What is a varicocele?

A varicocele is when the veins in your scrotum become enlarged (larger than normal) or swollen. Varicocele is sometimes spelled 'varicocoele'.

Some people say a varicocele looks or feels like a 'bag of worms'. It usually occurs only on the left side of your scrotum, but it can happen on both sides. It's rare to have a varicocele only on the right side of your scrotum.

A varicocele usually develops after the age of puberty and becomes more common as you get older.

Roughly 15 in every 100 people will have a varicocele during their lifetime.

What are the symptoms of a varicocele?

The most common symptom of a varicocele is a lump in your scrotum. This can usually be felt or seen when you're standing up.

If the varicocele is small, you might only notice it if you are standing up and you:

• cough
• strain, as though you're trying to push out a bowel motion (poo)

Most people don't feel any pain from a varicocele. However, you might feel a dull ache or 'heavy' sensation in your scrotum.

Some people find a varicocele can be uncomfortable after exercising or standing for a long time.

Symptoms usually improve when you lie down.

Ask your doctor how to check your testicles for any changes. You can also watch this video from Healthy Male.

What causes a varicocele?

A varicocele is caused by a problem with the veins that drain blood from your testicles. Veins contain valves that help keep the blood flowing towards your heart. If these valves are not working properly, blood can leak back down into the vein causing it to become larger than normal.

You are more likely to develop a varicocele if:

• you have varicose veins in your legs
• someone else in your family has had a varicocele
• you have a body mass index (BMI) of less than 25

Having a mass in your abdomen can cause a varicocele, but this is rare.

When should I see my doctor?

You should see your doctor if you:

• have pain in your scrotum
• notice a lump in your scrotum
• notice a change in the shape of your testicles
• have an ache in your testicles that does not go away

If you have a varicocele and you're worried about the possibility of fertility problems, it's a good idea to discuss it with your doctor.

How is a varicocele diagnosed?

Your doctor will usually be able to diagnose a varicocele by examining your scrotum and testicles. Your doctor may recommend further tests, such as:

• an ultrasound scan of your scrotum
• a semen analysis (to assess your fertility)
• a testosterone blood test
  

How is a varicocele treated?

Many people with a varicocele have no symptoms or complications, so do not need any treatment. Your doctor may recommend follow-up appointments each year to check your varicocele.

Your doctor may suggest treatment if your varicocele:

• is painful or uncomfortable
• is making one testicle smaller than the other
• might be causing fertility problems

There are several treatments for a varicocele. When deciding which treatment is right for you your doctor will consider your:

• age
• fertility
• treatment preference

Inguinal ligation

This is a surgical procedure that ties off the swollen veins to help the blood flow return to normal. It's usually done under general anaesthetic. Most people go home the day of surgery and will fully recover after 1 week.

Embolisation

This is a keyhole surgery that uses tiny metal coils or chemicals to block the enlarged veins. These are inserted through a tiny cut made in the skin, often in your groin. It's usually done under local anaesthetic and most people recover after a few days.

What are the complications of varicocele?

A varicocele can cause complications, including:

• one testicle growing slower than the other, especially in teenagers
• hypogonadism (reduced testosterone production from the affected testicle)
• problems with fertility

Can varicoceles be prevented?

There is no known way of preventing varicoceles.

By regularly checking your testicles, you can pick up any changes early. This can help prevent some conditions from becoming worse.

Your doctor can show you how to do this if you are unsure.

Resources and support

Read more about varicoceles and checking your testicles at the Healthy Male website.

The Department of Health, Disability and Ageing website has information on male reproductive health.

The Fertility Society of Australia and New Zealand has more information about the causes and treatment of male infertility.

Languages other than English

If English is not your preferred language:

• Sexual Health Victoria has information on male sexual health in multiple languages
• Health Translations has information on male reproductive health

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.