Main
- Varicocele — enlargement of the veins of the spermatic cord: it occurs more often on the left, is frequently detected in young men and may be asymptomatic.
- The main symptom is a dull dragging pain and heaviness in the scrotum: it worsens after exertion or towards the evening and eases when lying down.
- Diagnosis includes examination and palpation of the scrotum while standing and lying down, and ultrasound with Doppler is performed for clarification.
- The condition is managed by a urologist: in the absence of symptoms observation is possible; if there is pain or an effect on fertility, surgery is discussed.
- There is no specific prevention: moderate activity, changing posture during the day and regular check-ups with a urologist help.
What is varicocele
Varicocele is a dilation of the veins that drain blood from the testicle, which is more common on the left. Below we explain how this mechanism works, why it occurs and who is affected more often.
What happens in the body
Varicocele develops when the veins that drain blood from the testicle lose the ability to maintain normal blood flow. Normally, the valves inside the veins act as one-way gates and allow blood to flow only upwards, towards the heart. If these gates do not close completely, blood partially flows back and stagnates in the vessels. Due to the stagnation, the veins gradually stretch and become wider than usual, forming a characteristic dilation. This more often happens on the left, because the left vein is longer and drains into a large vessel at a different angle. Blood stagnation raises the temperature in the area of the testicle and changes the conditions of its function, which over time may affect its function. Therefore, if such a dilation is detected, it is reasonable not to postpone a visit to a urologist for a calm discussion of the situation.
What causes it to develop
- Insufficiency of the venous valves: the leaflets inside the vein do not close completely, so blood moves in the opposite direction and stagnates.
- Anatomical features of the left side: the left vein is longer than the right one and drains at a right angle, which makes blood outflow more difficult.
- Increased pressure in the abdominal veins: pressure higher than usual is transmitted to the testicular veins and prevents blood from rising upwards.
- Congenital features of the vein structure: in some men, the vessel walls or their valves are formed differently, which predisposes to dilation.
- A combination of several causes: often the factors act together, so the exact cause in each case is determined by a doctor.
Who encounters this more often
Varicocele is more often detected in young men, especially at an age when the body is still actively growing and developing. In adolescents, vein dilation is often found incidentally, during an examination for another reason, since there may be no complaints at all. The condition occurs noticeably more often on the left than on the right, which is related to the structural features of the veins on this side. Heredity also plays a role: if close relatives had such a dilation, the likelihood of its occurrence is higher. Lifestyle also matters — prolonged standing, heavy physical exertion and straining in the abdomen create additional stress on the veins. In many men, the condition proceeds without complaints and is detected only during a targeted examination. Therefore, if in doubt, it is worth discussing with a doctor whether an examination is needed, rather than relying on how you feel.
What symptoms can occur?
Varicocele often runs without complaints, so it is not always possible to recognise it by sensations. Below is an analysis of which signs do still appear and in which cases help is needed without delay.
How it is noticed at the very beginning
Varicocele in the early stage most often does not make itself known, and a man does not suspect the condition for a long time. The first sensations are usually described as a dull dragging pain or heaviness in the scrotum, which appears closer to the evening. Such discomfort is easily put down to tiredness after a working day, a long journey or lifting heavy weights. Many note that the unpleasant sensations weaken once they lie down and rest, and therefore do not attach importance to them. Gradually the discomfort begins to return more often, and sometimes a feeling of fullness on one side is added to it. In some men the enlarged veins can be noticed on ordinary examination, although the man himself feels nothing. If the unpleasant sensations recur regularly, it is reasonable not to postpone a visit to a urologist and to find out their cause.
Signs that occur most often
- Dull or dragging pain in the scrotum: the sensation is aching and not sharp, it can persist for hours and interfere with usual activities.
- A feeling of heaviness or fullness: a man describes it as pressure from within, which intensifies towards the end of the day and after exertion.
- Enlargement or drooping of one half of the scrotum: one side looks larger or is positioned lower than the other, which is noticed on examination.
- Discomfort on exertion or prolonged standing: lifting heavy weights and standing on the feet for many hours make the sensations more noticeable, while resting lying down weakens them.
- Detection of enlarged veins on examination: the doctor sees dilated vessels, although the man may have no complaints at all.
- Consulting about difficulties with conception: sometimes the condition is found precisely when a couple is being investigated because pregnancy does not occur.
When to seek help urgently
Examinations and tests
Examination for varicocele is structured step by step: first the doctor talks to the patient and examines the scrotum, and only then, if necessary, adds instrumental and laboratory methods. Below is a description of what exactly each stage includes and what information it provides.
How the examination begins
Examination for varicocele begins with history-taking and examination, including palpation of the scrotum in the standing and lying positions. The doctor clarifies the complaints, the history of their onset and the circumstances under which the patient notices changes. Examination in two positions helps assess how the dilated veins respond to changes in body position and strain. Then, to clarify the picture, ultrasound with Dopplerography is used, which shows blood flow in the vessels. Additional examinations may include tests to assess testicular function, if there are grounds for this. If other diseases are suspected, additional methods are prescribed so as not to miss another cause of the complaints. If the examination raises doubts, it is ultrasound with Dopplerography that provides the most complete picture. Therefore, it is worth coming to the appointment prepared to undergo an examination and, if necessary, an instrumental investigation on the same day.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries: bring all available doctors' reports, because they help reconstruct the picture and avoid repeat investigations.
- Previous ultrasound results: if the examination has already been performed, bring the images and descriptions so that the doctor can compare the data.
- Test results: laboratory forms, if available, show how testicular function parameters have changed over time.
- Your own observations: write down when the complaints appeared, how they change at rest, under strain and at different times of the day.
- A list of questions: formulate in advance what you want to clarify with the doctor so that you do not forget anything during the conversation.
Which doctor should I see?
The section explains which specialist to consult for varicocele, what happens at the first appointment and what areas of care it comprises. It also separately covers which part of the result depends on the regularity of follow-up with a doctor.
Which specialist manages this condition
Varicocele is managed by a urologist, and it is to them that patients are referred when a dilation of the veins of the pampiniform plexus is suspected. The urologist examines the scrotum, assesses the size and side of the lesion, and compares the complaints with the patient's age. If there is no urologist nearby, one can start with a surgeon or a general physician, who will give a referral onwards. The approach depends on the complaints, age and the effect on testicular function, so the first appointment is built around history-taking and examination. In the absence of complaints and with normal parameters, observation alone is often sufficient, without active interventions. If varicocele causes pain or affects fertility, the doctor may recommend surgery, and the choice of method is discussed individually. Book an appointment with a urologist in advance so as not to postpone the assessment of the condition for months.
What treatment consists of
- Observation: regular examinations in the absence of complaints allow the doctor to track the dynamics and notice changes in time.
- Selection of therapy: if there is discomfort, the doctor selects treatment taking into account the complaints, age and general condition of the patient.
- Surgery: intervention is discussed when there are indications, when varicocele affects fertility or causes pain.
- Follow-up examinations: repeat visits after any stage help to assess the result and adjust further steps.
What depends on the patient themselves
The regularity of follow-up with a urologist determines how predictably the situation with varicocele will develop. The patient decides for themselves whether to come for a follow-up examination or to postpone the visit until pain appears. Missed examinations do not allow the doctor to notice how the condition is changing and whether it affects testicular function. In the absence of complaints, many consider observation unnecessary, although it is precisely this that gives a clear picture. If discomfort appears, it is important to mention it at the appointment rather than wait until the pain becomes constant. An honest account of how one feels helps the doctor more accurately assess whether surgery is needed or whether it is enough to continue observation. Keep simple notes about your sensations and take them to the appointment so as not to forget anything.
What helps prevent an exacerbation?
There is no specific prevention of varicocele, since it is based on anatomical features. However, reasonable habits and regular monitoring help to notice changes in time.
What is changed in habits
Daily habits directly affect how a person tolerates varicocele and how quickly they notice changes. Regular moderate physical activity maintains vascular tone and general well-being without sudden overloads. Heavy physical labour and lifting large weights create excessive pressure in the veins of the scrotum and can intensify unpleasant sensations. Prolonged sitting or standing in one position causes blood to stagnate in the pelvis, so it is useful to change position during the day. Tight underwear and clothing that squeeze the groin interfere with normal blood outflow and add discomfort. Overheating — hot baths, sauna, prolonged exposure to warmth — should also be limited if complaints have appeared. If a pulling pain or heaviness in the scrotum appears, there is no need to wait until it gets worse — it is more reasonable to see a urologist straight away.
What should be kept under control
- Timely visit to a urologist: if a pulling pain, heaviness or discomfort in the scrotum appears, a visit to a specialist helps to understand the causes without delay.
- Regular preventive check-ups: planned visits to a urologist provide an opportunity to notice changes in time, even if nothing is bothering you at the moment.
- Examination when planning pregnancy: a couple preparing to become parents would benefit from undergoing a check-up in order to take possible difficulties into account in advance.
- Your own observations: note when discomfort appears, what it is associated with and how it changes over time — this will help the doctor during the appointment.
- Talking to the doctor about how you feel: any new sensations should be discussed with a specialist rather than postponed until the moment when it becomes hard to bear.
How often to see a doctor
Regular monitoring by a urologist is needed even when your well-being remains good and nothing is bothering you. Varicocele may not make itself known for a long time, while changes accumulate unnoticed by the person themselves. Planned check-ups allow the doctor to assess the condition over time and to notice in time what escapes attention. If complaints appear — pain, heaviness, discomfort — the visit should not be postponed, even if the sensations seem insignificant. For couples planning a pregnancy, examination helps to take possible difficulties into account in advance and to approach this step more calmly. The frequency of visits is determined by the doctor taking into account complaints and examination results, so there is no universal schedule here. It is more reasonable to arrange the next appointment in advance than to return to this question only when symptoms worsen.
What is worth remembering
Varicocele is a condition in which the veins of the pampiniform plexus around the testicle become dilated, and this is noticeable on examination or on ultrasound. The discussion of it should be concluded with a few points that help in making a calm and considered decision.
Key points
Varicocele does not always require intervention: in some men it causes no symptoms at all and does not interfere with life. Varicocele can be noticed by a feeling of heaviness or a dragging pain in the scrotum, which worsens after exertion or towards the evening. At the same time, similar sensations are caused by other conditions, so examination alone without ultrasound settles nothing. Varicocele is often found during investigation for reduced fertility, when there are no other explanations. One should not put off a visit to a urologist or andrologist if the pain persists or interferes with everyday activities. The decision on observation or surgery is made on the basis of the combination of signs, not on a single symptom. The foundation in this matter is an in-person examination and a specialist's conclusion, not advice from a chat.
