotum sometimes become enlarged, including anatomical reasons: For instance, if the testicular vein joins the renal (kidney) vein at an almost right angle in the pelvis, the blood in the veins flows more slowly. This can cause the blood to build up in the scrotum, resulting in a varicocele. When the curve where the two veins meet is too tight, it's usually on the left side. That's why varicoceles are more common on the left side of the scrotum. Other possible causes of varicoceles include weak walls of the vein at birth and – like varicose veins elsewhere in the body – weak valves inside the vein.

In rare cases, varicoceles are caused by a tumor in the pelvis or abdomen. Tumors can push against veins and prevent the blood from flowing properly.

Prevalence

Varicoceles are common, particularly in teenage boys and men between the ages of 15 and 25. Experts believe that 5 to 15% of all men have a varicocele. About 90% of them have it on the left side of their scrotum.

Effects

It is thought that varicoceles can reduce fertility. Varicoceles are more common in men who have fertility problems. According to estimates, about 25 to 37% of all men who have poor sperm quality also have a varicocele. But varicoceles don’t always affect fertility: Many men with varicoceles don't have fertility problems.

Diagnosis

Doctors can diagnose larger varicoceles just by looking at them or feeling them. They sometimes have to apply pressure to the belly so that the varicose vein fills with blood and can be felt.

Smaller varicoceles can only be found using ultrasound (sonography).

Treatment

Varicoceles usually don't need to be treated. Men who have fertility problems are sometimes offered treatment to try to increase their chances of having children.

The treatment involves “shutting down” the affected vein so that the blood can flow through healthy, nearby veins instead. This can be done by blocking the vein using minimally-invasive procedures (embolization) or by performing varicose vein surgery.

The vein can be blocked with medication or special small metal coils that are released using a catheter inserted into the vein. The medication or coils cause a blood clot to form in the varicose vein, closing it off. The medical term for this is embolization. A different form of embolization – known as sclerotherapy – involves using a solution that damages the walls of the vein, causing them to scar and stick together. In surgery, the swollen vein and the surrounding smaller veins are either cut or tied off. This is either done through "open" surgery using a larger cut – for instance in the scrotum or in the groin – or through minimally invasive "keyhole" surgery. In keyhole surgery, the surgical instruments are inserted through small cuts.

The possible complications of treatment include bleeding, wound infections, injury to nerves or swelling in the scrotum (a hydrocele).

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Sources

• Gasser T. Basiswissen Urologie. Berlin: Springer; 2015.
• Hautmann R, Huland H. Urologie. Berlin: Springer; 2013.
• Kroese AC, de Lange NM, Collins J, Evers JL. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev 2012; (10): CD000479. [PubMed: 23076888]
• Pschyrembel. Klinisches Wörterbuch. Berlin: De Gruyter; 2017.
• Silay MS, Hoen L, Quadackaers J, Undre S, Bogaert G, Dogan HS et al. Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. Eur Urol 2019; 75(3): 448-461. [PubMed: 30316583]
• Wang H, Ji ZG. Microsurgery Versus Laparoscopic Surgery for Varicocele: A Meta-Analysis and Systematic Review of Randomized Controlled Trials. J Invest Surg 2018 [Epub ahead of print]: 1-9.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

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