Varicocele Symptoms: Early Signs of Male Reproductive Health Issues

Varicocele Symptoms: A Complete Guide to Diagnosis and Treatment

Varicocele symptoms may encompass testicular pain, dull ache and infertility. It is a common condition affecting approximately 15%–20% of men in India. There are five grades that define the condition’s severity, from mild to extreme. Doctors believe that a faulty valve in the testicular vein causes the veins to swell. Treatment includes at-home remedies, medications and surgery.

Good reproductive health is essential for healthy bodily function. However, certain conditions may affect this. Varicocele is a condition affecting the veins in the scrotum in men, causing swelling and pain. Although it is not a life-threatening condition, managing it is essential for good reproductive health. In this blog, we will discuss varicocele symptoms, their causes and treatment options.

What are the symptoms of varicocele?

This condition rarely produces any symptoms in men. In fact, up to  80% to 90% of cases are asymptomatic and are discovered during routine fertility evaluations.

However, in severe cases, you may notice the following varicocele symptoms:

• Small Lump: You may notice a small lump which feels like spaghetti or worms above the testicles. However, it usually appears in severe stages.
• Testicular Pain: Another indication of varicocele is a constant and dull pain in the scrotum. The pain may get better when you lie down.
• Differently Sized Testicles: Varicocele may cause one testicle—usually the left—to appear smaller due to impaired blood flow and testicular atrophy.
• Infertility: Since the pampiniform plexus is unable to maintain the correct temperature for testicular function, it may result in infertility. However, the chances of it happening are low.
• Testicular Atrophy: Reduced testicular function may cause the testicles to shrink in size.
   

What is a varicocele?

Varicocele is a condition characterised by enlarged veins in the scrotum. The scrotum is located behind the penis and contains the testicles. These enlarged veins, also known as the pampiniform plexus, can cause pain and discomfort. However, many people remain asymptomatic. The condition is usually left-sided, with an 85% prevalence.

Studies show that varicocele commonly develops between the ages of 15 and 25, particularly during adolescence. The pampiniform plexus veins help cool the blood in the testicular artery. However, when they become enlarged, the testicles can overheat and disrupt sperm production.

What are the 5 stages of varicocele?

Doctors categorise varicocele into five stages based on the Sarteschi/Liguori classification. It classifies this condition based on the dilated vein’s relationship with the testis. It also takes into consideration testicle size and the presence of varicosities. These stages are as follows:

• Grade 1 Varicocele: In this stage, swelling is rarely visible or felt. Unless a doctor is performing a Valsalva manoeuvre, you cannot notice symptoms. Doctors can detect inguinal reflux (blood flowing backwards) during this test.
• Grade 2 Varicocele: In grade 2, the veins are more swollen than in grade 1. However, they still do not cause any noticeable symptoms. A doctor can observe varicose veins (swelling) during a Valsalva manoeuvre as it reaches the upper part of the testicle. However, it is invisible while lying down.
• Grade 3 Varicocele: Grade 3 is one of the most severe stages of varicocele. It can feel like a ball of worms or noodles. You may also experience pain and other symptoms. Grade 3 varicoceles are clinically visible in about 10% to 20% of cases and often correlate with discomfort.
• Grade 4 Varicocele: In this stage, the enlarged veins are visible and cause pain. Doctors do not have to perform a Valsalva manoeuvre to check for this condition. Varicocele grade 4 symptoms include testicular atrophy and infertility. Moreover, the veins are visible while lying down as well.
• Grade 5 Varicocele: This is the most severe stage of the condition and requires medical intervention. You will be able to notice varicose veins, both while lying down and standing up. Moreover, the backward flow of blood is present at rest. Testicular hypotrophy may also develop at this stage.
   

What Causes Varicocele?

The exact cause of varicocele is unknown. Doctors suggest that a malfunction in the valves of the veins in the spermatic cord may cause the pampiniform plexus to dilate and swell. Each scrotum has a network of veins that carry oxygen-depleted blood back to the heart.

However, when this process fails, people start to experience the symptoms of varicocele. Moreover, men's anatomy differs between the right and left sides. The left scrotal veins follow a different path back towards the heart, which makes the condition more common on the left side.

What are the complications of varicocele?

Although it is a very common condition, certain rare complications may arise. These are as follows:

• Azoospermia: This occurs when semen does not contain any sperm during ejaculation and is a common cause of male infertility. It is seen in approximately 4.3% to 13.3% of men with varicocele.
• Male Hypogonadism: Low testosterone may lead to problems such as low libido, shrunken testicles and decreased muscle mass. It may also cause depression.
   

How do doctors diagnose varicocele?

Usually, doctors perform the Valsalva manoeuvre and a physical examination to diagnose varicocele. The following diagnostic tests are typically used:

• Valsalva Manoeuvre: In this test, the patient stands upright and pushes downwards, keeping the nose and mouth closed to prevent air from escaping. When the patient strains in this way, doctors can identify varicose veins in the scrotum.
• Pelvic Ultrasound: This non-invasive test provides a detailed image of the pelvis and scrotum. It is one of the most common diagnostic tools. Colour Doppler ultrasound has a 93% sensitivity in detecting varicocele.
• Semen Analysis: Doctors collect a semen sample and send it to a lab for analysis. Laboratory technicians evaluate the semen for sperm count and quality.
• Blood Test: Blood tests are used to check levels of testosterone and follicle-stimulating hormone (FSH), which help detect varicocele and assess reproductive health.
   

What are the treatment options for varicocele?

Varicocele treatment depends on the severity of the condition. Lower-stage varicocele can be treated with at-home remedies. However, stages 4 and 5 may require surgical intervention. The treatment options include:

• Wardrobe Change: Symptoms may ease by using tight-fitting underwear. These garments help reduce discomfort during activities such as exercise and sports.
• Applying an Ice Pack: Massaging the scrotum with ice can relieve dull and chronic pain. It is advisable to do this for 15 minutes a day.
• Over-the-counter Medicines: If the above methods do not work, over-the-counter medications can help relieve pain. However, make sure to consult a doctor before taking them.
   

Doctors may recommend these treatments for lower-grade varicocele symptoms. However, if the symptoms are significantly affecting your life, a varicocelectomy is usually recommended. In this procedure, a surgeon cuts the swollen veins and seals their ends to ensure proper blood flow in the scrotum.

Final Thoughts

Varicocele symptoms, including a dull ache, scrotal heaviness or visibly enlarged veins, may appear minor at first but can significantly impact male fertility, hormonal balance and overall testicular function over time. Early diagnosis plays a key role in preventing long-term complications such as infertility or testicular atrophy.

Fortunately, with medical advancements, both conservative and surgical treatments for varicocele are now highly effective and widely accessible. If you suspect any symptoms, consult a qualified healthcare provider for timely evaluation and proper management tailored to your condition.