Varicocele: The "Bag of Worms" Doctors Check During Fertility Workups

A varicocele is a swelling of the veins inside the scrotum, often described by doctors as feeling like a "bag of worms." It's a common finding during fertility evaluations and can sometimes affect sperm quality. This guide explains what varicoceles are, highlights varicocele symptoms, and outlines diagnosis and treatment in clear, straightforward language. If you ever feel unsure, always speak to a doctor.

What Is a Varicocele?

A varicocele develops when valves inside the veins in the spermatic cord (which holds up each testicle) don't work properly. Instead of flowing toward the heart, blood pools in these veins, causing them to enlarge. This is similar to varicose veins you may see in the legs.

Key points:

• It most often appears on the left side of the scrotum.
• It can occur in males of any age but is most common in teens and young adults.
• Many men with varicoceles experience no discomfort.

Why "Bag of Worms"?

Doctors call it a "bag of worms" because:

• On physical exam, the enlarged veins feel soft and squiggly under the skin.
• This texture is distinct from a solid lump, which could indicate other issues.

Understanding this unique feel helps doctors differentiate a varicocele from other scrotal concerns.

How Common Are Varicoceles?

• Up to 15% of all adult men have a varicocele.
• As many as 35–40% of men evaluated for infertility are found to have one.
• Many never know they have one because they don't cause obvious symptoms.

varicocele symptoms

Most varicoceles are painless, but some men notice:

• A dull, aching pain or discomfort in the scrotum, especially after standing or physical activity.
• A feeling of heaviness or dragging in the testicle.
• Visible or palpable enlarged veins above the testicle.
• Slight shrinkage of the affected testicle (atrophy).
• Occasionally, an increase in scrotal temperature, which may affect sperm production.

If you're experiencing any of these signs and want to better understand what might be causing them, you can use Ubie's free AI symptom checker to get personalized insights in just a few minutes.

How Do Doctors Diagnose Varicocele?

Diagnosis usually involves:

1. Physical Examination

   • The doctor inspects and feels the scrotum while you're standing and lying down.
   • You may be asked to take a deep breath and hold it ("Valsalva maneuver") to make the veins more prominent.

2. Scrotal Ultrasound

   • Uses sound waves to visualize blood flow and vein size.
   • Confirms the presence and severity of a varicocele.

3. Semen Analysis (if fertility is a concern)

   • Evaluates sperm count, movement, and shape.
   • Helps determine if the varicocele is affecting sperm quality.

Varicoceles and Fertility

Varicoceles are the most common correctable cause of male infertility. They may:

• Increase scrotal temperature, which can impair sperm production.
• Cause blood to flow backward toward the testicle, leading to oxidative stress on sperm-forming cells.
• Lead to decreased sperm count, poor motility (movement), and abnormal shape.

However, not every varicocele harms fertility. Many men with varicoceles father children without treatment. The decision to treat often depends on:

• Abnormal semen analysis.
• Pain or discomfort.
• Testicular atrophy (shrinkage).

Treatment Options

If a varicocele is causing pain or impacting fertility, doctors may recommend:

• Observation (Watchful Waiting)

• Suitable if symptoms are mild or fertility isn't affected.
• Regular check-ups monitor any changes in size or discomfort.

• Varicocelectomy (Surgical Repair)

• Performed through a small incision in the groin or abdomen.
• Ties off the enlarged veins so blood reroutes through normal veins.
• Outpatient procedure, with most men returning to normal activities in a week or two.

• Percutaneous Embolization

• A minimally invasive, radiology-guided procedure.
• A coil or special solution blocks the enlarged veins.
• Short recovery time and less post-operative discomfort for some.

All treatments aim to:

• Reduce pain.
• Improve sperm quality.
• Prevent further testicular damage.

Potential Benefits and Risks

Benefits:

• Relief of discomfort.
• Possible improvement in semen parameters.
• Prevention of testicular shrinkage.

Risks (low but important to consider):

• Hydrocele (fluid build-up around the testicle).
• Recurrence of the varicocele.
• Injury to nearby structures (rare).

When to Seek Medical Advice

Although varicoceles are usually not emergencies, see a doctor if you notice:

• Sudden or severe scrotal pain.
• Rapid swelling or redness of the scrotum.
• A new, hard lump in the testicle.
• Any sign of infection (fever, chills, pain).

Always speak to a healthcare professional about anything that could be serious or life-threatening. Early evaluation ensures you get the right care without unnecessary worry.

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Remember, knowledge and timely action are your best tools. If you have any concerns or persistent symptoms, make an appointment with your doctor to discuss the next steps. And if you'd like an initial assessment of your symptoms before your visit, try Ubie's free AI-powered symptom checker for helpful guidance in minutes. Good health starts with awareness and early care.