Varicocele is a dilation of the veins above the testicles.

A varicocele is not always a problematic condition, and is present in about 15% of men.  A varicocele may need treatment, however, if it is causing male infertility (low sperm count or oligospermia) or scrotal pain.

A varicocele is most often located on the left side.  It is caused when the veins that drain blood from the testicle into the abdomen become dilated.  This happens because the valves that prevent backwards flow of blood in the veins don’t work properly.  As a result, there is a backward pooling of blood in the veins back toward the testicles, causing dilation of the veins.  The varicocele impairs sperm production by creating an environment around the testicle that is less than optimal for sperm production.

Often, a varicocele does not cause any symptoms and many men may not know they have one.  Occasionally varicocele may cause a dull ache or heaviness in the scrotum. Discomfort may be made worse by prolonged standing or activity and may seem worse at the end of the day.  If you have these symptoms you doctor must examine you to exclude causes other than varicocele.
Men with varicocele are also more likely to have a low sperm count or problems with fertility.  40% of men seeking evaluation for male infertility have a varicocele.  The good news is that varicocele repair can often improve sperm count and fertility.

Often a physical exam is all that is required to diagnose a varicocele.  Sometimes an ultrasound may be done for further investigation, but varicoceles that are only noted on ultrasound but cannot be felt on exam usually do not need treatment.  If you are having fertility problems, a semen analysis will be ordered to check the sperm count.

Treatment options
Adults who do not have pain or male infertility likely do not need any treatment other than observation.  Children with varicoceles may need treatment if there is decreased testicular growth on the affected side.

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