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Quick Answer: A doctor diagnoses a varicocele mainly by talking with you and examining your scrotum. You will usually stand, then lie down, and you may be asked to bear down. The doctor may give the varicocele a grade. An ultrasound is used only when the exam is unclear or more detail is needed. |
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.
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Medical disclaimer: This article is for general education only. It does not replace a personal check, diagnosis, or treatment by a qualified doctor. Always ask your own doctor about your health. If you have sudden, severe testicle pain, go to a hospital emergency department immediately.
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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:
- A private, warm room. Cold makes the scrotum tighten. This can hide swollen veins.
- Standing first. Veins fill with blood when you stand. This makes a varicocele easier to feel.
- Gentle feeling of the veins. Your doctor gently feels the area above each testicle. Swollen veins can feel like soft, twisted cords.
- 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.
- Checking both sides. Varicoceles are most common on the left. Your doctor still checks both sides.
- 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.
| Grade | What It Means in Plain Words |
| Subclinical | Cannot be felt or seen in the exam. Found only on an ultrasound. |
| Grade 1 | Small. Felt only when you bear down. |
| Grade 2 | Medium. Felt while you stand normally, without bearing down. |
| Grade 3 | Large. Can be seen through the skin of the scrotum. |
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:
- You lie on your back. A towel may be used to cover you.
- A cool gel is put on the skin of your scrotum.
- A small handheld device, called a probe, is moved gently over the area.
- 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:
- Your medical history
- The physical exam
- The grade, if a varicocele is found
- 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.
