Varicocele: Varicose vein in testicle

Last updated: May 18, 2026

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Varicocele is a common presentation in my andrology clinic, defined as an abnormal dilatation of the scrotal venous plexus (pampiniform plexus) — essentially varicose veins of the testicle. It resembles the varicose veins seen in the leg and becomes more common with age.

• Urology center Bangkok hospital Thailand Booking online 02-310-3009 bhquro@bdms.co.th
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Varicocele is a largely silent disease. It is reported in 15–20% of adult males overall, and rises to 40% among men investigated for male infertility. Two main anatomical causes explain its development:

1. Anatomical asymmetry — the left testicular vein drains at a right angle into the left renal vein (versus the right testicular vein draining obliquely into the inferior vena cava), making left-sided varicocele significantly larger and more common than right-sided
2. Failure of the anti-reflux venous valve within the testicular venous system, causing retrograde blood pooling

The 3 major presentations of Varicocele

1. Male infertility — pooled deoxygenated blood reduces sperm quality and quantity through oxidative stress, direct hydrostatic pressure on the testicle, and elevated scrotal temperature
2. Testicular discomfort or scrotal heaviness — from the same mechanisms; the testicle’s pain receptors signal discomfort from increased venous pressure
3. Self-discovery of a “bag of worms” sensation — varicocele is graded in 3 stages: Grade I (palpable only with Valsalva), Grade II (palpable without Valsalva), Grade III (visibly dilated veins). Higher grades are more easily felt or seen by the patient themselves, prompting them to seek advice

Evaluation includes a thorough history, scrotal physical examination, and high-resolution color Doppler ultrasound of the scrotum to confirm the diagnosis, grade the varicocele, and assess testicular volume.

When treatment is indicated, the approach is surgical varicocele correction (varicocelectomy). Indications for surgery include:

• Abnormal semen analysis with desire for fertility
• Persistent varicocele-related pain

The most important factor is the patient’s own decision and expectations. Varicocele correction surgery does not guarantee 100% improvement in fertility or pain, and recurrence can occur even after successful surgery. A detailed urologist-patient discussion is always essential before proceeding.

Frequently Asked Questions About Varicocele

Does varicocele cause male infertility?

Yes — varicocele is the most common correctable cause of male infertility. It is found in up to 40% of men investigated for fertility problems. The enlarged venous plexus causes pooling of deoxygenated blood around the testicle, which impairs sperm production through oxidative stress, elevated scrotal temperature (normally 2–3°C below body temperature, essential for spermatogenesis), and direct hydrostatic venous pressure on testicular tissue. Varicocele correction surgery (varicocelectomy) can improve sperm parameters in a significant proportion of cases.

How is varicocele diagnosed?

Diagnosis is based on physical examination and scrotal color Doppler ultrasound. On exam, a varicocele feels like a “bag of worms” in the scrotum, typically on the left side. It is graded I to III based on palpability and visibility: Grade I is palpable only during Valsalva maneuver; Grade II is palpable at rest; Grade III is visible to the naked eye. Color Doppler ultrasound confirms the dilated veins (>3mm) and detects retrograde venous flow, while also measuring testicular volume to assess any testicular atrophy from chronic venous pressure.

Does varicocele surgery guarantee improved fertility?

No. Varicocelectomy improves semen parameters in approximately 60–70% of men with varicocele-associated infertility, but does not guarantee pregnancy. Natural conception rates improve after surgery in appropriately selected patients, particularly those with clinical (Grade II–III) varicocele, abnormal semen analysis, and a female partner with no major fertility issues. Surgery may also reduce testicular pain in symptomatic cases. Recurrence is possible even after technically successful surgery, and the final decision to proceed must be made after careful joint discussion between the urologist and the couple.

If you have concerns about varicocele and its impact on fertility or scrotal discomfort, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.