Varicocele: Causes, Symptoms, Diagnosis & Treatment

Varicocele is a common condition in which the veins inside the scrotum become enlarged. These veins normally carry blood away from the testicles. When the valves inside these veins do not work properly, blood can collect around the testicle and cause the veins to enlarge.

Many men with varicocele do not experience any symptoms and may discover the condition during a routine examination or while undergoing an evaluation for infertility. However, some men may develop scrotal discomfort, testicular size changes, or problems with sperm production.

Varicocele does not always require treatment. Our doctors usually recommend management based on symptoms, testicular health, semen parameters, fertility goals, and other clinical findings.

At Jyoti Hospital, Gurugram, our urology team can evaluate varicocele and determine whether observation, further testing, or treatment is appropriate for your individual condition.

What Is a Varicocele?

A varicocele develops when the veins that drain blood from the testicle become enlarged and prominent.

You can think of these veins as a drainage network around the testicle. Normally, valves help blood move upward toward the heart. If these valves do not function properly, blood can flow backward and collect in the veins.

This process can cause the veins to become enlarged.

Varicoceles most commonly develop on the left side, although they can also occur on the right side or affect both sides.

Our doctors describe a varicocele as:

Clinical varicocele: A doctor can feel or see the enlarged veins during a physical examination.
Subclinical varicocele: Imaging may detect the abnormal veins, but a doctor cannot feel them during examination.

A clinical varicocele becomes particularly important when a man also has infertility or abnormal semen parameters.

Is Varicocele Common?

Yes. Varicocele is relatively common among men, and many men never need treatment.

The condition becomes more clinically important when it causes:

Persistent scrotal discomfort
Testicular growth or size differences
Abnormal semen parameters
Difficulty conceiving
Problems with testicular function

Because many varicoceles cause no symptoms, our doctors do not automatically recommend surgery after discovering one.

Instead, they assess the overall clinical picture.

What Causes Varicocele?

The exact mechanism involves impaired drainage of blood through the testicular veins.

Several anatomical factors can contribute to this problem. The left testicular vein follows a different drainage pathway from the right, which helps explain why varicoceles occur more frequently on the left side.

A varicocele may become more noticeable when a person stands for a long time or strains because these activities can increase pressure within the veins.

However, everyday activities do not necessarily cause a varicocele.

What Are the Symptoms of Varicocele?

Many men have no symptoms at all. When symptoms occur, they may include:

1. Dull or Aching Scrotal Pain

A varicocele can cause a dull, dragging or aching sensation in the scrotum.

The discomfort may become more noticeable:

After prolonged standing
After physical activity
Toward the end of the day
During periods of increased abdominal pressure

The pain may improve when you lie down.

However, scrotal pain can have many causes. Therefore, you should not assume that every scrotal pain comes from a varicocele.

2. Enlarged or Prominent Veins

A larger varicocele may produce visible or palpable veins inside the scrotum.

Some people describe the appearance as resembling a “bag of worms.”

3. Testicular Size Difference

A significant varicocele may affect testicular development or function.

Our doctors may notice that one testicle appears smaller than the other, particularly in adolescents.

4. Fertility Problems

Some men with varicocele may have abnormal semen parameters.

Our doctors may identify:

Reduced sperm concentration
Reduced sperm motility
Abnormal sperm morphology
Reduced overall semen quality

However, having a varicocele does not automatically mean that a man is infertile.

Our doctors need to evaluate the couple and the man’s complete fertility profile before linking the varicocele to infertility.

How Can Varicocele Affect Fertility?

Our doctors continue to study the exact mechanisms through which varicocele can affect sperm production. Several factors may contribute such as:

Increased Testicular Temperature
- The testicles normally function at a temperature slightly lower than the body’s core temperature. Abnormal blood pooling around the testicle may interfere with this temperature regulation.
Oxidative Stress
- Varicocele may increase oxidative stress, which can damage sperm cells and affect sperm function.
Changes in Testicular Function
- Some men with clinically significant varicocele may develop changes in sperm production or testicular function.
Hormonal and Cellular Changes
- A varicocele may also affect the local environment of the testicle and the cells involved in sperm production.

However, not every man with a varicocele develops fertility problems.

The WHO’s 2025 infertility guideline recognises male factors as an important component of infertility evaluation and recommends evidence-based assessment and treatment rather than treating one abnormal finding in isolation.

Does Varicocele Always Cause Infertility?

No. This is one of the most important points to understand.

A man can have a varicocele and still have:

Normal sperm production
Normal semen parameters
Normal testosterone levels
Normal sexual function
Normal fertility

Therefore, our doctors do not recommend surgery simply because an ultrasound shows a varicocele.

Instead, our urologist considers factors such as:

Whether the varicocele is clinically palpable
Whether the couple has infertility
Semen analysis results
Testicular size and function
Pain or other symptoms
The man’s fertility goals
The fertility status of the female partner

Varicocele and Male Infertility

Varicocele is one of the potentially treatable conditions that our doctors may identify during a male infertility evaluation.

However, infertility usually involves multiple factors.

For this reason, our doctors evaluate both partners rather than assuming that a varicocele alone explains the difficulty in conceiving.

A semen analysis usually forms an important part of the male evaluation. If the first test shows abnormalities, our urologist may recommend repeat testing and additional investigations depending on the results.

At Jyoti Hospital, Gurugram, our urology team can combine the clinical examination with semen analysis and other appropriate investigations to determine whether the varicocele may be contributing to fertility problems.

Types and Grades of Varicocele

Our doctors may classify varicoceles according to how easily they can detect them during physical examination.

A commonly used clinical grading system includes:

Grade 1

Our doctor can feel the varicocele only when you perform a Valsalva manoeuvre, which involves bearing down or straining.

Grade 2

Our doctor can feel the varicocele while you are standing, even without straining.

Grade 3

The enlarged veins are visible as well as palpable.

Our doctors may also describe a varicocele as subclinical when imaging detects it but physical examination does not.

The grade alone does not determine whether you need treatment.

Your symptoms, testicular findings, fertility goals and semen parameters matter more when our doctor makes a treatment decision.

How Is Varicocele Diagnosed?

Our urologist usually starts with a detailed medical history and physical examination.

1. Physical Examination

Our doctor examines the scrotum while you are standing and may ask you to perform a Valsalva manoeuvre.

Our doctor checks for:

Enlarged veins
Testicular size
Testicular position
Tenderness
Differences between the two testicles

The examination can often identify a clinical varicocele.

2. Scrotal Ultrasound

Our doctors may recommend a scrotal ultrasound with Doppler when the diagnosis remains uncertain or when they need additional information.

Doppler ultrasound can assess blood flow and help identify abnormal venous reflux.

It can also help our doctors evaluate other causes of scrotal swelling or pain.

However, finding a small varicocele on ultrasound does not automatically mean that you need treatment.

3. Semen Analysis

If fertility is a concern, our doctor may recommend semen analysis.

The test evaluates important sperm characteristics, including:

Sperm concentration
Total sperm number
Sperm motility
Sperm morphology

Our doctors may repeat the test when the initial results are abnormal.

4. Hormonal Testing

Our doctors may recommend blood tests for hormones such as:

Testosterone
Follicle-stimulating hormone (FSH)
Luteinising hormone (LH)

The exact tests depend on your symptoms, examination and semen results.

5. Other Fertility Tests

Some men may require additional investigations depending on their medical history and semen results.

These may include:

Genetic testing
Advanced sperm testing
Additional hormonal evaluation
Evaluation for other causes of infertility

Our urologist should select these tests based on your individual findings rather than ordering every test routinely.

Treatment Options for Varicocele

The appropriate treatment depends on the reason for treatment. Our doctors do not recommend surgery for every varicocele.

If the varicocele causes no significant symptoms and does not affect testicular development or fertility, our urologist may recommend observation.

When treatment becomes necessary, the main options include varicocele repair through surgery or percutaneous embolization.

1. Observation

Many men with varicocele do not require an immediate procedure.

Our doctor may recommend monitoring when:

You have no significant symptoms
Your testicular development remains normal
Your semen parameters remain satisfactory
You are not experiencing infertility
The varicocele does not appear to affect testicular function

Our urologist may monitor the condition through physical examinations, testicular measurements and semen analysis when appropriate.

Importantly, our doctors generally do not recommend surgery simply because an ultrasound detects a small or non-palpable varicocele. The AUA/ASRM guideline specifically recommends against varicocelectomy for non-palpable varicoceles detected only through imaging.

2. Conservative Treatment for Varicocele-Related Pain

If a mild varicocele causes discomfort but does not create a strong indication for surgery, our doctor may initially recommend conservative management.

This may include:

Supportive underwear
Avoiding activities that clearly worsen the pain
Appropriate pain medication when medically suitable
Monitoring symptoms

Persistent, worsening or severe scrotal pain requires medical evaluation because several other conditions can cause similar symptoms.

3. Varicocele Repair Surgery

When a varicocele requires surgical treatment, the surgeon closes the abnormal veins so that blood can drain through healthier veins.

Several surgical approaches exist, including:

Subinguinal microsurgical varicocele repair
Inguinal varicocelectomy
Open retroperitoneal or high ligation
Laparoscopic varicocelectomy

Among these techniques, subinguinal microsurgical varicocele repair is widely regarded as one of the most effective approaches when performed by an experienced microsurgeon, particularly because it allows the surgeon to identify individual veins while preserving the testicular artery and lymphatic vessels.

Subinguinal Microsurgical Varicocele Repair

Subinguinal microsurgical varicocele repair is a minimally invasive surgical technique used to treat varicocele.

The surgeon makes a small incision just below the groin crease and brings the spermatic cord into view. Using an operating microscope or high-power magnification, the surgeon carefully identifies the abnormal veins.

The surgeon then ligates or divides the veins responsible for the varicocele while preserving important structures, particularly:

Testicular arteries
Lymphatic vessels
The vas deferens
Healthy veins needed for testicular drainage

The procedure allows the surgeon to identify small venous branches that may be difficult to see with conventional techniques.

Why use a microscope?

The veins and arteries around the spermatic cord can be very small and closely positioned.

Microsurgical magnification gives the surgeon a much clearer view of these structures.

This allows the surgeon to:

Identify more venous branches
Preserve the testicular artery
Preserve lymphatic vessels
Reduce the likelihood of leaving behind abnormal veins
Reduce the risk of hydrocele
Reduce recurrence risk

The EAU paediatric urology guideline also recognises the advantages of inguinal/subinguinal microsurgical approaches and recommends lymphatic-sparing techniques to reduce hydrocele formation.

Why Is Subinguinal Microsurgical Varicocele Repair Considered Better?

Subinguinal microsurgical repair has several important advantages over conventional open and laparoscopic techniques.

However, “better” does not mean that every patient needs this approach. Our urologist select the technique based on your anatomy, symptoms, fertility goals, previous treatment and surgeon expertise.

1. Better Identification of Small Veins

The microscope provides significant magnification.

This allows the surgeon to identify smaller veins that may otherwise remain untreated.

Treating these veins can help reduce the risk of persistent or recurrent varicocele.

A 2025 network meta-analysis found that microsurgical subinguinal varicocelectomy ranked highly for reducing postoperative recurrence and showed favourable results for several other outcomes. The authors nevertheless noted that surgical selection should consider patient needs and surgeon experience.

2. Lower Recurrence Rate

One of the important advantages of microsurgical repair is the ability to identify and treat multiple abnormal venous branches.

Studies comparing surgical techniques have generally reported lower recurrence rates with microsurgical approaches than with conventional open or laparoscopic surgery.

For example, one randomized comparison reported recurrence in only 1 patient in the microsurgical group compared with 7 after open surgery and 9 after laparoscopic surgery.

Another randomized study involving 298 infertile patients reported recurrence rates of approximately:

2.6% with subinguinal microsurgery
11% with open inguinal surgery
17% with laparoscopy

The microsurgical group also had no postoperative hydroceles in that study.

These results support the use of microsurgical techniques when the patient has an appropriate indication for repair.

3. Lower Risk of Hydrocele

A hydrocele is a collection of fluid around the testicle.

It can occur when the lymphatic vessels are damaged during varicocele surgery.

Microsurgical repair allows the surgeon to identify and preserve these small lymphatic vessels.

Studies and meta-analyses have consistently associated microsurgical approaches with lower hydrocele rates than several conventional approaches.

Lymphatic-sparing microsurgical repair therefore offers an important advantage, particularly when the goal involves preserving normal testicular anatomy.

4. Better Preservation of the Testicular Artery

The testicular artery supplies blood to the testicle.

Because the artery can be very small, it can be difficult to identify during non-microsurgical procedures.

Microsurgical magnification allows the surgeon to carefully distinguish the artery from the surrounding veins.

The surgeon can therefore preserve the artery while treating the abnormal veins.

This artery-sparing approach helps protect testicular blood supply.

5. Precise, Vein-by-Vein Repair

A major advantage of the subinguinal microsurgical approach is its precision.

Instead of treating a larger group of vessels without direct magnification, the surgeon can identify individual veins and preserve structures that should remain intact.

This precision becomes particularly important because the spermatic cord contains:

Multiple veins
Testicular artery
Lymphatic vessels
Vas deferens
Other small structures

Microsurgical magnification helps the surgeon distinguish these structures during the procedure.

Subinguinal Microsurgical Repair vs Other Varicocele Treatments

Feature	Subinguinal Microsurgical Repair	Conventional Open Repair	Laparoscopic Repair	Embolization
Magnification	High-power microscope	Usually no microscope	Camera/laparoscope	Imaging guidance
Small venous branches	Excellent identification	More difficult	Good but different anatomy	Depends on venous anatomy
Testicular artery preservation	Excellent with microsurgical technique	More difficult	Possible, but approach differs	Not directly surgically manipulated
Lymphatic preservation	Excellent with lymphatic-sparing technique	More difficult	Possible	No surgical lymphatic dissection
Hydrocele risk	Generally low	Higher than microsurgical in many studies	Higher than microsurgical in several studies	Generally low
Recurrence risk	Generally lowest among commonly used surgical approaches	Higher than microsurgery in many studies	Higher than microsurgery in many studies	Can be higher and depends on anatomy/technical success
Abdominal entry	No	No	Yes	No surgical abdominal entry
Incision	Small subinguinal incision	Groin/inguinal incision	Several small abdominal incisions	Catheter puncture
General anaesthesia	May not always be required, depending on centre and patient	Depends on technique	Usually required	Usually sedation/local anaesthesia
Fertility-focused use	Strong evidence and commonly preferred	Effective but less precise	Effective but more invasive	Alternative for selected patients
Main limitation	Requires microsurgical expertise and may take longer	Less precise vessel identification	Abdominal access and higher recurrence/hydrocele in comparative studies	Technical failure or recurrence can occur

Evidence from randomized studies and meta-analyses generally favours microsurgical approaches for lower recurrence and hydrocele rates, although pregnancy outcomes do not always differ significantly between every technique.

When Is Subinguinal Microsurgical Repair Preferred?

Your urologist may consider this approach particularly when:

You have a palpable clinical varicocele
You are trying to conceive
Your semen analysis shows abnormalities
The varicocele may contribute to impaired fertility
You have testicular size or function concerns
You have persistent symptoms that justify intervention
You want a fertility-focused surgical approach
You have not previously undergone extensive surgery in the same area

The AUA/ASRM guideline recommends considering surgical varicocelectomy in men attempting to conceive who have palpable varicocele, infertility and abnormal semen parameters, while treatment decisions require individual assessment.

5. Percutaneous Varicocele Embolization

Embolization provides a non-surgical alternative.

During the procedure, an interventional radiologist guides a catheter into the affected vein and blocks abnormal blood flow using appropriate embolic material.

Potential advantages include:

No conventional surgical incision
No direct dissection around the spermatic cord
Usually shorter recovery
Useful in selected recurrent cases

However, embolization is not suitable for everyone.

Our doctor will be able to access and successfully treat the abnormal venous pathway. Recurrence or technical failure can occur.

Can Varicocele Surgery Improve Fertility?

In appropriately selected men, treating a clinical varicocele can improve semen parameters and may improve the chances of pregnancy.

However, varicocele surgery does not guarantee pregnancy.

The AUA/ASRM guideline notes evidence suggesting improved pregnancy rates after varicocele repair in selected men, but it also highlights limitations in the available evidence, including non-randomised studies and variation between treatment approaches.

Therefore, our doctors do not recommend varicocelectomy simply to treat an ultrasound finding.

Our doctors first determine whether the varicocele is clinically significant and whether it fits the patient’s fertility situation.

What Happens After Varicocele Surgery?

Your recovery depends on the procedure used.

You may experience:

Mild discomfort
Bruising
Temporary swelling
A feeling of heaviness

Our doctor will provide specific instructions regarding:

Physical activity
Exercise
Sexual activity
Wound care
Pain medication
Follow-up appointments

If you undergo treatment because of infertility, our doctor may repeat semen analysis after an appropriate interval to assess whether semen parameters have improved.

Remember that sperm production takes time. Therefore, fertility improvement does not necessarily occur immediately after treatment.

Possible Complications of Varicocele Treatment

Varicocele treatment is generally considered safe when an appropriately trained specialist performs it, but complications can occur.

Potential complications include:

Hydrocele
Recurrence or persistence of varicocele
Infection
Bleeding or bruising
Persistent pain
Injury to the testicular artery
Rarely, testicular damage

Our urologist should explain the potential benefits and risks before recommending treatment.

Can Varicocele Come Back After Treatment?

Yes.

A varicocele can recur or persist after treatment.

The likelihood depends on factors such as:

Treatment technique
Anatomy
Experience of the treating specialist
The presence of collateral veins

Follow-up helps our doctor identify persistent or recurrent disease when clinically necessary.

Varicocele and Testosterone

Some men with varicocele may show changes in testicular hormonal function, although not every man develops low testosterone.

If you experience symptoms such as:

Reduced sexual desire
Fatigue
Reduced muscle strength
Erectile difficulties
Other symptoms suggestive of hormonal problems

our doctor may consider hormonal testing.

However, you should not start testosterone treatment on your own, particularly if you are trying to have children. Testosterone therapy can suppress sperm production and may reduce fertility.

Our urologist should evaluate the underlying problem before recommending hormonal treatment.

Does Varicocele Cause Erectile Dysfunction?

Varicocele primarily affects the testicles and male reproductive function rather than directly causing erectile dysfunction.

Some men with varicocele may experience both conditions, but one does not automatically cause the other.

If you have erectile dysfunction as well as varicocele, our doctor evaluate both conditions separately.

Conditions such as diabetes, high blood pressure, obesity, cardiovascular disease, hormonal problems, stress and medication effects can contribute to erectile dysfunction.

Varicocele in Teenagers and Adolescents

Our doctors can discover varicocele during adolescence.

In younger patients, the main concern involves testicular development.

A significant difference in testicular size or impaired testicular growth may prompt closer monitoring or treatment.

Parents should not ignore:

A new scrotal swelling
A visible network of veins
Testicular size differences
Persistent scrotal discomfort
Any unusual change noticed during puberty

Our urologist can assess the condition and recommend observation or treatment when necessary.

Can You Prevent Varicocele?

You cannot reliably prevent every varicocele because anatomical factors contribute significantly to its development.

However, you can protect your overall reproductive health by:

Maintaining a healthy weight
Exercising regularly
Avoiding smoking
Limiting excessive alcohol consumption
Managing chronic health conditions
Avoiding unnecessary exposure to excessive heat
Seeking medical attention for persistent scrotal symptoms
Getting appropriate fertility evaluation when conception takes longer than expected

These measures support general health but cannot guarantee prevention of varicocele.

Varicocele and Infertility: What Should You Do?

If you have a varicocele and you are trying to conceive, do not assume that surgery is automatically necessary.

Instead, discuss the following with your urologist:

Is the varicocele clinically palpable?
Are the semen parameters abnormal?
Does the affected testicle show reduced size or function?
Are there other male infertility factors?
Has the female partner undergone appropriate fertility evaluation?
Would treating the varicocele meaningfully change the fertility plan?
Should you consider natural conception, surgery, sperm retrieval or assisted reproductive techniques?

A personalised evaluation can prevent unnecessary treatment and help you choose the most appropriate fertility pathway.

When Should You See a Urologist?

Consult our urologist if you notice:

A new lump or swelling in the scrotum
Enlarged veins around the testicle
Persistent scrotal pain
Testicular size differences
Testicular discomfort during physical activity
Difficulty conceiving
Abnormal semen analysis
Concerns about fertility
Symptoms that develop suddenly

Sudden and severe testicular pain requires urgent medical assessment. Testicular torsion and other emergencies can present with acute scrotal pain and require prompt treatment.

How Jyoti Hospital Can Help With Varicocele

At Jyoti Hospital, Gurugram, our urology services focus on evaluating the complete clinical picture rather than treating an isolated scan finding.

Depending on your symptoms and fertility goals, your evaluation may include:

Detailed medical history
Physical examination
Scrotal examination
Doppler ultrasound when indicated
Semen analysis
Hormonal evaluation when appropriate
Assessment of testicular size and function
Evaluation for other causes of male infertility
Discussion of observation versus treatment
Surgical or other treatment options when clinically appropriate
Fertility planning when varicocele affects conception

Our approach aims to identify whether the varicocele actually affects your health or fertility and then select the least invasive appropriate management.

If you have already received a diagnosis of varicocele, bring your previous ultrasound and semen-analysis reports to your consultation. These reports can help our urologist assess your condition more accurately.

Final Thoughts

Varicocele is a common condition involving enlarged veins around the testicle. Many men never develop symptoms or fertility problems and may only need observation.

However, some men can experience scrotal discomfort, testicular changes or abnormal semen parameters. In these situations, our urologist assess the varicocele along with the man’s overall reproductive health.

Importantly, not every varicocele requires surgery. Our doctors consider treatment when the clinical findings support a meaningful benefit, particularly in appropriately selected men with infertility and abnormal semen parameters.

If you have been diagnosed with varicocele or have concerns about fertility, an evaluation at Jyoti Hospital, Gurugram can help determine whether you need monitoring, further testing or treatment.

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FAQs

Is varicocele dangerous?
- Most varicoceles are not immediately dangerous. However, some can contribute to scrotal discomfort, testicular changes or abnormal semen parameters. A urologist can determine whether you need treatment.
Can varicocele cause infertility?
- A varicocele can contribute to abnormal sperm production in some men, but having a varicocele does not automatically mean that you are infertile.
Can varicocele be cured without surgery?
- Some men do not need treatment at all. However, conservative measures do not physically eliminate an established varicocele. When treatment becomes necessary, doctors may consider surgery or embolization depending on the circumstances.
Can varicocele affect sperm count?
- Yes. Some men with clinically significant varicocele have abnormal semen parameters, including reduced sperm concentration or motility.
Does varicocele affect sexual performance?
- Varicocele does not directly cause sexual dysfunction in most men. If you experience erectile dysfunction or reduced sexual desire, your doctor should evaluate those symptoms separately.