Varicocele

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 2 Apr 2025

Last updated: 26 Jul 2024

A varicocele is an abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.

Incidence is 15% in adolescent boys and adult men; 90% occur on the left side; 10% are bilateral.

May impede adolescent testicular growth and affect adult semen parameters and testosterone production.

40% of men evaluated in a male fertility clinic will have a varicocele.

Diagnosis is usually clinical; ultrasound may be helpful where there is doubt about the diagnosis.

Surgical correction may reverse testicular growth arrest in adolescents and improve semen parameters in adults.

Definition

A varicocele is the abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.[1]

History and exam

Key diagnostic factors

painless scrotal mass
left-sided signs/symptoms
small testicle

Full details

Other diagnostic factors

infertility
age >12
scrotal or groin pain

Full details

Risk factors

somatometric parameters (tall/low BMI)
family history of varicocele

Full details

Diagnostic tests

1st tests to order

clinical diagnosis

Full details

Tests to consider

scrotal ultrasound with color flow Doppler imaging
semen analysis
serum FSH (± GnRH stimulation)
serum testosterone
DNA fragmentation index (DFI)
CT abdomen/pelvis
MRI abdomen/pelvis
retroperitoneal ultrasound

Full details

Treatment algorithm

ACUTE

adolescent

adult

Contributors

Authors

Jay Ira Sandlow, MD

Professor and Chair

Department of Urology

Medical College of Wisconsin

Milwaukee

Disclosures

JIS declares that he has received stock options as a member of the Scientific Advisory Board for Contraline, Inc. and has served as a faculty member on the Vasectomy course for the American Urological Association.

Daniel L. Pelzman, MD

Fellow in Male Reproductive and Sexual Health

Department of Urology

Medical College of Wisconsin

Milwaukee

Disclosures

DLP declares that he has no competing interests.

Acknowledgements

Dr Jay Ira Sandlow and Dr Daniel L. Pelzman would like to gratefully acknowledge Dr Jagan K. Kansal, Dr Pravin Rao, Dr Miguel Pineda, Dr John C. Thomas, and Dr Wayne Kuang, previous contributors to this topic.

Disclosures

JKK, PR, MP, JCT, and WK declare that they have no competing interests.

Peer reviewers

Siam Oottamasathien, MD

Assistant Professor

Division of Pediatric Urology

University of Utah

Primary Children's Medical Center

Salt Lake City

Disclosures

SO declares that she has no competing interests.

Jeffrey Donohoe, MD

Assistant Professor

Pediatric Urology

Medical College of Georgia

Augusta

Disclosures

JD declares that he has no competing interests.

Daniel H. Williams, MD

Assistant Professor

Department of Urology

Head

Section of Male Infertility and Andrology

University of Wisconsin School of Medicine and Public Health

Madison

Disclosures

DHW declares that he has no competing interests.

Edmund Sabanegh, Jr, MD

Director

Center for Male Fertility

Glickman Urological and Kidney Institute

Cleveland

Disclosures

ES declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. J Urol. 2021 Jan;205(1):36-43.Full text Abstract

European Association of Urology. Sexual and reproductive health guidelines. Apr 2024 [internet publication].Full text

Persad E, O'Loughlin CA, Kaur S, et al. Surgical or radiological treatment for varicoceles in subfertile men. Cochrane Database Syst Rev. 2021 Apr 23;4:CD000479.Full text Abstract

European Association of Urology. Guidelines on paediatric urology. Apr 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Paratesticular mass
- Cord hydrocele
- Inguinal hernia
More Differentials
Guidelines
- Guidelines on paediatric urology
- Sexual and reproductive health: male infertility
More Guidelines
Patient information
Varicocele
Fertility problems: some reasons
More Patient information
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Varicocele

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

adolescent

adult

Contributors

Authors

Jay Ira Sandlow, MD

Disclosures

Daniel L. Pelzman, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Siam Oottamasathien, MD

Disclosures

Jeffrey Donohoe, MD

Disclosures

Daniel H. Williams, MD

Disclosures

Edmund Sabanegh, Jr, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice