Overview

A varicocele is dilation of the pampiniform venous plexus — essentially varicose veins in the scrotum. Pooling of warm blood raises scrotal temperature, harming sperm production. Varicoceles affect ~15% of all men but 35–40% of infertile men, making them the most common identifiable and correctable cause of male infertility.

Symptoms

• Most cause no symptoms
• Dull ache or heaviness in the affected testicle — worse with standing or exercise
• Visible or palpable "bag of worms" above the testicle
• Testicular atrophy (shrinkage) in younger men
• Abnormal semen analysis or infertility

Causes

• Venous valve incompetence — blood pools and flows backwards
• Left-sided predominance — due to the angle of left testicular vein drainage
• Most develop during adolescence
• A new right-sided varicocele in an older man warrants investigation for retroperitoneal mass

Complications

• Impaired sperm production — reduced count, motility, and morphology
• Progressive testicular damage if untreated in adolescents
• Testosterone deficiency in large varicoceles

Diagnosis

• Physical examination with Valsalva manoeuvre
• Scrotal Doppler ultrasound — gold standard; confirms retrograde flow
• Semen analysis and hormone profile

Treatment

• Microsurgical varicocelectomy — gold standard; highest success, lowest recurrence
• Laparoscopic varicocelectomy — minimally invasive alternative
• Percutaneous embolisation — radiological; local anaesthesia
• IVF with ICSI — when female factors also present or severe parameters unlikely to normalise

Concerned about a varicocele? Book a consultation today