7 Key Varicocele Symptoms You Should Never Ignore

Varicocele is a common condition affecting approximately 15% of men, characterized by the enlargement of veins within the scrotum, similar to varicose veins that can occur in the legs. While many men with varicocele may not experience any symptoms, others can develop noticeable signs that impact their quality of life and fertility. Understanding these symptoms is crucial for early detection and proper management of this condition.

The condition typically develops during puberty and is more commonly found on the left side of the scrotum due to anatomical differences in venous drainage. Although varicocele is generally benign, it can lead to complications such as testicular atrophy, hormonal imbalances, and male infertility if left unaddressed. Recognizing the warning signs early can help you seek appropriate medical attention and prevent potential complications.

In this comprehensive guide, we’ll explore the seven key symptoms of varicocele, helping you identify whether you might be experiencing this condition and when it’s time to consult with a healthcare professional.

1. Visible or Palpable Enlarged Veins in the Scrotum

One of the most distinctive and recognizable symptoms of varicocele is the appearance of enlarged, twisted veins within the scrotum. These veins often have a characteristic appearance that doctors describe as a “bag of worms” due to their bulging, rope-like texture.

Visual characteristics:

• The affected veins may be visible through the scrotal skin, especially when standing
• They typically appear more prominent after physical exertion or prolonged standing
• The enlarged veins may become less noticeable when lying down, as gravity no longer affects blood pooling
• The scrotum may appear asymmetrical, with one side looking larger or fuller than the other

Palpation findings:

• When touching the scrotum, you may feel a soft, irregular mass above the testicle
• The texture is often described as feeling like a bag filled with worms or spaghetti
• The enlarged veins are usually more easily felt when performing the Valsalva maneuver (bearing down as if having a bowel movement)

This symptom is often the first sign that prompts men to seek medical evaluation, as the physical change can be concerning and noticeable during self-examination or routine activities.

2. Dull, Aching Pain or Discomfort in the Testicle

Testicular pain or discomfort is one of the most common symptomatic complaints among men with varicocele. Unlike sharp, acute pain associated with testicular torsion or trauma, varicocele-related pain tends to be chronic and characterized by a dull, aching sensation.

Pain characteristics include:

• A heavy, dragging sensation in the affected testicle or scrotum
• Dull, aching discomfort rather than sharp or stabbing pain
• Pain that worsens throughout the day, particularly after prolonged standing or physical activity
• Discomfort that typically improves when lying down or elevating the scrotum
• Pain intensity ranging from mild to moderate; severe pain is uncommon

Factors that may worsen the pain:

• Extended periods of standing or sitting
• Physical exercise, especially activities involving straining or heavy lifting
• Warm weather or hot environments that cause blood vessel dilation
• Sexual activity or arousal in some cases

It’s important to note that not all men with varicocele experience pain. Studies suggest that only about one-third of varicocele cases present with discomfort. However, when pain is present, it can significantly impact daily activities and quality of life, making it an important symptom to address.

3. Testicular Shrinkage or Atrophy

Testicular atrophy, or the shrinking of one or both testicles, is a concerning symptom that can occur with varicocele, particularly in adolescents and young men. This happens because the pooled blood in the enlarged veins increases testicular temperature and may impair blood flow, affecting normal testicular function and development.

Key aspects of testicular atrophy in varicocele:

Size differences:

• The affected testicle may be noticeably smaller than the unaffected one
• A size difference of 2-3 milliliters or more in testicular volume is considered clinically significant
• The atrophy is typically progressive if the varicocele is left untreated
• Both testicles may be smaller than normal in bilateral varicocele cases, though this is less common

Implications:

• Testicular atrophy may indicate impaired testosterone production
• Smaller testicle size is associated with reduced sperm production
• This symptom is particularly concerning in adolescents, as it can affect normal development
• Early detection and intervention may help prevent further atrophy or even reverse the condition

Testicular atrophy is often detected during physical examination rather than by the patient themselves, which highlights the importance of regular check-ups, especially for adolescents and men concerned about fertility.

4. Fertility Problems and Abnormal Semen Parameters

Varicocele is the most common correctable cause of male infertility, present in approximately 35-40% of men with primary infertility and up to 80% of men with secondary infertility. The impact on fertility occurs due to several mechanisms related to increased scrotal temperature and impaired testicular function.

Fertility-related symptoms and findings:

Difficulty conceiving:

• Inability to achieve pregnancy with a partner after 12 months of regular, unprotected intercourse
• Previous successful conceptions followed by current difficulty (secondary infertility)
• Recurrent pregnancy losses in the partner that may be linked to sperm DNA damage

Abnormal semen analysis results:

• Low sperm count (oligospermia): Reduced number of sperm cells per milliliter of semen
• Poor sperm motility (asthenospermia): Decreased percentage of sperm with normal movement
• Abnormal sperm morphology (teratospermia): Higher percentage of abnormally shaped sperm
• Increased sperm DNA fragmentation: Damage to the genetic material within sperm cells
• Reduced semen volume: Less seminal fluid than normal ranges

Mechanisms affecting fertility:

• Elevated testicular temperature due to blood pooling disrupts spermatogenesis
• Reflux of adrenal and renal metabolites into the testicular vein may have toxic effects
• Oxidative stress from increased reactive oxygen species damages sperm cells
• Impaired blood flow affects nutrient and oxygen delivery to testicular tissue

Many men only discover they have varicocele when undergoing fertility evaluation, as the condition may not cause other noticeable symptoms. This makes fertility issues sometimes the first and only presenting symptom.

5. Heaviness or Dragging Sensation in the Scrotum

A persistent feeling of heaviness or a dragging sensation in the scrotum is a characteristic symptom experienced by many men with varicocele. This symptom differs from acute pain but can be equally bothersome and affect daily comfort and activities.

Characteristics of this sensation:

Physical feeling:

• A sense that the scrotum is being pulled downward
• Feeling of fullness or congestion in the affected side
• Sensation similar to carrying a small weight in the scrotum
• General discomfort rather than sharp or localized pain

Timing and triggers:

• Typically worsens as the day progresses
• More pronounced after standing for extended periods
• Increases following physical activity or exercise
• May intensify in warm weather or after hot showers
• Usually improves significantly when lying down, especially with legs elevated

Impact on daily life:

• May cause discomfort during work, especially for those in jobs requiring prolonged standing
• Can interfere with exercise routines or athletic performance
• May lead to postural changes as men unconsciously try to relieve the sensation
• Can affect sleep quality if discomfort persists into the evening

This symptom is caused by the accumulation of blood in the dilated veins, which increases the weight and pressure within the scrotum. The gravitational effect explains why the sensation worsens throughout the day and improves with rest.

6. Scrotal Swelling or Asymmetry

Noticeable swelling or asymmetry of the scrotum is another key symptom of varicocele. While some degree of asymmetry is normal (the left testicle typically hangs slightly lower), varicocele can cause more pronounced differences that become visually apparent.

Types of swelling and asymmetry:

Unilateral enlargement:

• One side of the scrotum appears larger or fuller than the other
• The left side is affected in approximately 90% of cases
• The enlargement is due to dilated veins rather than the testicle itself
• Size difference may be subtle when lying down but more obvious when standing

Textural changes:

• The affected side may feel softer or more compressible
• A lumpy or irregular texture may be palpable above the testicle
• The scrotal skin may appear slightly stretched or fuller
• Veins may be visible through the scrotal skin as blue or dark lines

Positional changes:

• Swelling typically increases when standing upright due to gravity
• Performing the Valsalva maneuver (bearing down) makes the swelling more prominent
• Lying down causes the swelling to decrease as blood drains from the veins
• Cold temperatures may cause temporary reduction in visible swelling

When to be concerned:

• Sudden onset of swelling, especially in men over 40, should be evaluated promptly to rule out other conditions
• Swelling that doesn’t reduce when lying down may indicate a different problem
• Accompanied by severe pain, fever, or redness requires immediate medical attention
• Rapidly increasing asymmetry should be assessed by a healthcare provider

Scrotal asymmetry from varicocele is usually a cosmetic concern but can also cause psychological distress and self-consciousness, particularly in younger men and adolescents.

7. Asymptomatic (No Noticeable Symptoms)

Interestingly, one of the most common “symptoms” of varicocele is the absence of any symptoms at all. Many men have varicocele without knowing it, as the condition often produces no noticeable discomfort or visible changes, especially in mild cases.

Key points about asymptomatic varicocele:

How it’s discovered:

• Incidental finding during routine physical examination
• Detected during fertility evaluation when investigating difficulty conceiving
• Found during medical examinations for military service, sports participation, or insurance purposes
• Discovered during imaging studies performed for unrelated reasons

Prevalence:

• Studies suggest that 70-80% of men with varicocele experience no symptoms
• Asymptomatic varicocele is more common in adolescents and young adults
• Many men go their entire lives without knowing they have the condition
• Subclinical varicocele (detected only by imaging) is even more common

Clinical significance:

• Even without symptoms, varicocele can still affect fertility in some men
• Asymptomatic varicocele may cause progressive testicular damage over time
• Regular monitoring may be recommended, especially in adolescents
• Not all asymptomatic varicoceles require treatment

Monitoring considerations:

• Adolescents with asymptomatic varicocele should have periodic testicular size measurements
• Men planning to have children may benefit from semen analysis even without symptoms
• Annual physical examinations can track any changes in the varicocele
• Development of symptoms or testicular size discrepancy may warrant intervention

The asymptomatic nature of many varicoceles highlights the importance of regular medical check-ups, particularly for young men and those experiencing fertility issues. Just because symptoms aren’t present doesn’t mean the condition isn’t affecting testicular health or reproductive function.

What Causes Varicocele?

Understanding the causes and risk factors of varicocele can help you better comprehend why this condition develops and who is most susceptible to it.

Primary causes:

Valve malfunction:

• Veins contain one-way valves that prevent blood from flowing backward
• When these valves fail or function improperly, blood pools in the veins
• The accumulation of blood causes the veins to enlarge and become varicocele
• This is similar to the mechanism that causes varicose veins in the legs

Anatomical factors:

• Left-sided predominance: The left testicular vein drains into the left renal vein at a right angle, creating higher pressure and making valve failure more likely
• Longer venous pathway: The left testicular vein is longer than the right, increasing the column of blood and pressure
• Compression: The left renal vein can be compressed between the aorta and superior mesenteric artery (nutcracker syndrome), increasing pressure in the testicular vein
• Absence or insufficiency of valves: Some men naturally have fewer or less effective valves in their testicular veins

Secondary varicocele causes:

• Abdominal or retroperitoneal masses: Tumors that compress the testicular vein and obstruct blood flow
• Kidney tumors: Particularly renal cell carcinoma, which can invade or compress the renal vein
• Blood clots: Thrombosis in the renal vein or inferior vena cava can cause secondary varicocele
• Increased abdominal pressure: Chronic constipation, heavy lifting, or obesity may contribute

Risk factors:

• Age: Most commonly develops during puberty (ages 15-25) when testicular blood flow increases
• Height: Taller men may have increased risk due to longer venous columns and higher hydrostatic pressure
• Family history: Some evidence suggests genetic predisposition
• Body build: Lean body habitus may increase risk, though this is debated
• Sudden development in older men: New varicocele after age 40 requires investigation to rule out underlying masses

Most cases of varicocele are idiopathic, meaning they occur without a clear underlying cause other than the valve dysfunction and anatomical factors described above. However, in older men or cases with atypical features, further investigation may be necessary to rule out secondary causes.

Frequently Asked Questions

Can varicocele go away on its own?

Varicocele typically does not resolve spontaneously once it has developed. The enlarged veins remain dilated due to the underlying valve dysfunction. However, symptoms may fluctuate in intensity, and some men experience periods with minimal discomfort. Regular monitoring is recommended, especially in adolescents, as treatment decisions depend on symptoms and testicular health.

At what age does varicocele usually develop?

Varicocele most commonly develops during puberty, typically between ages 15 and 25, when increased testicular blood flow and rapid growth occur. However, it can develop at any age. The condition rarely appears before puberty, and new onset varicocele in men over 40 should be evaluated carefully to rule out underlying pathology such as abdominal masses.

Does varicocele always cause infertility?

No, varicocele does not always cause infertility. While it is present in 35-40% of men with fertility problems, many men with varicocele can father children naturally. The impact on fertility varies depending on the severity of the varicocele, duration of the condition, and individual factors. Not all men with varicocele will experience reproductive difficulties.

Can varicocele occur on both sides?

Yes, though bilateral varicocele is less common than left-sided varicocele. Approximately 90% of cases occur on the left side, 10% are bilateral, and isolated right-sided varicocele is rare (less than 2%). Right-sided or bilateral varicocele may warrant additional investigation to rule out secondary causes, particularly venous obstruction from abdominal masses.

Is varicocele painful all the time?

No, varicocele pain is typically not constant. When pain occurs, it usually follows a pattern of worsening throughout the day with standing and physical activity, then improving with rest and lying down. Many men experience only intermittent discomfort, while others have persistent dull aching. Some men with varicocele never experience pain at all.

Can exercise make varicocele worse?

Exercise and physical activity can temporarily worsen varicocele symptoms by increasing blood flow and pressure in the affected veins. Activities involving straining, heavy lifting, or prolonged standing may cause more discomfort. However, exercise does not cause permanent worsening of the condition. Many men with varicocele can continue exercising with appropriate support garments and modifications as needed.

How can I tell the difference between varicocele and other scrotal conditions?

Varicocele has distinctive features: a “bag of worms” texture, symptoms that worsen when standing and improve when lying down, and gradual onset. Other conditions like hydrocele (fluid-filled sac) feel smooth and transilluminate light, epididymitis causes acute pain with inflammation, and testicular cancer presents as a hard, painless lump. Any scrotal abnormality should be evaluated by a healthcare professional for accurate diagnosis.

When should I see a doctor about varicocele symptoms?

You should consult a doctor if you notice any lumps or swelling in your scrotum, experience persistent testicular pain or discomfort, observe visible enlarged veins, notice one testicle is smaller than the other, or have difficulty conceiving after one year of trying. Sudden onset of severe pain, rapid swelling, or varicocele symptoms appearing for the first time after age 40 require prompt medical evaluation.

References:

• Mayo Clinic – Varicocele
• Urology Care Foundation – Varicoceles
• National Institute of Child Health and Human Development – Varicocele
• MedlinePlus – Varicocele
• NHS – Varicocele
• Johns Hopkins Medicine – Varicocele