What Is Varicocele and Why Does It Affect Even Young Men?

Most men have never heard of a varicocele until they experience discomfort or begin trying to have children. Yet, varicocele is a very  common vascular condition affecting the male reproductive system.

Although it often develops during adolescence or early adulthood, many men do not receive a diagnosis until years later. Some experience aching pain or a feeling of heaviness. Others discover the condition during an infertility evaluation.

The good news is that varicocele is highly treatable. Today, minimally invasive procedures can relieve symptoms and improve blood flow without the need for traditional surgery.

Understanding what a varicocele is—and why it develops so early in life—can help men seek treatment before the condition begins affecting their health or fertility.

What Is a Varicocele?

A varicocele is an enlargement of the veins inside the scrotum. These veins form a network called the pampiniform plexus, which helps regulate the temperature of the testicles.

A simple way to picture a varicocele is to think about varicose veins in the legs. In both conditions, weakened vein valves allow blood to flow backward instead of toward the heart. As blood pools inside the veins, pressure builds and the veins enlarge.

Why Does a Varicocele Develop?

Healthy veins contain one-way valves that keep blood moving in the correct direction.

When these valves weaken or fail, blood flows backward and collects inside the scrotal veins.

Over time, pressure stretches the veins, causing them to enlarge.

Most varicoceles develop gradually and are not caused by exercise, heavy lifting, or sexual activity.

Why Does Varicocele Affect Even Young Men?

Unlike many vascular diseases that appear later in life, varicocele usually develops during adolescence.

It Often Appears Between Ages 15 and 25

During puberty, blood flow to the reproductive organs increases significantly.

Researchers believe this increased circulation places more pressure on the testicular veins. If the vein valves do not function properly, blood begins pooling inside the veins.

According to Johns Hopkins Medicine, most varicoceles develop between 15 and 25 years of age.

Why Is the Left Side More Common?

About 80% to 90% of varicoceles occur on the left side.

The reason lies in anatomy.

The left testicular vein drains into the left renal vein at a right angle. This creates greater venous pressure than on the right side, making backward blood flow more likely.

Bilateral varicoceles can also occur, although they are less common.

How Common Is Varicocele?

Many men are surprised to learn just how common this condition is.

Recent research shows:

• Approximately 15% of all adult men have a varicocele.
• Around 35% to 40% of men with primary infertility have a varicocele.
• Nearly 80% of men with secondary infertility are found to have a varicocele.
• About 85% of varicoceles occur on the left side.
• Most cases first develop during adolescence, although symptoms may not appear until adulthood.

According to the European Association of Urology (EAU), varicocele remains the most common correctable cause of male infertility.

What Symptoms Can a Varicocele Cause?

Many men never experience symptoms.

However, others develop problems that gradually worsen over time.

Common Symptoms Include

• Dull or aching scrotal pain
• A feeling of heaviness
• Enlarged or twisted veins
• Swelling inside the scrotum
• Pain after standing for long periods
• Pain after exercise
• Symptoms that improve when lying down

Pain is usually mild at first.

As venous pressure increases, discomfort may become more noticeable throughout the day.

Some Men Have No Symptoms at All

Many varicoceles are discovered during routine physical exams. Others are identified during fertility evaluations. This is one reason regular medical checkups remain important.

How Can Varicocele Affect Fertility?

One of the biggest concerns surrounding varicocele is its impact on male fertility.

Increased Testicular Temperature

Healthy sperm production requires the testicles to remain slightly cooler than normal body temperature.

The pampiniform plexus acts as a natural cooling system.

When blood pools inside these veins, scrotal temperature increases.

Even a small temperature increase may interfere with sperm production.

Reduced Sperm Quality

Research suggests varicocele may contribute to:

• Lower sperm count
• Reduced sperm movement (motility)
• Poor sperm shape (morphology)
• Increased sperm DNA damage

Not every man with a varicocele develops infertility. However, the condition remains one of the leading reversible causes of male infertility worldwide.

How Is a Varicocele Diagnosed?

Diagnosis usually begins with a physical examination.

Physical Examination

Your physician may ask you to stand while examining the scrotum.

Larger varicoceles often feel like a “bag of worms” because of the enlarged veins.

Scrotal Ultrasound

Ultrasound provides a detailed view of the veins.

It also measures blood flow and confirms whether blood is moving backward.

Because ultrasound is painless and non-invasive, it has become the preferred imaging test for diagnosis.

How Is Varicocele Treated?

Treatment depends on symptoms, fertility goals, and the severity of the condition.

Observation

Men without symptoms or fertility concerns only require periodic monitoring.

Surgical Repair

Traditional surgery ties off the enlarged veins to redirect blood flow through healthy vessels.

Although effective, surgery requires incisions and recovery time.

Varicocele Embolization: A Minimally Invasive Alternative

Today, many patients are good candidates for Varicocele Embolization.

During this outpatient procedure, an interventional specialist inserts a tiny catheter through the neck and travels inside the body into the  affected veins using real-time imaging.

Micro particles are deployed to  close the abnormal veins.

Blood  reroutes through healthy veins, relieving pressure within the scrotum.

The procedure takes 30 minutes and the patient goes back home with just a bandaid on the neck. 

Patients resume regular activities the same day.

Advantages of Varicocele Embolization

Compared with surgery, embolization offers several benefits:

• No surgical incision
• Local anesthesia with light sedation
• Outpatient procedure
• Fast recovery
• No discomfort
• Quick return to work and normal activities

When Should You See a Specialist?

Schedule an evaluation if you experience:

• Persistent scrotal pain
• A feeling of heaviness
• Enlarged veins inside the scrotum
• Difficulty conceiving
• Testicular shrinkage
• Symptoms that worsen throughout the day

Early diagnosis can prevent symptoms from becoming more severe and improves treatment outcomes.

Final Thoughts

Varicocele is far more common than many men realize.

Fortunately, modern medicine offers effective treatments, including minimally invasive embolization that avoids traditional surgery.

If you have noticed scrotal discomfort, enlarged veins, or fertility concerns, don’t ignore them. A consultation with a vascular specialist can determine whether varicocele is the cause and help you choose the treatment that best fits your needs.

Frequently Asked Questions About Varicocele

Academic and Medical Sources

Urology Care Foundation – Varicocele

https://www.urologyhealth.org/urology-a-z/v/varicoceles

European Association of Urology (EAU) – Male Infertility Guidelines

https://uroweb.org/guidelines/male-infertility

American Urological Association (AUA) – Male Infertility Guideline

https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility

Johns Hopkins Medicine – Varicocele

https://www.hopkinsmedicine.org/health/conditions-and-diseases/varicocele

Mayo Clinic – Varicocele

https://www.mayoclinic.org/diseases-conditions/varicocele

Cleveland Clinic – Varicocele

https://my.clevelandclinic.org/health/diseases/15239-varicocele

Society of Interventional Radiology – Varicocele Embolization

https://www.sirweb.org/for-patients/varicocele-embolization

National Library of Medicine (PubMed)

https://pubmed.ncbi.nlm.nih.gov