Do You Have a Varicocele? Symptoms, Fertility Risks, and Your Next Steps

A varicocele is a common condition that affects the veins inside the scrotum (the sac that holds the testicles). It happens when these veins become enlarged, similar to varicose veins in the legs.

Many men with a varicocele don't realize they have one. Others notice discomfort, swelling, or fertility problems. Understanding varicocele and infertility signs can help you decide when to monitor symptoms and when to seek medical care.

This guide explains what a varicocele is, the symptoms to watch for, how it can affect fertility, and what you can do next.

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What Is a Varicocele?

Inside the scrotum is a network of veins called the pampiniform plexus. These veins help regulate the temperature of the testicles, which is important for sperm production.

A varicocele forms when:

• Veins become enlarged due to poor blood flow.
• Valves inside the veins do not work properly.
• Blood pools instead of circulating efficiently.

Varicoceles are common. Medical studies estimate they affect:

• About 15% of all men
• Up to 40% of men evaluated for infertility

They most often occur on the left side, due to differences in how veins drain on that side of the body.

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Common Symptoms of Varicocele

Not everyone with a varicocele has symptoms. In fact, many cases are discovered during fertility testing or a routine physical exam.

When symptoms do occur, they may include:

• A dull, aching pain in the scrotum
• A feeling of heaviness or dragging in the testicle
• Visible or enlarged veins that may look like a "bag of worms"
• Scrotal swelling
• Pain that worsens after standing for long periods or physical activity
• Relief when lying down

The discomfort is usually mild but can become more noticeable over time.

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Varicocele and Infertility Signs

One of the most important concerns with varicoceles is their link to fertility problems.

How Can a Varicocele Affect Fertility?

The testicles need to stay slightly cooler than normal body temperature to produce healthy sperm. A varicocele can:

• Raise testicular temperature
• Reduce oxygen supply to testicular tissue
• Increase oxidative stress (damage from unstable molecules)
• Affect hormone production, including testosterone

Over time, this may impair sperm production and function.

Signs of Varicocele-Related Infertility

You usually cannot "feel" infertility. However, possible varicocele and infertility signs include:

• Difficulty conceiving after 12 months of regular, unprotected intercourse
• Abnormal semen analysis results (low sperm count, poor motility, abnormal shape)
• Shrinking (atrophy) of one testicle, especially in adolescents
• Low testosterone symptoms such as reduced energy or libido

It's important to note that not every varicocele causes infertility. Many men with varicoceles have normal sperm counts and father children without difficulty.

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When Should You Be Concerned?

A varicocele is usually not life-threatening. However, you should pay closer attention if you experience:

• Persistent or worsening scrotal pain
• Noticeable testicular shrinkage
• Fertility challenges
• A sudden new mass in the scrotum
• Severe pain that comes on quickly

Sudden, intense scrotal pain is not typical for a simple varicocele and requires immediate medical evaluation to rule out emergencies such as testicular torsion.

If you're experiencing symptoms and want to better understand whether they align with a varicocele, you can use a free Varicocele symptom checker to evaluate your condition and prepare informed questions for your healthcare provider.

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How Is a Varicocele Diagnosed?

A doctor—usually a primary care provider or urologist—can diagnose a varicocele through:

1. Physical Exam

• Examining the scrotum while you are standing
• Asking you to bear down (Valsalva maneuver) to make the veins more visible

2. Scrotal Ultrasound

• Uses sound waves to confirm enlarged veins
• Measures blood flow and vein size
• Helps rule out other causes of swelling

3. Semen Analysis (if fertility is a concern)

• Evaluates sperm count, movement, and shape
• Often repeated to confirm results

Early diagnosis is especially important for adolescents, as untreated varicoceles may affect testicular development.

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Do All Varicoceles Need Treatment?

No. Treatment depends on symptoms and fertility goals.

You may not need treatment if:

• You have no pain
• Your fertility is not affected
• Testicular size is normal
• Hormone levels are stable

In these cases, monitoring may be enough.

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Treatment Options

If a varicocele causes pain, infertility, or testicular shrinkage, treatment may be recommended.

1. Conservative Management

For mild discomfort:

• Wear supportive underwear
• Avoid prolonged standing
• Use over-the-counter pain relief as advised by a doctor

2. Surgical Repair (Varicocelectomy)

This is a common and generally safe procedure where:

• The enlarged veins are tied off to redirect blood flow
• It is usually done as outpatient surgery
• Recovery typically takes 1–2 weeks

Studies show that surgery can improve semen parameters in many men, though pregnancy outcomes vary.

3. Percutaneous Embolization

A minimally invasive procedure where:

• A radiologist blocks off affected veins using coils or a special solution
• No large incision is required
• Recovery is often quicker than surgery

Your doctor will help determine which option is appropriate based on your symptoms, age, and fertility goals.

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What About Testosterone?

Some research suggests varicoceles may lower testosterone levels in certain men. After treatment, testosterone levels may improve in some cases.

If you experience:

• Low energy
• Reduced sex drive
• Mood changes
• Decreased muscle mass

Your doctor may recommend blood tests to check hormone levels.

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Can You Prevent a Varicocele?

There is no proven way to prevent a varicocele. They are largely due to vein anatomy and valve function.

However, maintaining overall health supports reproductive function:

• Maintain a healthy weight
• Avoid tobacco use
• Limit excessive heat exposure (e.g., hot tubs)
• Manage chronic conditions like diabetes

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Your Next Steps

If you suspect a varicocele, consider the following:

• Monitor symptoms (pain, swelling, changes in testicle size)
• Seek medical advice if fertility is a goal and conception is delayed
• Get a professional exam for persistent discomfort
• Use a free online Varicocele symptom assessment tool to help identify your symptoms and prepare for a more productive doctor's visit

Most importantly, speak to a doctor about any symptoms that are severe, persistent, or concerning. Sudden scrotal pain, a rapidly growing mass, or systemic symptoms (such as fever) require prompt medical evaluation.

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The Bottom Line

A varicocele is common and often harmless. However, understanding varicocele and infertility signs is important—especially if you are trying to conceive or experiencing discomfort.

Key points to remember:

• Many varicoceles cause no symptoms.
• Some can affect sperm quality and testosterone levels.
• Treatment is available and often effective when needed.
• Sudden or severe symptoms require urgent medical attention.

If you're unsure whether your symptoms point to a varicocele, take the next step by checking your symptoms and speaking with a qualified healthcare provider. Early evaluation can give you clarity, peace of mind, and the right plan moving forward.