Varicocele: symptoms, fertility effects and treatment options

A varicocele is a group of enlarged veins in the scrotum. United Lincolnshire Hospitals describes the valves in these veins as not working properly, so the veins widen and become more obvious, rather like varicose veins in the leg. Milton Keynes University Hospital says it is more common on the left side of the scrotum but may occur on either, and that it is not certain what causes it, although a valve defect in the veins may be responsible.

Varicoceles are not always visible, but the Milton Keynes leaflet points out that they do affect the blood flow in the testicles, which is why they are checked for in fertility investigations.

Most varicoceles cause no symptoms. When they do, the leaflets describe an uncomfortable heaviness on one side of the scrotum, a dull ache that builds as the day wears on, a dragging or aching pain, and visible or prominent veins.

Any new lump, swelling or persistent pain in the scrotum should be examined by a doctor rather than assumed to be a varicocele. Sudden severe testicular pain is an emergency and needs urgent care.

Milton Keynes University Hospital says a doctor can usually diagnose a varicocele by feeling the scrotum, and that a scrotal ultrasound may be needed to confirm it. When a varicocele is found during fertility testing, the usual next steps are a semen analysis and a discussion with a urologist about whether treatment is likely to help.

Ultrasound can also look for other causes of scrotal swelling and help assess the size of the testicles. If the varicocele has grown large, the Milton Keynes leaflet notes the testicle on that side could shrink and fertility could possibly be reduced.

Varicoceles are sometimes diagnosed during the investigation of infertility, and United Lincolnshire Hospitals says treatment may help your sperm count. The Milton Keynes leaflet is more cautious: repair may improve fertility, but this is not guaranteed. The United Lincolnshire leaflet adds that if an improvement in fertility is expected, it may take several months to appear.

In practice, that means a varicocele alone is not a reason for treatment. Treatment is generally discussed when there is discomfort, or when a varicocele is found alongside a fertility problem, and the decision rests on semen results, the partner's fertility assessment and how long a couple have been trying.

Surgery is usually recommended if the varicocele is causing discomfort or on occasion when it is affecting fertility function. Observation is also a valid choice when there are no symptoms. Cambridge University Hospitals lists observation, radiological embolisation and open surgery as alternatives to keyhole surgery.

For keyhole surgery, the Cambridge leaflet lists common effects of temporary shoulder-tip pain and abdominal bloating, and notes the external appearance of the varicocele may not change significantly even though symptoms are relieved. Occasional problems include bleeding, infection, pain or hernia at the wound, failure to cure the varicocele, and later development of a fluid swelling around the testicle (hydrocele). Rare complications include damage to or shrinking of the testicle if the blood supply is affected.

For embolisation, United Lincolnshire Hospitals lists bruising or soreness at the needle site, mild scrotal or loin discomfort for a few days and small skin infections as common, with the possibility that the varicocele remains or returns. Contrast dye can affect the kidneys in people whose kidney function is already poor, and the procedure involves a small dose of X-ray radiation. If you need an MRI later, tell the radiographer you have had an embolisation.

After open surgery, Milton Keynes advises supportive underwear to relieve discomfort and swelling, and to reduce the risk of a haematoma. It suggests avoiding tight trousers for a few days, daily showers until the wound has healed, no heavy lifting or vigorous exercise, including sex, for the first two weeks, and a return to work after a few days depending on the job. The veins above the left testicle may look slightly more prominent at first.

Contact your GP if you develop difficulty passing urine, severe swelling or redness of the scrotum, bleeding or discharge from the wound, increasing pain not controlled with painkillers, or a high temperature.

A GP can examine you and arrange an ultrasound and semen analysis. If treatment is advised, referral goes to urology, with embolisation done by interventional radiology. Where fertility is the concern, the partner's assessment is usually considered at the same time so that decisions are made on the couple's whole picture.

Private urology and radiology services can reduce waits for imaging and procedures. Ask which technique is proposed and why, what the realistic chance of improvement is for your semen results, how recurrence is handled and whether follow-up semen tests are included.