AsiaNews Iran's Health and Beauty Desk — A varicocele is an abnormal enlargement of the network of veins that drains a testicle. It is similar in principle to a varicose vein in the leg and is most often found on the left because blood follows a different anatomical route on that side.
Many varicoceles are discovered during a routine examination and never require treatment. Others cause a dull ache, visible or palpable enlarged veins, a difference in testicle size or difficulty conceiving. A new lump, swelling or pain should not be self-diagnosed because several other conditions can produce similar symptoms.
Common signs and symptoms
- A dull or aching discomfort that becomes more noticeable after standing or late in the day.
- Relief when lying down.
- A soft mass above the testicle, sometimes described as feeling like a “bag of worms”.
- One testicle appearing smaller than the other.
- Abnormal semen findings or infertility in some patients.
Why varicoceles develop
The exact cause is not always clear. One explanation is that valves inside the veins do not keep blood moving efficiently, allowing it to pool and widen the vessels. The anatomy of the left testicular vein makes left-sided varicocele much more common.
Varicoceles are associated with reduced sperm production or quality in some men, possibly through changes in testicular temperature and blood flow. The important qualification is that not every varicocele causes infertility, and finding one does not automatically explain every abnormal semen result.
How diagnosis is made
A clinician usually begins with a physical examination while the patient is standing and may ask him to briefly bear down. Ultrasound can be used when the examination is uncertain, symptoms are unusual or another cause must be excluded. Men being assessed for fertility may also have semen analysis and, when appropriate, hormone testing.
| Situation |
Typical approach |
| No symptoms and normal testicular development |
Observation and follow-up |
| Palpable varicocele, infertility and abnormal semen parameters |
A specialist may consider repair |
| Persistent pain after other causes excluded |
Individual discussion of benefits and risks |
| Adolescent with reduced testicle growth |
Paediatric urology assessment |
Treatment: observation, surgery or embolisation
Supportive underwear and ordinary pain relief may help mild discomfort, but medication does not remove the enlarged veins. Definitive treatment closes or redirects blood flow away from the affected veins. This can be done through surgical varicocelectomy or, in selected patients, radiological embolisation.
The American Urological Association and the American Society for Reproductive Medicine advise clinicians to consider surgery for men trying to conceive when a varicocele is palpable, infertility is present and semen parameters are abnormal. Repair based only on an ultrasound finding that cannot be felt on examination is generally not recommended.
Treatment is not automatic. The decision depends on symptoms, fertility goals, examination findings, age and the balance of likely benefit against risk.
When urgent care is needed
Sudden severe testicular pain, rapidly increasing swelling, nausea, vomiting, fever or a hard new lump requires prompt medical attention. Testicular torsion and other urgent conditions can resemble less serious problems and may threaten the testicle if treatment is delayed.
Frequently asked questions
Can a varicocele cause infertility?
It can contribute in some men, but many people with a varicocele remain fertile.
Does every varicocele need surgery?
No. Symptom-free cases with normal development or fertility may only need observation.
Can exercise make it worse?
Standing or exertion can make aching more noticeable, but individual advice should come from a clinician who has examined the patient.
This article is general information and not a diagnosis. If you have pain, swelling, a lump or fertility concerns, consult a qualified clinician. Share your questions in the comments below this article with readers of AsiaNews Iran.