Varicose Veins in the Scrotum: Rx

May 25th, 2012 § 17 comments

Mr. Smith asked me to explain the different methods of treating varicose veins in the scrotum known as a varicocele.  There are a few:

  • A surgeon makes a small incision in the groin, and ties or clips the veins.  The surgeon may use an operating microscope or wear glasses with magnifying lenses to preserve small arteries supplying blood to the testis.
  • A surgeon uses a telescope called a laparoscope to find the veins inside the abdomen and tie or clip them.
  • A radiologist threads a small tube through the veins and injects material to plug them.

Most surgeons who specialize in male fertility prefer to use an operating microscope or wear glasses with magnifying lenses to perform the procedure, but excellent results can be obtained with either laparoscopy or radiology.  A man should ask his doctor about his or her experience, what he or she prefers and why.

This series of pictures shows what the procedure looks like under the operating microscope.  The surgeon uses a small probe to listen to the veins as they sound different than arteries.  In this procedure, titanium clips were used to block the veins, but surgical suture can also be used.


Thanks, Mr. Smith, for asking a great question!

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§ 17 Responses to Varicose Veins in the Scrotum: Rx"

  • T says:

    interesting read. I just had the microsurgery. I wish i’d read this first, so i could have asked more informed and detailed questions.

    Regardless, the urologist seems to have done a good job. I’m a month on, and i healed rather quickly.

    We’ll see in 3 months if this surgery fixed my sperm.

  • Phil says:

    Did you have a result from the surgery?

  • Rachel says:

    Does treating the varicocele always result in better sperm production?

    • maledoc says:

      Hi Rachel, the short answer is no. Part of the problem in assessing outcomes is that sperm counts are highly variable, so if you just happen to catch a man on a down day after the varicocele operation, he may have improved overall, but that spot semen analysis won’t show it. Few men want to do a whole lot of semen analyses before and after surgery just to get the most accurate scientific picture 🙂 There are also varicoceles that are either so minimal that an operation won’t affect sperm production because the varicocele isn’t affecting sperm production, as well as varicoceles that are so large for so long that sperm production is irretrievably diminished. Doctors use other measures besides the semen analysis, like lab tests and the size and consistency of the testis on physical examination, to gauge how the varicocele is affecting sperm production. Ultimately, varicocelectomy, like any surgery, is a judgement call involving a man and his surgeon.

  • Rachel says:

    Thank you for the reply! I read an article that claimed that in order to see improvement in sperm and/or testoterone levels, both testicles need to be treated even if there is only an obvious varicocele on one side. Do you think that’s true?

    • maledoc says:

      That’s a really great point, Rachel. Some surgeons have reported that even if it’s only one side that has a big varicocele, treating both sides results in an improvement. Not everybody agrees, so that one remains a judgement call with a man and his surgeon.

  • ajesh says:

    hello dr my doc suggested its not a matter if there is vericose vein ….. but fo me its paining my testis and penis is paining why its happeningg

    • maledoc says:

      I’m very sympathetic to you, Ajesh, but as I’ve written before on one of your comments, I can’t answer personal questions about your own health. Please read the FAQ, and please don’t ask again.

  • Candy says:

    Sir. Would varicocele have any effect on size .of scrotum,sex power,or it gives any advantage in planning to have boy baby

    • maledoc says:

      The scrotum may be enlarged by very large dilated veins. That would not be a good thing. Not sure what “sex power” is. There’s no relation to gender selection that is known.

  • Raul says:

    Hello doctor,

    The testicular atrophy caused by varicocele can be reversed? In case of fall in testosterone levels, they can return to normal?


    • maledoc says:

      Hi Raul, every man is different. That’s why a man with a varicocele and a small testis should see his doctor for his particular condition.

  • Mikael says:

    hi doctor
    Varicocelectomy is a procedure which binds varicose veins which drain the blood testis. After this procedure is performed, blood drainage is made by where? This new “way” of drainage is efficient?

  • Juan says:

    Hi doc,

    The pain in testicle is reversible?

    • maledoc says:

      Every man is different. Sometimes it is reversible and sometimes it isn’t. A man with pain in his scrotum should definitely see his doctor.

  • maledoc says:

    It’s been many years, and I’ve finally turned off comments for this WordPress blog. Why? Although it’s the first question in the FAQ, I still get comments (a bunch a day!) asking personal medical questions that I can’t answer. That’s sad and frustrating for me, because as a doctor, I really like to help patients. But this WordPress site was never meant to deliver personal medical care, and the University lawyers tell me that doing so would run afoul of State and Federal laws.

    If you have specific questions about your own personal care, I urge you as outlined in the FAQ to use the American Urological Association’s Society for the Study of Male Reproduction’s search engine

    I also urge you to read through all of and especially the comments. For the five or so years that it was active, A lot of excellent questions were asked, including by other healthcare providers. Chances are, if you have a general question, it’s been answered here and more than once.