Varicocele
A varicocele is enlarged, dilated veins in the scrotum, similar to varicose veins elsewhere, and one of the most common correctable causes of male infertility. Repair decisions follow the ASRM Committee Opinion on Varicocele and Infertility.
Symptoms
A dull ache or heaviness in the scrotum, worse with standing or at the end of the day, or sometimes no symptoms at all -- found incidentally on exam.
Causes and risk
Varicoceles occur when valves in the veins draining the testicle don't work properly, allowing blood to pool; they're more common on the left side due to anatomy.
How it is evaluated
Diagnosis is clinical -- palpation with the patient standing and performing a Valsalva maneuver -- with ultrasound reserved for an inconclusive exam.
Treatment
Repair (surgical or radiologic) is indicated for a palpable varicocele plus infertility plus an abnormal semen analysis, or for significant pain, per AUA/ASRM guidance. Varicoceles found only on imaging (subclinical), without a palpable component, are not treated.
When to seek care
Sudden severe scrotal pain suggests torsion rather than a varicocele and needs emergency evaluation. A right-sided varicocele that doesn't decompress when lying down is unusual and can indicate an abdominal cause worth investigating.