Doctors refer to varicose veins in the scrotum as varicoceles. Despite being common, they are usually asymptomatic. Sometimes though, they can cause swelling, a feeling of tightness or a dull, “dragging” pain in the scrotum.
At a glance
- Varicose veins in the scrotum are called varicoceles.
- Similarly to varicose veins in the legs, varicoceles form when a build-up of blood in the veins causes them to become permanently enlarged.
- Varicoceles form in the veins that run along the spermatic cord.
- Experts predict that 5 to 15 percent of all men have a varicocele.
- If a man who is unable to have children has a varicocele, doctors may sometimes suggest treatment to increase his fertility.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
What is a varicocele?
Varicose veins are not only found in the legs: if they occur in the scrotum, they are known as varicoceles.
Varicoceles form in the veins that run along the spermatic cord. This carries the blood from the testicles back into the body. Similarly to other varicose veins, varicoceles form when a build-up of blood in the veins causes them to become permanently enlarged.
What symptoms does a varicocele cause?
In most cases, varicoceles have no direct symptoms whatsoever. Sometimes though, they can cause swelling, a feeling of tightness or a dull, “dragging” pain in the scrotum.
A varicocele can also affect fertility and may sometimes prevent men from having children.
What causes a varicocele?
The veins in the scrotum can become enlarged for a number of reasons. They can have their causes in individual physical conditions: the blood flows slower, for instance, if the testicular vein joins the renal vein almost at a right angle in the pelvis. This can cause a build-up of blood in the scrotum, resulting in a varicocele.
As unfavorable join angles are generally found more often on the left-hand side, varicoceles are also more common on this side. In some cases, varicoceles can also be caused by a congenital weakness of the vein wall. Like with other varicose veins, the same applies to weakened venous valves.
If a tumor presses against the veins and prevents the blood from flowing properly, this can also cause a varicose vein in the scrotum. This situation is very rare though. If it does occur, experts refer to the condition as a “symptomatic” varicocele to distinguish it from a “normal” varicocele.
How common are varicoceles?
Varicoceles are most commonly recorded in teenagers and young men between the ages of 15 and 25. According to estimates, they affect 5 to 15 percent of all men.
In about 90 percent of those affected, the varicocele forms in the left half of the scrotum.
How is a varicocele diagnosed?
If varicoceles are large, doctors are able to directly see or feel them. Sometimes, however, they have to press on the stomach during an examination to fill the varicose vein with blood so that they can feel it. An ultrasound examination (sonography) is needed to detect smaller varicoceles.
How are varicoceles treated?
In most cases, varicoceles do not need to be treated. If, however, they are affecting the fertility of a man who is unable to have children, the doctor may suggest treatment.
The affected vein is shut down so that the blood can flow through neighboring healthy veins. There are three methods for doing this:
The vein is blocked (embolized) using medication or special little metal coils. These are inserted into the vein via a catheter and cause a blood clot to form in the varicose vein, closing it off.
Sclerotherapy follows a similar approach: a drug attacks the blood vessel wall causing the vein to stick together.
If surgery is performed, the doctor clips or ties off the swollen vein and the surrounding smaller veins. This is done using “open” surgery via a larger cut, for example in the scrotum or groin.
Varicocele treatment can also lead to complications, including bleeding, infected wounds, nerve injury or swelling in the scrotum known as a hydrocele.
Further information, for example on the question if treatment of a varicocele improves fertility, can be found at gesundheitsinformation.de.
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- Hautmann R, Huland H. Urologie. Berlin: Springer; 2013.
- Kroese AC, de Lange NM, Collins J, Evers JL. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev 2012; (10): CD000479. Aufgerufen am 8.6.2020.
- Pschyrembel. Klinisches Wörterbuch. De Gruyter: Berlin 2017.
- Silay MS, Hoen L, Quadackaers J, Undre S, Bogaert G, Dogan HS et al. Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. Eur Urol 2019; 75(3): 448-461. Aufgerufen am 8.6.2020.
In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).As at: