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Maybe you have an appointment coming up and feel nervous. Or maybe you are holding an ultrasound report full of strange words.

Both are very common. This article walks you through each step of a varicocele diagnosis, so you know what to expect.

⚠️ Go to an emergency department now if: You have sudden, severe pain in a testicle. Do not wait for a routine appointment. This can be a twisted testicle (testicular torsion). It needs treatment within hours. It is not the usual pattern of a varicocele.

Varicocele Diagnosis: Why a Doctor’s Check Matters

A varicocele is a group of swollen veins inside the scrotum. The scrotum is the skin pouch that holds the testicles.

Varicoceles are common. Many cause no harm at all. But only a trained doctor can confirm one.

Why You Can’t Confirm It From Symptoms

Some men notice a heavy, dragging feeling, or veins that “look like worms.” These signs can point to a varicocele.

But other conditions can feel very similar. You can read more about common varicocele symptoms. Still, only an examination can show what is really going on.

Why a Report Alone Is Not Enough

Picture this. You get a scan at a diagnostic center. That night, you sit with the report and search every word on your phone.

You feel more worried, not less. That is normal. A report makes the most sense when the doctor who examined you reads it with you.

The Fear Behind the Question

Most men who search this topic carry quiet worries. You may be thinking:

•     “Will the exam be embarrassing?”
•     “Is this something serious?”
•     “Will this affect my chance of having children?”
•     “Does my report mean I need an operation?”

These are fair questions. This article answers the first two directly.

For fertility and treatment, we have separate guides, linked below. That way, each answer gets the care it deserves.

How Soon Should You Get Assessed?

Not every change needs the same speed. Use this simple guide.

Urgent: go to an emergency department today

•     Sudden, severe pain in a testicle

Act soon: book an appointment within days

•     A new lump or swelling you have not had checked
•     One testicle looks smaller than before
•     A swelling that does not go down when you lie flat

Watchful: keep your regular follow-up

•     A small varicocele that your doctor has already checked and that has not changed

If you are unsure which group you fit, choose the faster option. It is always fine to get checked.

What Happens During a Varicocele Assessment

A varicocele assessment is usually short. It has two main parts: a conversation and a physical examination.

Step 1: Your Medical History

Your doctor will start by talking with you. They may ask:

•     When you first noticed a change. A long-standing change and a sudden one can mean different things.
•     If you feel any discomfort, and when. For example, some men feel a dull ache after standing all day.
•     About past surgery or injury. This includes any operation on the groin or scrotum.
•     About your general health. This includes your medicines and other conditions.
•     If you are planning a family. This is asked only to decide if other tests may help.

Answer as openly as you can. Honest answers help your doctor reach the right conclusion.

What you share stays private between you and your doctor.

Step 2: The Varicocele Examination

The physical exam is the most important step. Your doctor will usually follow this routine:

1.   A private, warm room. Cold makes the scrotum tighten. This can hide swollen veins.
2.   Standing first. Veins fill with blood when you stand. This makes a varicocele easier to feel.
3.   Gentle feeling of the veins. Your doctor gently feels the area above each testicle. Swollen veins can feel like soft, twisted cords.
4.   Bearing down. You may be asked to take a deep breath, hold it, and push down, as if straining on the toilet. Doctors call this the Valsalva maneuver. It can make a small varicocele easier to feel.
5.   Checking both sides. Varicoceles are most common on the left. Your doctor still checks both sides.
6.   Lying down. Your doctor may check again while you lie on your back. A typical varicocele gets smaller or empties when you lie flat.

Step 3: Checking Testicle Size

Your doctor will compare the size of your two testicles. Sometimes a varicocele is linked with one testicle being smaller.

Your doctor may use an orchidometer. This is a string of oval beads, each of a known size. The doctor holds the beads beside the testicle to find the closest match.

It is quick and painless.

For parents of teenage boys: this size check is often a key part of the visit. Doctors may compare growth over time before suggesting any next step.

Feeling Shy? Here Is What to Expect

Many men feel shy before a genital exam. Some delay seeing a doctor for months because of it. You are not alone.

Doctors do these exams often. To them, it is a routine medical check, done with care and respect.

Here is what you can usually expect:

•     It is brief. It often takes only a few minutes.
•     It should not hurt. You may feel gentle pressure.
•     You stay in control. You can ask the doctor to explain each step first. You can ask to pause at any time.
•     You can ask for support. You can ask if a chaperone or trusted person may be present.

How to Prepare for Your Visit

•     Bring any old reports, scans, or prescriptions.
•     Write down your questions before you go.
•     Wear loose, comfortable clothes.

Varicocele Grading Explained

After the exam, your doctor may describe your varicocele with a grade. Varicocele grading is based on how easily the veins can be felt or seen.

What a Grade Does Not Tell You

A grade describes size. It helps your doctor record findings and track changes over time.

But a grade does not decide whether you need treatment. A higher grade does not automatically mean an operation.

A grade also cannot predict your fertility by itself. If this is your worry, read how varicocele may relate to male fertility.

For questions about care, see our guide on whether treatment is needed.

When Is a Varicocele Ultrasound Used?

Many varicoceles can be found with a careful exam alone. An ultrasound is not needed for everyone.

Your doctor will suggest one only when it is likely to add useful information.

Situations Where an Ultrasound May Help

•     The exam is unclear. Body shape, a tight scrotum, or old scars can make veins hard to feel.
•     Your doctor wants to confirm the findings. An ultrasound shows the veins directly.
•     A more exact size check is needed. Ultrasound measures testicle size more precisely.
•     The varicocele may have come back. After past treatment, a scan can check this.
•     Something seems unusual. Your doctor may want a closer look.

What a Scrotal Ultrasound for Varicocele Feels Like

The test is usually called a scrotal Doppler ultrasound. “Doppler” shows which way blood is flowing in the veins.

Here is what usually happens:

1.   You lie on your back. A towel may be used to cover you.
2.   A cool gel is put on the skin of your scrotum.
3.   A small handheld device, called a probe, is moved gently over the area.
4.   You may be asked to bear down or stand, so blood flow can be checked.

The scan uses sound waves, not radiation. It is usually painless. You can go back to normal activities straight after.

Understanding Your Ultrasound Report

Reports are often written in technical English. Here are common terms in plain words:

•     Pampiniform plexus: The network of small veins around the testicle. A varicocele is a swelling of these veins.
•     Dilated veins: Veins that are wider than usual.
•     Venous reflux: Blood flowing backward in the veins. This is a key thing the scan looks for.
•     Testicular volume: The measured size of each testicle, often in milliliters (mL).
•     Bilateral: Both sides are affected.

About the Numbers on Your Report

Your report may list a number for vein width. It is natural to search what it means.

But cut-off values differ between guidelines and centers. One number cannot confirm or rule out a varicocele.

There is nothing wrong with reading your report. Just bring it to your doctor. They can connect it to what they felt in the exam and what you told them.

How Your Doctor Puts It All Together

A varicocele diagnosis is never based on one finding. Your doctor combines four pieces:

1.   Your medical history
2.   The physical exam
3.   The grade, if a varicocele is found
4.   Ultrasound results, if a scan was done

This is why two men with similar reports may get different advice.

When Your Doctor May Look Further

Most varicoceles follow a familiar pattern. Sometimes a feature is different. Then your doctor may arrange extra imaging, such as a scan of the abdomen. Examples include:

•     A varicocele only on the right side
•     A varicocele that appears suddenly in an adult
•     Veins that do not empty when you lie down

If this happens, try not to panic. It is a sign of careful practice. It helps make sure nothing is missed.

Other Conditions Your Doctor Will Rule Out

Several other conditions can cause a swelling or lump in the scrotum:

•     Hydrocele: Fluid build-up around the testicle
•     Inguinal hernia: Tissue pushing down from the groin
•     Epididymal cyst: A small fluid-filled sac near the testicle
•     Testicular lump: A firm lump inside the testicle, which always needs a prompt check

Never assume a new lump is “just a varicocele.” Please get it checked.

Other Tests You May Hear About

If you are trying for a baby, your doctor may mention a semen analysis (a lab test of a sperm sample) or hormone blood tests.

These tests do not diagnose a varicocele. They answer a separate fertility question. Learn more in our guide on varicocele and male fertility.

After Diagnosis: What Comes Next

A diagnosis is not a treatment decision. These are two separate steps.

Many men with a varicocele never need treatment. Their doctor simply suggests regular check-ups.

To learn what choices may be discussed, see varicocele treatment options. For the bigger picture, read our complete guide to understanding varicocele.

Key Takeaways

•     A doctor diagnoses a varicocele mainly through history and examination.
•     The exam is usually quick, private, and not painful.
•     A grade describes size. It does not decide treatment or predict fertility.
•     An ultrasound helps in some cases. Not everyone needs one.
•     Your report makes most sense when your doctor reviews it with you.
•     Sudden, severe testicle pain is an emergency.

Frequently Asked Questions

Can a varicocele be diagnosed without an ultrasound?

Yes, often it can. Many varicoceles are clearly felt during a careful exam, especially when you stand and bear down. An ultrasound is usually suggested only when the exam is unclear, when exact measurements are needed, or when something looks unusual.

Is the varicocele examination painful?

No, it should not be painful. You may feel gentle pressure for a few minutes. If anything feels uncomfortable, tell your doctor straight away. You can also ask them to explain each step first.

Why does the doctor ask me to stand and bear down?

Standing lets blood fill the scrotal veins. Bearing down raises pressure in your belly for a moment. Both make a small varicocele easier to feel, so it is less likely to be missed.

What does a Grade 2 varicocele mean?

A Grade 2 varicocele can be felt while you stand normally, without bearing down. It usually cannot be seen through the skin. It is a medium size on exam. Your doctor will consider it with your other findings.

Does a higher grade mean I need surgery?

Not necessarily. A grade describes size only. Your doctor also looks at discomfort, testicle size, age, and family plans. Many men with any grade are simply monitored. Learn more about varicocele treatment options.

Can I read my own ultrasound report?

Yes, and knowing common terms can help you feel prepared. But cut-off values vary between centers, and one number rarely tells the full story. Bring your report to your doctor for a proper review.

What is a subclinical varicocele?

It is a varicocele that cannot be felt or seen during an exam. It shows up only on an ultrasound. Your doctor will explain whether it matters for you, based on why the scan was done.

Getting Assessed in Dhaka

If you have noticed a change, or you have a report you want to understand, a calm and private check is a good next step.

Learn more about varicocele assessment in Dhaka, or book a consultation at a time that suits you.

About the Author:

Md. Salauddin Biswas works as a healthcare website SEO and content strategist, assisting doctors and clinics in converting complex medical subjects into clear, trustworthy content.

He holds an MA in Medical Anthropology from the University of Heidelberg, Germany, and an MA in Islamic History & Culture from the University of Dhaka, where he graduated with 1st Class, 1st Position.

He is a former Senior Research Associate at the James P Grant School of Public Health, BRAC University, and a published author in peer-reviewed health research. He has worked in healthcare SEO since 2017 and is based in Dhaka, Bangladesh. Learn more at salauddinbiswas.com/about/.

Medically Reviewed by:

Dr. Nazrul Islam, MBBS, MS (General Surgery)

FCPS (Surgery) · MS (Colorectal Surgery) · FACS (Fellow, American College of Surgeons)

Assistant Professor (Colorectal Surgery), Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh.

Learn more about Dr. Nazrul Islam.

 References: 

• Kim DK, Kim DS, Kam SC, Lee HS, Lee WK, Song SH. Recent Guidelines and Perspectives for Varicocele: A Clinical Consensus and Recommendations from the Korean Society for Sexual Medicine and Andrology. World Journal of Men’s Health. 2025.
• Freeman S, Bertolotto M, Richenberg J, Belfield J, et al. Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group for detection, classification, and grading. European Radiology.
• American Urological Association and American Society for Reproductive Medicine. Report on Varicocele and Infertility.

You may notice a dull pain after a long day, a sensation of heaviness on one side, or new visible veins in your scrotum.

It is normal to feel concerned; many men experience these symptoms. This article explains common varicocele symptoms, when to see a doctor, and when urgent care is needed.

What Is a Varicocele?

A varicocele is when veins in the scrotum—the skin sac that holds the testicles—become enlarged.

These veins carry blood away from the testicle. When they get bigger, they can look and feel like varicose veins in the legs.

Varicoceles are common and usually develop slowly, most often on the left side.

For more information, please refer to our guide on understanding varicocele.

Many Varicoceles Cause No Symptoms

You can have a varicocele and not notice it at all. Many men only find out by accident, such as during:

• A routine check-up
• A visit for another health concern
• A self-check or while bathing

It’s common to have no symptoms. This doesn’t mean anything has been missed or that you need to do anything.

Symptoms vary from person to person. Some men barely notice them, while others feel more discomfort. Both are normal.

Common Varicocele Signs and Symptoms

Varicocele signs are usually mild and tend to develop slowly, not suddenly.

People usually notice the following signs:

A Dull Ache or Varicocele Pain:

Varicocele pain is usually dull rather than sharp. People often describe it as:

• Aching or dragging
• Mild discomfort that comes and goes
• A feeling of fullness in the scrotum

The pain often improves when you lie flat on your back. This position helps blood drain from the veins, which lowers the pressure.

This is a common sign of varicocele, but it’s not enough to confirm you have one.

Scrotal Heaviness:

A common symptom is a heavy feeling in the scrotum. Sometimes one side feels heavier, fuller, or like it’s being pulled down.
This feeling is usually stronger on one side, most often the left. Many men notice it at the end of the day, and it often goes away after rest or sleep.

Visible Scrotal Veins:

A large varicocele can make the veins in the scrotum visible. You might see bluish, twisted veins through the skin.

You might also feel soft, rope-like cords above the testicle. These veins usually:

• Stand out more when you stand up
• Look less obvious when you lie down
• Are easier to notice in warm weather or after a hot bath

Small varicoceles often can’t be seen or felt at home. They’re usually found by a doctor during an exam.

A Difference in Testicle Size:

One testicle may look or feel smaller than the other. This change is usually slow and slight.
If you notice this, see a doctor. Don’t try to judge the cause yourself, since size differences can have several reasons.

When Symptoms Tend to Show Up

Varicocele symptoms often follow a pattern. You might notice them more:

• If you have stood for a long time, jobs that keep you on your feet can make the ache more noticeable.
• By the end of the day, discomfort tends to increase as the day progresses.
• While carrying out the action or afterwards. Doing some exercise, lifting heavy objects, or straining can temporarily worsen the heaviness.
• When it’s hot; whether due to hot weather or from taking a hot bath the veins can become more noticeable.

Varicoceles usually show up during the teenage years or early adulthood, but they can happen at any age.

What Varicocele Discomfort Usually Is Not

Varicocele discomfort is usually mild and develops slowly. It’s not typically:

• Sudden, severe, or stabbing pain
• Pain that comes with fever, nausea, or vomiting
• Swelling that grows quickly

If you have any of these symptoms, something else could be going on. For more details, see the urgent care section below.

Not Every Scrotal Change Is a Varicocele

This is one of the main points of the article.

Pain, swelling, or a lump in the scrotum can have many causes. Some are harmless, while others need quick treatment.

Conditions that can cause similar symptoms include:

• Hydrocele: fluid that builds up around the testicle
• Epididymitis or orchitis: swelling or infection of the tube behind the testicle, or of the testicle itself
• Inguinal hernia: tissue from the belly pushing into the groin or scrotum
• Cyst: a small, fluid-filled lump, often near the top of the testicle
• Testicular torsion: the testicle twists and cuts off its own blood supply
• Testicular tumor: less common, but important to rule out

Don’t assume a lump is a varicocele, even if a friend had something similar. Only an exam can tell for sure.

Most changes in the scrotum aren’t serious, but only a doctor’s exam can confirm that.

⚠️When to Seek Urgent Medical Care

Get emergency help right away if you have:

• There may be a sudden and intense pain in one of the testicles, which can be a sign of testicular torsion and requires treatment within hours in order to save the testicle.
• Testicular pain with nausea or vomiting
• A scrotum that swells quickly, or turns red, hot, or tender
• Scrotal pain or swelling with a fever, which may point to an infection
• Pain or swelling after an injury to the groin

You shouldn’t wait to find out whether it goes away or spend time searching online. Go to the nearest emergency department. cy, and the symptoms indicate other issues.

When to Book a Doctor’s Appointment

Some symptoms aren’t emergencies, but it’s still a good idea to see a doctor soon.
Book an appointment if you:

• Notice a new lump, swelling, or change in your scrotum, even if it doesn’t hurt
• Have an ache or heaviness that lasts more than a few days or keeps coming back
• Can see or feel enlarged, twisted veins
• Notice one testicle looks or feels smaller, especially if it’s new
• Find that the veins don’t get smaller when you lie down
• Notice veins that appear suddenly, appear only on the right side, or first appear later in adult life
• Feel discomfort that gets in the way of work, exercise, or daily life
• Are worried about having children

To rule out any other possible causes, it’s best to have these symptoms checked soon rather than wait. You should contact the clinic.

How to Prepare for Your Visit

A few notes can help your doctor understand your situation. Before your appointment, make a list of:

• When you first noticed the change
• Which side does it affect
• Whether it has grown or changed
• What makes it better or worse, such as standing, lying down, heat, or exercise
• Any other symptoms, like fever or pain when passing urine
• Any questions or worries you have

Doctors check this area every day, so there’s no need to feel embarrassed. Clear details help them give you clear answers.

What Comes Next

A doctor will talk with you and do an exam to find out if you have a varicocele. To learn more about the diagnosis process, see the section on how a varicocele is diagnosed.

If you’re worried about fertility, check the section on varicocele and male fertility. The effect varies from man to man and requires a personal evaluation.

Key Takeaways

✅ Many varicoceles cause no symptoms. Some are found by chance during a routine check.

✅ Common signs are a dull ache, scrotal heaviness, and visible or twisted veins.

✅ Symptoms often get worse after standing, at the end of the day, or with effort, and ease when you lie down.

✅ Symptoms can’t confirm a varicocele. Other conditions can feel the same.

✅ A new lump always needs a doctor’s check. Don’t assume it’s a varicocele.

✅ Sudden, severe testicular pain is an emergency. Get urgent care right away.

Frequently Asked Questions

Does a varicocele always cause pain?
No. Many men have no symptoms at all. When pain happens, it is usually a dull, dragging ache, not a sharp pain.

Is varicocele pain constant?
Usually not. It tends to come and go. It often gets worse with standing or activity and eases with rest.

Why does the ache get better when I lie down?
Lying flat helps blood drain from the widened veins. That lowers the pressure, so the ache often eases.

Can I tell on my own if I have a varicocele?
You can notice changes, but you can’t confirm a varicocele yourself. Other conditions can cause the same symptoms. A doctor needs to examine you.

Which side does a varicocele usually affect?
It most often affects the left side. Tell your doctor if you notice changes on the right side or on both sides.

Is a varicocele dangerous?
A varicocele is usually not an emergency. But sudden, severe testicular pain always needs urgent care, because it may be a different, time-sensitive problem.

Talk to a Doctor About Your Symptoms

You don’t have to figure this out alone. If you’ve noticed any of the signs above, or you simply want peace of mind, an examination is the safest next step.

Your doctor will listen, examine you, and explain what is happening in your case.

If you’re in Dhaka, you can learn more about varicocele care in Dhaka with Dr. Nazrul Islam [verify clinician services, credentials, and clinic location before publishing], or contact the clinic to book a consultation.

References

• EAU Guidelines on Sexual and Reproductive Health (2025 PDF) – https://d56bochluxqnz.cloudfront.net/documents/EAU-Guidelines-on-Sexual-and-Reproductive-Health-2025.pdf
• AUA/ASRM Guideline: Diagnosis and Treatment of Infertility in Men, Part I – https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000001521
• World Journal of Men’s Health review: Recent Guidelines and Perspectives for Varicocele – https://www.wjmh.org/pdf/10.5534/wjmh.240290

About the Author:

Md. Salauddin Biswas works as a healthcare website SEO and content strategist, assisting doctors and clinics in converting complex medical subjects into clear, trustworthy content.

He holds an MA in Medical Anthropology from the University of Heidelberg, Germany, and an MA in Islamic History & Culture from the University of Dhaka, where he graduated with 1st Class, 1st Position.

He is a former Senior Research Associate at the James P Grant School of Public Health, BRAC University, and a published author in peer-reviewed health research. He has worked in healthcare SEO since 2017 and is based in Dhaka, Bangladesh. Learn more at salauddinbiswas.com/about/.

Medically Reviewed by:

Dr. Nazrul Islam, MBBS, MS (General Surgery)

FCPS (Surgery) · MS (Colorectal Surgery) · FACS (Fellow, American College of Surgeons)

Assistant Professor (Colorectal Surgery), Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh.

Learn more about Dr. Nazrul Islam.

Related Topics:

Varicocele Symptoms
Varicocele Diagnosis
Varicocele and Fertility
Varicocele Treatment Options
Varicocele Surgery
Varicocele Surgery vs Embolization
Last Updated: September 28, 2026

Quick Answer:

A varicocele is made up of enlarged veins in the scrotum, similar to varicose veins in the legs. Many men have no symptoms, but if symptoms do appear, they might notice a dull ache, visible veins, or a feeling of heaviness. Not every varicocele needs treatment. Before deciding what to do, it helps to understand what a varicocele is, what symptoms to look for, how it is diagnosed, and whether it could affect fertility.

You might have noticed a change, like a dull pain in your scrotum or a new feeling of heaviness. Maybe you saw enlarged veins while in the shower, or your doctor mentioned ‘varicocele’ during a checkup or fertility test.

It’s normal to feel concerned. The scrotum is a sensitive area, so any change can be worrying. You might wonder if this is serious, if it will get worse, or if it could affect your ability to have children.

This page is here to help you understand what a varicocele is, what symptoms you might have, how doctors find it, and whether it could affect your fertility. You don’t have to decide anything right now. The goal is to give you clear, honest information so you know which questions to ask and which steps might be right for you.

​

What Is a Varicocele?

A varicocele consists of the enlargement of the veins in the scrotum, which form part of the pampiniform plexus, a network responsible for draining blood from the testicles.

Varicoceles are similar to varicose veins in the legs because the same process happens. If the valves in the veins do not function properly, blood collects rather than flowing smoothly back to the heart. This causes the veins to stretch and get bigger over time.

Varicoceles are common. Research shows they affect about 10 to 15 out of every 100 men. They usually appear during puberty, when blood flow to the scrotum increases as the body grows.

Most varicoceles are found on the left side. This is because the vein from the left testicle drains into a larger vein at a steeper angle, making it harder for blood to flow upward. Right-sided or bilateral varicoceles are less common.

It’s important to remember that having a varicocele does not mean you have a problem. Many men live with a varicocele all their lives without symptoms, fertility issues, or needing any treatment.

A varicocele only needs attention if it causes discomfort, is found during a fertility check, or is noticed during a physical exam and needs monitoring. Understanding what a varicocele is helps you and your doctor decide if it should be treated or simply observed.

​

Why Understanding Matters

Not all varicoceles cause problems. Some men never know they have one, while others only find out during a fertility checkup.

Before you look for treatment options or worry about what might happen, it helps to consider three main questions:

Am I experiencing any symptoms?

Some varicoceles cause discomfort or visible changes, but many do not. Knowing what symptoms to look for helps you explain your experience clearly to your doctor.

How is it diagnosed?

A varicocele can be confirmed with a physical exam and sometimes an ultrasound. Understanding this process can help you feel less uncertain.

Would this have an effect on my fertility?

This is often the question that worries people most. While there is a real link between varicocele and fertility, it does not affect everyone the same way. Each case needs to be looked at individually.

Let’s look at each question to help you understand your situation before deciding what to do next.

​

What symptoms might you notice?

Many varicoceles cause no symptoms whatsoever. They are found by accident during a routine physical examination or when assessing fertility.

When symptoms do appear, they are usually mild and develop slowly. Here are some things men often notice:

A sense of dullness or heaviness.

This is the most common complaint. It is not sharp or severe, but more of a tired, dull feeling in the scrotum. The discomfort often worsens after prolonged standing, during physical activity, or at the end of the day, and usually improves when you lie down.

Visible or palpable veins.

You might notice veins above the testicle that look enlarged and twisted. Some men describe the area as feeling like ‘a bag of worms’ when touched. The veins are easier to see when standing and less noticeable when lying down.

A difference in testicle size.

Over time, the affected testicle may become smaller than the other. This happens because poor blood flow can affect testicular health. It is not usually painful, but you might notice the difference.

The symptoms vary depending on the position.

Discomfort usually improves when you lie down because gravity is no longer pulling against blood flow. Symptoms can worsen during exercise, with heavy lifting, or after prolonged standing.

Important safety note:

Severe, sudden pain in the testicles is not a typical symptom of varicocele. If you feel sharp, intense pain that starts suddenly, see a doctor right away. This could be a sign of testicular torsion or another serious problem.

For more information on recognizing and understanding the symptoms of varicocele, including when to seek medical care, please see our detailed page on Varicocele Symptoms.

​

Question 2: What Is the Method of Diagnosis?

A varicocele is diagnosed with a physical exam and, if needed, imaging tests. The process is simple and does not involve surgery.

Physical examination.

Your doctor will check your scrotum while you are standing, because varicoceles are easier to find in this position, as gravity causes more blood to pool. The doctor may ask you to perform a Valsalva maneuver, which involves taking a deep breath and bearing down, as when having a bowel movement. This increases pressure in your abdomen and makes the enlarged veins easier to see.

The doctor will examine both testicles to assess their size and consistency and look for any lumps or abnormalities.

Scrotal ultrasound.

If the physical exam is unclear or your doctor wants to confirm the diagnosis and check how serious it is, you will be assessed for severity. This is a painless test that uses sound waves to create images of the veins and testicles. It can show blood flow patterns and measure vein size.

Ultrasound is particularly useful for a small varicocele, if you are overweight (since this can make the physical examination more difficult), or when there are concerns about other scrotal conditions.

Grading.

Doctors may grade varicoceles from Grade 1 (small, only felt during a Valsalva maneuver) to Grade 3 (large and visible without any maneuver). The grade shows the size, not how serious it is. A large varicocele does not always need treatment, and a small one is not always harmless. The overall situation is more important than the grade alone.

Why professional assessment matters.

You cannot diagnose a varicocele on your own. While symptoms and self-checks might make you suspect it, only a qualified doctor can confirm the diagnosis and rule out other similar conditions.

If you want to understand the entire diagnostic procedure, including what to anticipate during the assessment and how the results are interpreted, please read the page on ‘How Is a Varicocele Diagnosed’.

Question 3: Might This Have an Effect on Fertility?

This is usually the question that worries people most. The short answer is that it is possible, but not certain.

The relationship between varicocele and fertility.

Research shows that varicoceles are more common in men with infertility than in the general population. The enlarged veins can raise the temperature around the testicles, which may affect sperm production. Poor blood flow can also cause waste products to build up, which can affect sperm quality.

However, it is important to know that not all men with a varicocele have fertility problems. Many men with varicoceles can have children without any trouble. Having a varicocele does not mean you are infertile.

When fertility concerns arise.

A varicocele becomes a fertility concern when:

• A couple have been trying to have a child for a year or so without success.
• A semen analysis will show that the sperm count, motility (the ability to move), or morphology (the shape) is abnormal.
• A varicocele is detected when assessing fertility, and no other cause of infertility is found.

Individual assessment is essential.

Many factors affect fertility, not just having a varicocele. Your partner’s health, timing, your general health, and other medical issues all play a role. A semen analysis gives some information about sperm quality, but one test does not tell the whole story. Often, more tests and a specialist’s opinion are needed.

What a varicocele does not mean.

This does not mean you cannot have children. It also does not mean that treatment will guarantee conception. Not every varicocele needs surgery to improve fertility.

Deciding whether to treat a varicocele to improve fertility should be done after a specialist carefully reviews your case. This includes looking at your partner’s fertility, your semen analysis results, and your overall health.

If you want to find out more about the relationship between varicocele and male fertility, including what your semen analysis results may indicate and when treatment might be considered, please see our page on Varicocele and Male Fertility.

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When to Consider Next Steps

Not every varicocele needs treatment. Many men live comfortably with the condition and do not need any intervention.

Treatment may be discussed if:

• You continue to experience discomfort which has an effect on your everyday life.
• You and your partner are experiencing difficulties with fertility, and a varicocele has been found as a possible cause.
• During the clinical assessment, a doctor notices concerning changes, for example a progressive shrinkage of the testes.

At that point, you and your doctor will decide together about treatment, considering the benefits, risks, and your personal situation.

If you want to learn about your treatment options, such as observation, surgery, and embolization, and how decisions are made, please read the page on Varicocele Treatment Options.

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What to Read Next

The first step is to understand what a varicocele is. The following pages let you explore this topic in more detail:

• If you want to find out more about symptoms, see our full guide on Varicocele Symptoms: What to Notice and When to Seek Care.
• If you’d like to know about the diagnostic process, see: How Is a Varicocele Diagnosed?
• If you’re worried about your fertility, see “Varicocele and Male Fertility: What the Relationship Means” for more information.
• If you’d like to look into treatment options, start with the following: Varicocele Treatment Options: Observation, Surgery and Embolization.
• If you’re after care in Dhaka, please go to our main page: Varicocele in Dhaka.

Conclusion

Varicoceles are common, and often there is no need to worry. But if you have symptoms, are concerned about fertility, or just want peace of mind, getting a proper assessment is the best step.

Dr. Nazrul Islam, a consultant general and colorectal surgeon in Dhaka, provides thorough and patient-focused assessments for men concerned about varicocele. He will clearly explain your condition, offer honest advice about treatment, and create a plan that fits your personal needs.

Book a consultation with Dr. Nazrul Islam to get the clarity you deserve.

References:

• World Health Organization. (2010). WHO laboratory manual for the examination and processing of human semen (5th ed.). url: https://mes-global.com/wp-content/uploads/2023/09/WHO5thEdition-1.pdf
• Jarow, J. P. (2001). Effects of varicocele on male fertility. Human Reproduction Update, 7(1), 59-64. url: https://pubmed.ncbi.nlm.nih.gov/11212076/
• Neves da Silva HV, Meller RL, Ogundipe EA, Rochon PJ. Varicoceles: Overview of Treatment from a Radiologic and Surgical Perspective. Semin Intervent Radiol. 2022 Dec 20;39(5):490-497. doi: 10.1055/s-0042-1757939. PMID: 36561940; PMCID: PMC9767781.

About the Author:

Md. Salauddin Biswas works as a healthcare website SEO and content strategist, assisting doctors and clinics in converting complex medical subjects into clear, trustworthy content.

He holds an MA in Medical Anthropology from the University of Heidelberg, Germany, and an MA in Islamic History & Culture from the University of Dhaka, where he graduated with 1st Class, 1st Position.

He is a former Senior Research Associate at the James P Grant School of Public Health, BRAC University, and a published author in peer-reviewed health research. He has worked in healthcare SEO since 2017 and is based in Dhaka, Bangladesh. Learn more at salauddinbiswas.com/about/.

Medically Reviewed by:

Dr. Nazrul Islam, MBBS, MS (General Surgery)

FCPS (Surgery) · MS (Colorectal Surgery) · FACS (Fellow, American College of Surgeons)

Assistant Professor (Colorectal Surgery), Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh.

Learn more about Dr. Nazrul Islam.

Related Topics:

• Varicocele Symptoms
• Varicocele Diagnosis
• Varicocele and Fertility
• Varicocele Treatment Options
• Varicocele Surgery
• Varicocele Surgery vs Embolization

Last Updated: September 28, 2026

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