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Diagnosis / Scrotal Varicocele / Male Infertility

A varicocele is the abnormal enlargement of the veins in the male scrotum, similar to varicose veins that occur in other parts of the body. The scrotum is the sac that contains the testicles, as well as the arteries and veins responsible for transporting blood to and from the reproductive glands, known as the pampiniform plexus.

Varicoceles are only found in the scrotum, and are a fairly common occurrence, especially in men between the ages of 15 and 25. In fact, they are found in 15 percent of adults, and 20 percent of adolescents. They typically form during puberty, and while they can form on either side, they are more frequently found on the left side of the scrotum.

A varicocele is a common cause of infertility in men, as it causes both low sperm production and decreased quality of sperm. It can also keep the testicles from developing normally, or cause them to shrink. Most of the time, varicoceles take time to develop, and are easy to diagnose. In many cases, treatment isn’t necessary, but if it is, there are several treatment options available.


As with varicose veins, varicoceles are often overlooked because there are no noticeable symptoms. However, if you do experience symptoms, they may include:

  • Swelling in the scrotum
  • A lump in one of your testicles
  • Visible veins in the scrotum that are twisted or enlarged

The most common symptom associated with a varicocele is pain. It may vary from dull to sharp, and increase over the course of the day, especially if you are standing or involved in physical activity for a long period of time. If you do experience any of the above symptoms, you should schedule an appointment with your doctor, as there are several medical conditions that can cause pain or swelling in the scrotum, some which require treatment immediately.

Cause of Varicoceles

Each testicle is held up by a spermatic cord, which also contains the nerves, arteries and veins that support the testicles. A varicocele forms when the valve that keeps blood in the veins flowing one-way back towards the heart is weakened and begins to allow blood to backflow, known as reflux. When the blood backflows, it pools in the vein and causes the vein to become engorged, resulting in ropy, twisted veins that can negatively affect fertility and signal more serious health concerns. The exact cause of a varicocele isn’t known, and there are no significant risk factors associated with their development.


Besides causing discomfort, varicoceles can result in:

  • Atrophy or shrinkage – when the varicocele damages the myriad of tubules found in the testicles that are responsible for producing sperm, the affected testicle will soften and shrink. The exact cause of the shrinkage is unknown, but may be a result of the increased pressure in the veins, as well as damage from toxins in the pooled blood.
  • Infertility – Varicoceles are found in up to 44 percent of men with primary infertility (someone who hasn’t conceived after trying for at least one year) and in up to 81 percent of men with secondary infertility (someone who has conceived once, but hasn’t been able to again). Varicoceles may raise the temperature in or around your testicle, keeping it too high and affecting the formation of sperm, as well as function and motility.

Treating a varicocele isn’t always necessary, but if you suffer from any of the above issues, you may want to consider treatment, especially if you are trying to conceive or may plan to in the future.

Diagnosis and Treatment

Diagnosis of a varicocele is usually done during a physical exam by your doctor. If the varicocele isn’t able to be seen or felt, your doctor may perform an ultrasound to obtain a more accurate diagnosis of the condition. Once diagnosed, your treatment options will depend on the severity of your pain, atrophy or infertility issues.

To alleviate pain or discomfort, it may be recommended that you wear a jock strap or tight underwear to provide extra support. Other treatment options include:

  • Varicocelectomy – this is an outpatient procedure in which the abnormal veins are tied off, causing blood to flow around the enlarged veins to the normal ones.
  • Varicocele embolization – this procedure involves a catheter inserted into the varicocele. A small coil is placed in the catheter, blocking blood from flowing toward the affected veins and allowing the blood to be rerouted to healthy veins.

If you have been diagnosed with a varicocele, call IVC today at 503-612-0498 to schedule an appointment with one of our team of experienced and professional interventional radiologists. You can also read our Men’s Health Brochure.

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Jason Bauer, MD RVT
Michael Pfister, MD RVT

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