Varicocele: What It Is, When It Matters, and When to Leave It Alone

อัปเดตล่าสุด: สิงหาคม 27, 2026

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A varicocele is a collection of dilated veins around the testicle — varicose veins, in the same sense as those in the leg. It affects roughly 15 to 20% of men, causes nothing at all in most of them, and is found in a much higher proportion of men investigated for infertility.

Two things follow from that, and this article is mostly about holding both at once. It is the commonest correctable cause of male infertility — and it is also frequently found in men it is doing nothing to, which is why not every varicocele should be operated on.

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Why it is almost always on the left

Two anatomical facts explain it. The left testicular vein joins the left renal vein at a right angle, a longer and less favourable route than on the right, where the vein drains obliquely straight into the main abdominal vein. And the small valves that should stop blood flowing backwards often fail, so blood pools.

That asymmetry is worth remembering, because it makes a right-sided varicocele unusual — and an isolated new one on the right is a reason to look further. See the red flags below.

How it presents

1. Found during a fertility investigation, in a man with no symptoms at all. This is the commonest route to diagnosis. Pooled blood raises the temperature around the testicle — which needs to run cooler than the rest of the body to make sperm — and exposes it to oxidative stress and pressure.
2. A dull ache or heaviness, typically worse at the end of a day spent standing, and relieved by lying down.
3. Felt or seen by the man himself — the classic description is a bag of worms above the testicle.

Grading is by examination rather than by scan: Grade I is felt only when bearing down, Grade II is felt without, and Grade III is visible through the skin. Ultrasound confirms it, measures the veins and the size of each testicle, and detects backward flow.

When treatment is worth it — and when it is not

The earlier version of this article gave two indications. The list below is fuller, and includes the situation most often missed as well as the one most often over-treated.

Reasons to treat

• A varicocele you can feel, an abnormal semen analysis, and a couple trying to conceive. This is the main one, and the female partner’s assessment belongs in the decision — operating on the man while an untreated problem sits on the other side helps nobody.
• Pain that is genuinely attributable to it and has not settled with simple measures.
• An adolescent whose affected testicle is failing to grow. This was absent from the earlier version and matters, because a boy with a varicocele and a testicle measurably smaller than the other side is losing something that can be recovered if treated and may not be later. It is a reason for a urological opinion rather than watchful waiting, and it is why a varicocele found in a teenager should be measured rather than merely noted.

Reasons not to

• A varicocele visible only on ultrasound and not felt on examination. Scans pick these up readily, and treating them is not supported — this is the commonest reason men are operated on unnecessarily. If a urologist cannot feel it, the scan finding alone is not a reason to operate.
• A man with a normal semen analysis who is not trying to conceive and has no pain. A varicocele that is doing nothing does not need correcting because it exists.

How it is treated, and what to expect

No medication corrects a varicocele — the dilated veins remain dilated whatever is taken by mouth, and supplements marketed for it do nothing to them. A venoactive drug of the kind used for leg varicose veins may ease the ache in someone avoiding surgery, on weak evidence; that is relief of a symptom rather than treatment of the condition, and it is discussed under can a varicocele be treated with tablets.

• Microsurgical varicocelectomy, through a small incision at the top of the scrotum using an operating microscope, is the approach with the lowest rates of recurrence and of the commonest complication.
• Embolisation, blocking the vein through a catheter without an incision, is an alternative — particularly where a varicocele has come back after surgery.

Honest expectations matter more here than technique. Semen parameters improve in a good proportion of appropriately selected men, but improvement is not the same as pregnancy, and neither is guaranteed. A varicocele can recur even after a technically sound operation. The recognised complications are fluid collecting around the testicle, recurrence, and — rarely — injury to the artery supplying it.

Judge the result at three months at the earliest, since sperm take about that long to be produced and mature — a test done sooner is still reporting on the situation before surgery. See how to read a semen analysis, and what the monthly chance of conception actually is.

Findings that need attention rather than a routine appointment

ในกรณีฉุกเฉินในประเทศไทย โทร 1669.

• A varicocele on the right side only, or one that appears suddenly, or one that does not drain away when you lie down. Because of the anatomy described above, these patterns raise the possibility that something in the abdomen is pressing on the vein, including a kidney tumour. It needs imaging of the abdomen rather than reassurance, and it is the single most important thing on this page.
• A firm lump within the testicle itself, as opposed to the soft veins above it. That is a different problem and needs assessing promptly.
• Sudden severe testicular pain — an emergency the same day, and not a varicocele.
• One testicle becoming noticeably smaller than the other, particularly in a teenager.

คำถามที่พบบ่อยเกี่ยวกับภาวะเส้นเลือดขอดในถุงอัณฑะ

ภาวะเส้นเลือดขอดในถุงอัณฑะทำให้เกิดภาวะมีบุตรยากในเพศชายหรือไม่?

It is the commonest correctable cause of male infertility, and it is found in a substantially higher proportion of men investigated for fertility than in the general population. Pooled blood raises scrotal temperature, which sperm production depends on being lower than body temperature, and exposes the testicle to oxidative stress and pressure. That said, many men with a varicocele are entirely fertile — its presence does not by itself explain a fertility problem.

ผลอัลตราซาวนด์พบเส้นเลือดขอดที่อัณฑะ แต่แพทย์คลำไม่พบ ควรผ่าตัดหรือไม่?

No. Treating a varicocele detectable only on imaging is not supported, and it is the commonest reason men undergo this operation without benefit. Grading is done by examination; the scan confirms and measures rather than decides.

Mine is on the right side. Does that matter?

It is worth mentioning specifically. Varicoceles are overwhelmingly left-sided for anatomical reasons, so an isolated right-sided varicocele — particularly one that has appeared suddenly or does not empty when you lie flat — warrants imaging of the abdomen to exclude something pressing on the vein.

Will surgery guarantee a pregnancy?

No. Semen parameters improve in a good proportion of well-selected men — a palpable varicocele, an abnormal semen analysis, and a partner without a major fertility problem — but improved parameters are not the same as a pregnancy, and recurrence is possible. Allow at least three months before judging the result.

My teenage son has been told he has a varicocele. What now?

Most need only monitoring, but the testicles should be measured rather than simply examined. If the affected side is failing to grow in step with the other, that is a reason for a urological opinion, since growth can often be recovered with treatment and may not be later.

Is there a tablet for it?

Not one that corrects it. No medication or supplement makes dilated veins go away, so the options for the varicocele itself are surgery, embolisation, or leaving it alone — and leaving it alone is the right answer for a great many men. A venoactive drug may ease the ache in someone avoiding surgery, on weak evidence, which is a different question and is covered under can a varicocele be treated with tablets.

การนัดหมายเพื่อปรึกษา

Dr. Soarawee Weerasopone sees male fertility and andrology patients at โรงพยาบาลกรุงเทพ สำนักงานใหญ่ และที่โรงพยาบาล สมิติเวช ศรีราชา ในจังหวัดชลบุรี เมื่อวันที่ 088-022-1445. Bring any semen analysis reports with their dates, and any results your partner already has.

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