Symptoms and Signs of Varicocele

Some men won’t even know they have a varicocele until they go to the doctor because they have problems conceiving.  Other men see the doctor because they experience severe pain and discomfort in their scrotum.  Symptoms can vary according to the size classification of varicoceles.  Symptoms also vary from man to man regardless of the size of the varicocele.

Small varicoceles (Grade 1)

  •  Asymptomatic
  • This means “to be without symptoms.” Often men with a small varicocele don’t have any symptoms. Most varicoceles are asymptomatic and harmless. Only 10% of varicoceles cause symptoms. So men, who don’t have a problem conceiving and don’t have any pain, might still have a small varicocele which they are unaware of.

  • Scrotal pain and discomfort
  • Even small varicoceles can be painful in some men.  Pain is especially reported after strenuous physical activity and is often relieved by lying down.  Some men report a feeling of heaviness in the scrotum.  This is possibly due to toxin build-up in the affected tissues because of poor venous drainage and because of inadequate oxygen and nutrient delivery to the tissues.

  • Discomfort in Groin area
  • Some men don’t describe the symptom as pain but rather as an uncomfortable feeling in their groin or scrotal area.  This can be because of the dilatation of the veins and possibly because of insufficient blood supply to the area.

  • Palpable mass
  • Small varicoceles are only palpable when intra-abdominal pressure is increased.  So only when the patient performs the Valsalva Maneuver  or performs an activity which increases intra-abdominal pressure can the varicocele be palpated.

  • Infertility/subfertility
  • A varicocele could be a cause of infertility and is a common finding (40%) in infertile men.  Although the exact reason for this is uncertain the main pathology behind the decreased production of sperm is considered to be elevated scrotal temperature. A varicocele is the most common surgically correctable cause of subfertility in men.

Medium varicoceles (Grade 2)

  • Palpable Mass – Bag of worms
  • The difference between a grade 1 and a grade 2 varicocele is that a grade 2 varicocele can be palpated without the need to increase intra-abdominal pressure.An obvious varicocele or those which are moderate to large in size are often described as feeling like a bag of worms. The patients are able to feel the mass by palpating the area with their hands.

  • Testicular Atrophy
  • If the testicle has been receiving inadequate oxygen supply for a while it can atrophy or shrink and will look smaller when compared to the unaffected testicle.  This is often irreversible.

  • Scrotal pain and discomfort
  • Any type of varicocele (small, medium or large) can cause the patient to experience pain, discomfort or scrotal heaviness.

  • Infertility/subfertility
  • The exact pathophysiology of how a varicocele causes infertility is unknown. It must be remembered that not all varicoceles impair overall sperm quality and fertility but it is best to have a semen analyses done to be sure.  Even though the varicoceles usually occur only on one side of the scrotum, varicocele can cause low sperm count in both testicles.

Large varicoceles (Grade 3)

Large varicoceles also present with the symptoms and signs as described for a medium varicocele namely: palpaple mass, testicular atrophy, scrotal pain and discomfort, and infertility.  The difference is that the mass is not only palpable but visible too.

  • Visible lump

A varicocele is classified as a grade 3 varicocele when it is visible while the patient stands.  Large varicoceles may look like a bulge inside the scrotum.