At the end of the day, my priority is your health and well-being. Whether you're dealing with a complex urological issue or seeking advice on a sensitive matter, I am here to provide the expert care you need with the compassion and understanding you deserve.
Varicocele: Understanding the 'Bag of Worms' in Your Scrotum
Varicocele: Understanding the 'Bag of Worms' in Your Scrotum
As a Consultant Urological Surgeon specialising inmale fertilityandandrology, I, Mr. Giangiacomo Ollandini, have helped countless men understand and overcome varicoceles. This guide shares my clinical expertise and experience in a way that empowers you to make informed decisions about your health. Hearing the term 'varicocele' or feeling something unusual in your scrotum can be worrying, so let's break down what it means, what causes it, and crucially, what can be done.
In simple terms, a varicocele is like varicose veins, but located in your scrotum. It occurs when the veins that are supposed to drain blood away from your testicles become enlarged and swollen. You might hear it described as feeling like a 'bag of worms'. [9, 12]
Varicoceles are surprisingly common, affecting about 15% of all men. They're even more common in men facing fertility challenges, found in up to 40% of men with primary infertility (difficulty conceiving for the first time) and up to 80% of men with secondary infertility (difficulty conceiving after having previously fathered a child). Because of this strong link to fertility, and the discomfort they can sometimes cause, it's a condition I take very seriously in my practice at GGOmed. [12]
What Are the Symptoms and Signs of a Varicocele?
It's important to know that many men with varicoceles have no symptoms at all. You might only find out you have one during a routine check-up or if you're being investigated for fertility issues. [14] However, when symptoms do occur, they can include: [12]
A dull, aching, or dragging sensation in your scrotum. This discomfort often feels worse after standing for long periods, at the end of the day, or after physical exertion. [12]
A noticeable lump or swelling either above or behind your testicle.
What many describe as a "bag of worms" feeling when they touch the affected area of the scrotum. [9, 12]
A difference in size between your testicles, with the testicle on the side of the varicocele sometimes appearing smaller (testicular atrophy). [12]
Less commonly, pain that seems to worsen throughout the day.
In my clinical experience, symptoms tend to be more noticeable in men with larger (Grade 3) varicoceles, but even smaller varicoceles, if they are impacting blood flow significantly, can affect fertility without causing much discomfort.
Why Do Varicoceles Develop? Understanding the Causes
In most instances, varicoceles develop because of faulty valves within the veins that are supposed to help drain blood from your testicles back towards your heart. [12] These valves normally act like one-way doors, preventing blood from flowing backward. When these valves don't work correctly (a condition we call valvular incompetence), blood can pool in the veins of the spermatic cord. This pooling causes the veins to stretch and enlarge, leading to the formation of a varicocele.
As mentioned, varicoceles are most common on the left side. [12] This is primarily due to the specific anatomy of the left testicular vein. It joins the left kidney (renal) vein at a sharp right angle, and it's also longer than the right testicular vein. This arrangement can create higher pressure in the left testicular vein, making it more susceptible to valve failure and varicocele development.
The Impact of Varicoceles on Male Fertility
A crucial aspect of understanding varicoceles is their potential impact on male fertility. As I mentioned earlier, around 40% of men with primary infertility (never fathered a child) and up to 80% with secondary infertility (difficulty conceiving again after previous success) are found to have varicoceles. [12] This makes varicoceles the most common correctable cause of male infertility. [5, 14]
But how does a collection of swollen veins affect sperm? A varicocele can negatively impact fertility through several key mechanisms: [12]
Increased Testicular Temperature: The pooling of warm blood from the abdomen around the testicle raises its temperature. Sperm production (spermatogenesis) is highly sensitive to temperature and works best when the testes are slightly cooler than core body temperature. Even a slight increase can impair sperm development.
Oxidative Stress: The stagnant blood flow in a varicocele can lead to an increase in reactive oxygen species (ROS), also known as free radicals. This creates an environment of oxidative stress, which can damage sperm DNA, reduce sperm motility (their ability to swim), and affect their ability to fertilise an egg. My services include DNA fragmentation testing. [5]
Hormonal Imbalance: Varicoceles can sometimes disrupt the delicate hormonal balance necessary for healthy sperm production by affecting the function of Leydig cells (which produce testosterone) and Sertoli cells (which nourish developing sperm) within the testicles. Concerns about low testosterone can be explored further. [6]
Reflux of Toxins: There's also a theory that backward flow of blood might carry waste products or metabolites from the adrenal gland or kidney (on the left side) down to the testicle, creating a less favourable environment.
In my clinical practice at GGOmed, treating clinically significant varicoceles in men with abnormal semen parametersoften leads to noticeable improvements in sperm count, motility (movement), and morphology (shape). This can enhance the chances of natural conception or improve outcomes with assisted reproductive techniques like IVF or ICSI. [5]
How is a Varicocele Diagnosed?
Diagnosing a varicocele typically starts with a straightforward physical examination in my clinic. I'll need to examine your scrotum while you are standing, as varicoceles are often more prominent in this position due to gravity. I may ask you to perform a Valsalva manoeuvre – which simply means bearing down or coughing – as this can make the enlarged veins easier to feel.
To get a more detailed picture, especially for smaller varicoceles, to confirm the diagnosis, or to assess testicular size accurately, I will usually recommend:
Scrotal Ultrasound (Doppler Ultrasound): This is a painless, non-invasive imaging scan that uses sound waves to create pictures of your testicles and the veins around them. The Doppler part of the scan can specifically measure blood flow and show if blood is flowing backward in the veins, which is characteristic of a varicocele. It also allows precise measurement of testicular volume, which can be important if we are monitoring for any impact on testicular growth or size. GGOmed provides Scrotal Ultrasound with Colour Doppler evaluation. [8]
Semen Analysis: If fertility is a concern, one or more semen analyses will be essential. This laboratory test evaluates various aspects of your sperm, including count, motility (movement), morphology (shape), and other parameters like DNA fragmentation. This helps us understand if the varicocele might be affecting your sperm quality. Fertility testing including semen analysis is a core part of my practice. [14]
What Are the Treatment Options for a Varicocele?
It's really important to understand that not all varicoceles need treatment. The decision to treat a varicocele is highly individualised and depends on several key factors, including:
Your Symptoms: Are you experiencing pain, discomfort, or a heavy sensation that affects your quality of life?
Fertility Concerns: Are you and your partner trying to conceive, and are there abnormalities in your semen analysis? Explore more on my Male Infertility page. [14]
Testicular Size: Is there a noticeable difference in size between your testicles, or evidence of impaired testicular growth (especially in adolescents)?
The Grade (Size) of the Varicocele: Larger varicoceles are often more likely to be causing issues.
As your urologist, my role is to discuss these factors with you thoroughly, explain the potential benefits and risks of each approach, and help you make an informed choice that aligns with your personal circumstances and goals.
The main treatment options include: [12]
Observation and Conservative Management: If your varicocele is small, not causing symptoms, and your fertility is not currently a concern (or semen parameters are normal), simply monitoring the situation may be appropriate. This might involve periodic check-ups.
Microsurgical Varicocelectomy: This is a surgical repair performed using a high-powered operating microscope. It is generally considered the gold standard treatment due to its high success rates and low complication rates. This is the technique I specialise in at GGOmed and most frequently recommend for men who require intervention, particularly for fertility reasons. [8, 12]
Radiological Embolization: This is a minimally invasive procedure performed by an interventional radiologist. It involves blocking the affected veins by inserting tiny coils or a special solution through a catheter, usually inserted via a vein in the groin or neck. [12]
Laparoscopic Repair (Keyhole Surgery): This involves making small incisions in the abdomen and using a camera and surgical instruments to clip the problematic veins higher up. It is less commonly performed now for varicoceles alone, given the excellent outcomes of microsurgery.
Microsurgical Varicocelectomy: The Gold Standard Explained
When it comes to treating varicoceles effectively and safely, particularly for fertility enhancement or significant symptoms, microsurgical varicocelectomy stands out as the gold standard. [8, 12] This is the technique I specialise in and have extensive experience with at GGOmed, and it's the one I recommend for most of my patients requiring surgical intervention due to its superior outcomes. [5]
What makes it the gold standard? It involves: [12]
A small, targeted incision (usually 2-3 cm) in the groin area (inguinal or subinguinal approach).
The use of a high-powered operating microscope, providing significantly magnified vision (typically 6x to 25x).
This allows for precise identification and ligation (tying off) of all the abnormal, dilated veins that form the varicocele.
Critically, it also enables the meticulous preservation of essential structures: the testicular artery (or arteries, as sometimes there are more than one) which supplies blood to the testicle, the lymphatic vessels which drain fluid and prevent hydrocele formation, and the vas deferens (the sperm tube).
The key benefits of this meticulous, microscope-assisted approach include significantly lower recurrence rates(typically less than 1-2% compared to 5-30% with other methods), minimal risk of complications like hydrocele formation (fluid around the testicle) or testicular artery injury, and generally better improvements insemen parametersand pregnancy rates for infertile men. For further details on what to expect, see the procedure information on my website. [15]
What is Recovery Like After Varicocele Repair?
One of the common concerns men have is about the recovery period after varicocele treatment. For microsurgical varicocelectomy, most of my patients experience a relatively quick and smooth recovery with minimal discomfort.
Here’s what you can generally expect:
You'll likely be able to go home the same day as your procedure (it's typically a day-case surgery).
Most men can return to desk-based work within a few days (e.g., 2-5 days), depending on comfort.
You can usually resume light activities within about a week.
A return to full physical activity, including sports and heavy lifting, is generally advised after 2-4 weeks, once healing is well underway.
To ensure the best possible recovery and minimise complications, I typically advise my patients to:
Wear supportive underwear (like snug briefs or an athletic supporter) for the first 1-2 weeks to reduce swelling and provide comfort.
Avoid heavy lifting (e.g., anything over 10-15 kg or 20-30 lbs) and strenuous exercise for the recommended period (usually 2-4 weeks).
Take prescribed or over-the-counter pain medication as needed. Most discomfort is usually well-controlled with simple analgesics.
Keep the incision site clean and dry as per the specific instructions you'll receive. For general post-procedure guidance, see the procedure information on my website. [15]
Impact of Varicoceles and Treatment on Fertility & Sexual Function
For men who undergo varicocele repair, especially for fertility concerns, the outcomes can be very positive:
Statistically, around 60-70% of men see an improvement in theirsperm parameters (count, motility, morphology) after successful varicocele repair. [14]
For couples trying to conceive, varicocele repair can significantly increase the chances of natural pregnancy, with rates often reported in the range of 30-60% in the year or two following surgery (this depends on many factors, including female partner fertility and age).
Even if natural conception doesn't occur, improving sperm quality through varicocele repair can sometimes improve the success rates of assisted reproductive techniques (ART) like IUI (intrauterine insemination) or IVF/ICSI, or potentially allow couples to opt for less invasive ART methods. My clinic provides expert advice and treatment plans for male infertility. [14]
Regarding sexual function, varicocele repair typically has a positive or, at worst, neutral effect:
Men who experienced scrotal pain or discomfort related to their varicocele during sexual activity often find this pain is significantly reduced or eliminated after repair.
Relief from chronic scrotal discomfort can lead to improved overall testicular comfort and well-being.
Erectile function is generally not negatively affected by varicocele surgery. Some studies even suggest that in men with varicoceles and low testosterone, repair might lead to an improvement in testosterone levels, which could indirectly benefit libido and erectile function, though this is an area of ongoing research. [6] You can find more information on sexual health on my Andrology services page. [8]
Frequently Asked Questions (FAQs) About Varicoceles
My Approach to Varicocele Care: Your Health, Your Decisions
As a Consultant Urological Surgeon, Mr. Giangiacomo Ollandini, with a specialist focus on male reproductive health and andrology at GGOmed, my approach to managing varicoceles is centred on providing you with expert, evidence-based care that is tailored to your individual needs and priorities. [5, 11] My goal is to empower you with clear information so we can make shared decisions about your health journey.
This involves several key principles:
Thorough and Accurate Assessment: It starts with listening carefully to your symptoms, concerns, and what you hope to achieve. This is followed by a comprehensive physical examination and appropriate diagnostic tests like scrotal Doppler ultrasound [8] and semen analysis (if fertility is relevant). [14] A precise diagnosis is the foundation of effective treatment.
Individualised Treatment Planning: I firmly believe that there's no "one-size-fits-all" approach to varicoceles. Whether treatment involves observation, conservative measures, or intervention like microsurgical varicocelectomy, the plan will be customised based on your specific varicocele grade, symptoms, fertility status and goals, testicular health, and personal preferences.
Commitment to Technical Excellence: For patients who require surgical intervention, particularly for fertility enhancement or significant pain, I specialise in and advocate for microsurgical varicocelectomy. [8, 12] This technique, performed under high magnification, offers the highest success rates and the lowest risk of complications, ensuring the best possible outcomes by meticulously preserving vital structures.
Holistic and Comprehensive Care: I view varicocele management within the broader context of your overall reproductive and sexual health. We'll discuss not just the varicocele itself, but also any related concerns like testosterone levels, sexual function, or general well-being. [6]
Clear Communication and Shared Decision-Making: My aim is to explain complex medical information in an understandable way, discussing all available options, their pros and cons, and what the scientific evidence shows. This enables you to be an active participant in your care and make choices you feel confident about. You can find patient guides and leaflets on my resources page. [4]
Long-Term Support and Follow-Up: My commitment to your care extends beyond any single procedure. I provide ongoing follow-up to monitor your progress, manage any concerns, and ensure the lasting success of your treatment.
If you're experiencing symptoms that might suggest a varicocele, have been diagnosed with one, or have concerns about its potential impact on your pain levels, testicular health, or fertility, I encourage you to book a consultation at GGOmed. Together, we can accurately diagnose your condition, discuss your specific situation in detail, and explore the most appropriate and effective treatment options tailored to you. [5, 11]
During your confidential consultation, we will:
Take a comprehensive history of your symptoms and concerns.
Discuss all your treatment options, explaining the benefits and risks of each.
Answer all your questions thoroughly to ensure you can make a fully informed decision about your care.
My practice, GGOmed, offers a welcoming and discreet environment for all men seeking expert urological and andrological care. My team and I are committed to providing a supportive and inclusive experience. [5]
To book your appointment at my clinics or to enquire about virtual consultations: [4, 5, 7]
Clinic Locations: London: Chelsea and Westminster Hospital Private Care; Nuffield Health Highgate Hospital. [5, 9] Milton Keynes: The Circle Saxon Clinic. [5, 9]
(Specific addresses available on the Our Locations page)
Take Control of Your Testicular Health Today
Understanding varicoceles is the first step to managing them effectively. Whether you're dealing with discomfort, concerned about fertility, or simply seeking clarity, expert guidance from Mr G Ollandini can make all the difference. I am dedicated to providing personalised, state-of-the-art care for men with varicoceles and other andrological conditions at GGOmed. [5]
References and Further Reading
This information is intended for educational purposes only and should not replace consultation with a qualified healthcare professional. Please book a consultation for advice tailored to your specific medical situation. Last updated: 12 October 2025.
GGOmed is committed to providing clear and reliable patient information.
```
PIF TICK accredited information
The Patient Information Forum is the UK membership organisation and network for people working in health information and support. The PIF TICK is the UK-wide Quality Mark for Health Information.
