Understanding Varicocele: Causes, Symptoms, and How It Is Treated

Varicocele is widely recognized as the most common correctable cause of male infertility. Despite this, many men remain unaware of the condition, often living with it for years without symptoms or diagnosis. It is frequently discovered incidentally during a routine examination, imaging study, or more commonly, as part of a fertility evaluation.

Key insight:

• Nearly 1 in 6 men may have a varicocele
• Up to 40% of men with infertility are affected

However, varicoceles are not only well understood but also highly treatable, with modern approaches offering effective results through minimally invasive techniques. Early identification and appropriate management can play a significant role in improving both reproductive outcomes and long-term testicular health.

What is a Varicocele?

A varicocele is an enlargement of veins within the scrotum, similar to varicose veins seen in the legs.

What causes it?

• Veins contain valves that regulate blood flow
• When these valves fail, blood flows backward and pools in the veins
• This leads to dilation and increased pressure

Why is it more common on the left side?

• The left testicular vein drains at a right angle into the renal vein
• This anatomical difference increases pressure, making left-sided varicocele more likely

Clinically, varicoceles are graded based on severity:

• Grade I: Small, detectable only during straining (Valsalva maneuver)
• Grade II: Palpable without straining but not visible
• Grade III: Large, visible through the skin and easily palpable

How Common Is It?

Varicocele is a common condition:

• It affects approximately 15% of all men
• It is present in 35–40% of men undergoing evaluation for infertility

In many cases, it remains asymptomatic and is only identified during investigations for unrelated concerns. This contributes to its underdiagnosis in the general population.

What Symptoms Should You Watch For?

Not all varicoceles cause symptoms but when they do, they can affect daily comfort.

Common signs include:

• A dull ache or heaviness in the scrotum, often worsening after prolonged standing or physical activity
• A visible or palpable mass, frequently described as a “bag of worms”
• A feeling of dragging discomfort in the testicle
• Reduced testicular size over time, particularly in younger patients

However, a significant number of men remain asymptomatic, which is why the condition is often discovered during fertility assessment rather than symptom-driven evaluation.

How Does a Varicocele Affect Fertility?

The relationship between varicocele and fertility is well established.

The primary mechanism involves impaired temperature regulation. The testicles require a temperature slightly lower than core body temperature for optimal sperm production. When blood pools in dilated veins, it raises the local temperature, disrupting this balance.

This can lead to:

• Reduced sperm count
• Decreased sperm motility (movement)
• Abnormal sperm morphology (shape)

In addition to affecting spermatogenesis (sperm production), varicoceles may also impact testosterone production by altering the function of Leydig cells within the testicles.

Over time, untreated varicoceles can result in progressive testicular damage, making early diagnosis and intervention particularly important in men with fertility concerns.

How Is It Diagnosed?

Diagnosis typically involves a combination of clinical examination and imaging.

Clinical Examination
A trained clinician can often detect a varicocele through physical examination, especially in higher-grade cases. The patient may be asked to stand and perform a Valsalva maneuver (bearing down), which makes the veins more prominent.

Scrotal Doppler Ultrasound
This is the standard imaging modality used to confirm diagnosis. It provides detailed information about:

• Vein size
• Blood flow patterns
• Presence of reflux (backward flow of blood)

The test is non-invasive, painless, and plays a crucial role in both diagnosis and treatment planning.

Additional Evaluation
In cases related to infertility, further assessment may include:

• Semen analysis
• Hormonal evaluation (including testosterone levels)

What Are the Treatment Options and Why Is Embolisation Preferred?

Treatment decisions depend on symptoms, fertility goals, and clinical findings.

Surgical Ligation
Traditional management involves surgical ligation, where the affected veins are tied off through open or laparoscopic surgery. While effective, surgery requires incisions, anesthesia, and a longer recovery period.

Varicocele Embolisation
Embolisation is a minimally invasive, image-guided procedure that has become an increasingly preferred alternative in appropriate patients.

The procedure involves:

• A small puncture (usually in the groin or neck)
• Insertion of a thin catheter into the venous system
• Navigation to the affected testicular vein under real-time imaging
• Placement of coils or a sclerosant to block the abnormal vein

By sealing these veins, blood flow is redirected through normal pathways, relieving the underlying pressure.

Key Advantages of Embolisation

• No general anaesthesia required
• Day-care procedure with same-day discharge
• Minimal discomfort and rapid recovery
• Comparable success rates to surgery
• Lower complication rates, including no risk of hydrocele formation
• Ability to treat both sides in a single session, if needed

For many patients, embolisation offers an effective balance between clinical outcomes and procedural simplicity.

What to Expect: Before, During, and After Embolisation

Before the Procedure

• Clinical consultation and examination
• Scrotal ultrasound
• Semen analysis (if fertility is a concern)

During the Procedure

• Performed under local anesthesia, sometimes with mild sedation
• A catheter is guided to the target veins using imaging
• Embolisation materials are placed to block abnormal flow
• Typically completed within 45–90 minutes

Patients remain awake and comfortable throughout.

After the Procedure

• Mild discomfort or heaviness for 24–48 hours
• Most patients return to routine activities within 1–2 days
• Minimal restrictions compared to surgery

Follow-Up

• Repeat semen analysis at 3 and 6 months (for fertility cases)
• Clinical review to assess symptom improvement

Improvements in sperm parameters, when they occur, are usually seen gradually over several months.

Why RIVEA

RIVEA provides a focused, evidence-based approach to the diagnosis and treatment of varicocele, with an emphasis on minimally invasive, image-guided care.

Expertise in interventional radiology
Procedures are performed by Dr. Arjun Reddy, one of the leading interventional radiologists in South India.

Advanced imaging with the Allia IGS 7 system
RIVEA utilizes the Allia IGS 7, a next-generation image-guided therapy platform designed to enhance procedural accuracy.

Key advantages include:

Minimally invasive, patient-friendly care
Treatments are designed to avoid surgery, reduce discomfort, and enable faster recovery.

Same-day procedures with rapid return to routine
Most embolisation treatments are completed as day-care procedures with minimal downtime.

With advances in minimally invasive techniques, effective treatment is now possible without the need for surgery in many cases. Embolisation offers a targeted, well-tolerated approach with strong clinical outcomes and minimal disruption to daily life.

At RIVEA, care is centered on delivering accurate diagnosis and effective treatment, with clarity at every step from initial assessment to recovery and follow-up.