How a Varicocele Can Affect Your Fertility

A varicocele is an enlargement of veins in the scrotum. It’s similar to varicose veins, which some people develop in their legs. 

People who develop a varicocele often say it feels like a “bag of worms” when they touch it. While this can sound alarming, varicoceles are harmless. Most people don’t need any treatment for their varicocele. But there’s one exception to that rule — when a varicocele affects fertility. 

Here’s what you need to know about how a varicocele can affect your fertility and your options for treatment. 

What causes a varicocele? 

A varicocele is a collection of swollen veins around the testicle. 

Veins are the blood vessels that carry blood back to the heart. Unlike arteries, veins have thin walls and rely on valves to control the direction of blood flow. Veins become swollen if they encounter pressure as they try to pump blood back to the heart. Varicose veins form when this happens in the veins in the legs. When it happens to the veins in the scrotum, it causes a varicocele. 

Varicoceles usually develop during puberty. Experts aren’t exactly sure why some people develop them and others do not. 

Are varicoceles common? 

Yes, varicoceles are very common. About 15% of males have a varicocele. 

Varicoceles are much more likely to develop around the left testicle. That’s because the veins around the left testicle take a different path back to the heart than the veins around the right testicle. In this path, they encounter more pressure than the veins on the right side.

Among people who develop varicoceles, about ⅓ get them around both testicles. But it’s unusual to have a varicocele only around the right testicle. 

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What are the symptoms of scrotum varicose veins?

Most people don’t have any symptoms from a varicocele. But some people can experience a dull ache or heavy feeling in their groin when they’re standing. This discomfort usually gets better if you lie down.  

Some varicoceles are smaller than others. If you have a small varicocele you might only notice some mild fullness of one side of your scrotum. If you have a larger varicocele, you might notice a very big difference in size between the two halves of your scrotum. You’ll also be able to feel the enlarged veins, which are soft and squishy. 

You might notice that your varicocele changes in size when you change position. In general, a varicocele increases in size when you stand up, and it gets smaller when you lie flat. 

A varicocele shouldn’t cause severe pain. If you have sudden, intense pain around your tesicle, don’t assume it’s because of your varicocele. Sudden, severe testicle pain can be a sign of  testicular torsion. Testicular torsion is a medical emergency that needs urgent treatment. 

How do you diagnose a varicocele?

A healthcare provider can diagnose your varicocele by talking to you, looking at your scrotum, and feeling the swollen area.  

Here’s what to expect during a physical exam to check for varicoceles:

• Your provider will examine your scrotum while you’re standing and then again while you lie flat. 

• They may ask you to “bear down,” as if you’re having a bowel movement. This will help them feel for any swelling in the veins. 

• Your provider will palpate your testicles. If there is a varicocele only on one side, the testicle on that side may be smaller. 

If you only have a varicocele on your right side, you may need an ultrasound CT scan. This will make sure nothing is blocking blood flow around your scrotum. 

Do varicoceles cause infertility? 

Varicoceles can affect male fertility. But the relationship between varicoceles and fertility isn’t cut and dry. Not everyone with a varicocele has fertility problems. In fact, only about 1 in 4 people with a varicocele have low fertility.

But if you’re experiencing infertility, a varicocele might be part of the problem. Large studies show that 40% of people with primary male infertility also have a varicocele. And about 75% of people with secondary male infertility have a varicocele. 

Varicoceles contain larger volumes of blood than usually sit around the testicle. Since blood is warm, the theory is that having a varicocele raises the temperature around the testicle. Higher temperatures make it harder for the testicle to make sperm. 

Varicoceles may also slow down testicle growth. Smaller testicles can’t produce as much sperm, which can also decrease fertility. 

How do you treat varicoceles? 

Not all varicoceles need treatment. Experts only recommend treatment if the varicocele is causing:

• Pain

• Infertility

• Change in testicle growth

Treatment options include:

• Varicocelectomy: This surgical procedure ties off the vein that comes from the testicle. This blocks off the vein so blood can’t collect there anymore. A surgeon has to do this procedure and you may need general anesthesia. 

• Embolization: This interventional radiology procedure blocks off the vein. A provider threads a catheter tube through the large vein in your leg and into your scrotum. Then they deliver a small coil or liquid medication through the tube into the vein, sealing it off from the inside out. For this procedure, most people only need sedation and local anesthesia.

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Written by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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