Varicocele is the dilation of the veins in the testicles, which can cause pain, swelling, and affect male fertility.
Penile conditions can compromise different penile structures related to fertility. This is the case of varicocele, a condition that, when diagnosed and followed up early, often has a favorable clinical course, according to individual assessment. Varicocele affects the scrotum, the skin pouch located below the penis that surrounds the testicles, abnormally dilating the testicular veins—especially after exertion—and may be associated with male infertility, requiring special attention when pregnancy is desired. Learn more about this condition and, especially, how to avoid complications of untreated varicocele.What is varicocele?
Varicocele is also called “varicose veins in the testicles” because the venous dilation resembles the varicose veins that occur in the legs. Its formation process is similar to the varicose veins in the lower limbs. Usually congenital, the condition occurs due to malformation or absence of the valves in the veins inside the scrotum. This negatively alters blood flow in the spermatic cord, which plays a key role in male fertility.Varicocele symptoms
Because it is a progressive condition, it is very important to be alert to the early signs, which include:- Testicular pain, often worse at the end of the day, especially on the left side;
- Testicular swelling;
- Presence of nodules in the testicles;
- A feeling of heaviness in the testicles;
- Testicular atrophy.
Varicocele types: grade 1, 2, and 3
There are three varicocele grades based on vein dilation size: grade I (mild), II (moderate), and III (marked). In grade I, venous dilations are small and can only be detected by a physician. In grade II, dilated veins are palpable with a testicular self-examination, but still not visible. In grade III, the veins are so dilated they can be seen under the scrotal skin. Across grades 1, 2, and 3, there is impaired testicular venous return—and the higher the grade, the greater the potential impact on male fertility.Varicocele treatment
If you notice compatible symptoms, it is recommended to see a urologist for evaluation and to define the most appropriate treatment. The physician will diagnose varicocele and indicate the best option for each case. The first step is to examine the area with a physical evaluation of the scrotum, scrotal ultrasound, testicular ultrasound, and scintigraphy. These tests help visualize venous dilation in the scrotal sac and rule out other conditions. If the man does not have pain and does not intend to have children (or more children), treatment can be deferred, regardless of the grade. In mild cases, treatment aims to relieve symptoms and improve local circulation. Physicians often recommend a scrotal support to provide stability and reduce muscle tension, along with analgesics and anti-inflammatories.
When is surgery indicated?
Grades II and III are often managed surgically, especially in men seeking paternity when infertility is documented. Surgical treatment for varicocele is straightforward and usually requires only a short hospitalization and recovery. Varicocelectomy ligates the varicose veins, redirecting blood to healthy veins. This approach aims to control pain and promote improvement in semen parameters, depending on the clinical context. In some situations, surgery may be associated with improved fertility. According to a 2023 meta-analysis in the World Journal of Men’s Health, the authors observed improved semen parameters in some cases, which may be associated with higher rates of spontaneous pregnancy. However, surgery does not prevent the formation of new varicose veins. Scrotal atrophy, which alters the size of the testicles, tends to be irreversible, although early treatment, especially in adolescence, may reduce the chance of progression.Postoperative care
After surgery, the operated area is often sensitive. In the first weeks, it is common to feel discomfort and mild pain in the region and the groin. The testicles may be slightly swollen for a few days, sometimes with redness. To ease postoperative effects, the main recommendations are:- Plenty of rest;
- Analgesic medications (dose as directed by the specialist);
- Applying an ice pack to the area;
- Use of scrotal support.
Varicocele: frequently asked questions
Can someone with varicocele have children?
Varicocele may be associated with changes that affect male fertility, depending on severity and duration. Venous dilations can impair semen quality due to altered thermal regulation in the testicles.Do testicular varicose veins interfere with erections?
Abnormal dilations and thermal changes in the testicles do not cause erectile dysfunction, as blood flow changes do not affect the penile base or shaft.Can someone with varicocele do weight training?
Valve insufficiency caused by varicocele does not necessarily worsen with physical activity or strength training in terms of disease stage. However, exertion may cause local discomfort or pain.What are the risks of “home” treatments for varicocele?
A “home remedy” does not consider an accurate diagnosis or a medical-scientific perspective. Besides not addressing the condition, some substances can seriously affect blood circulation, dilating or constricting vessels in the affected area—even when the product claims the opposite. Other organs can also be harmed, such as the stomach and liver.What happens if varicocele is not treated?
In more severe stages (grade III), the main consequence is interference with sperm production, which can lead to infertility. Without appropriate management, infertility may be irreversible, leading to permanent sterility.How to prevent varicocele?
Men with a family history can seek a urologist from puberty onward to assess the need for early management. Other risk factors for varicocele include being taller, having leg varicose veins, and hemorrhoids. Because the condition is linked to heredity, it is not possible to fully prevent varicocele.Ask your questions with Dr. Paulo Egydio
Taking care of male sexual health is important to avoid complications—whether infertility related to varicocele, penile curvature due to Peyronie’s disease, or erectile dysfunction. In such cases, seek evaluation with a qualified urologist to obtain an accurate diagnosis and discuss individualized options.If you have symptoms or questions, you can complete the pre-analysis form to share your case and receive educational guidance.
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