Varicoceles
Varicoceles In Teens And Young Men
A varicocele is an enlarged cluster of veins inside the scrotum. Many boys and young men never notice it. Others feel aching, heaviness, or worry about future fertility.
At Riverstone Urology Specialists in Cypress, Dr. Russell Libby evaluates varicoceles with a focus on growth, comfort, and long term fertility. This page explains what families need to know when a pediatrician or school physical finds a varicocele.
What Is A Varicocele?
A varicocele is a group of enlarged veins in the pampiniform plexus, the network of veins that drains blood from each testicle. These veins sit in the scrotum, the sac that holds the testicles.
When The Veins Stretch And Twist, They Often Feel Like A Soft “Bag Of Worms” Above The Testicle. Varicoceles Usually
- Occur on the left side
- Appear during puberty or the teenage years
- Affects roughly one out of ten to fifteen males
The problem is similar to a varicose vein in the leg. Blood does not flow out of the scrotum as smoothly as it should, so the veins swell.
How The Veins Work In A Healthy Scrotum
The Scrotum Holds The Testicles, Which Produce Sperm And Testosterone. Each Testicle Hangs From A Structure Called The Spermatic Cord. The Cord Contains
- The vas deferens, which carries sperm
- The testicular artery
- Nerves
- The pampiniform plexus, a fine network of veins
These veins help keep testicle temperature slightly lower than core body temperature. That small difference matters for healthy sperm production.
When the veins enlarge and blood pools, the testicle can warm up and lose some of that temperature control. Over time, this can affect growth of the testicle and sperm quality, especially if the varicocele is large and left untreated.
Symptoms And How Varicoceles Are Found
Most Boys And Men With A Varicocele Have No Symptoms. Many First Hear About It At
- A school or sports physical
- A routine checkup with their pediatrician or family doctor
- A urology visit for another concern
Possible Signs Include
- A soft, ropey, “bag of worms” feeling above the testicle
- A heavy or dull ache in the scrotum, often worse after standing for a long time
- A left testicle that looks or feels smaller than the right during puberty
- Fertility problems later in life
Teens sometimes notice a lump or odd texture during self exam, then a doctor confirms the finding.
Diagnosis Usually Begins With
- A physical exam while standing and lying down
- A scrotal ultrasound to measure testicle size and look at blood flow and veins
What Causes A Varicocele
Several Factors Come Together To Create A Varicocele. In Many Males
- Valves inside the scrotal veins do not work well or are missing
- Blood tends to flow backward and pool in the veins
- The left testicular vein drains into larger veins at an angle that makes pooling more likely
In rare cases, pressure from swollen lymph nodes or another mass in the abdomen can block blood return and cause swelling in the scrotal veins. A careful exam and ultrasound help rule out these unusual causes.
Most teens with a varicocele do not have a serious underlying disease. The veins themselves are the main issue.
When Parents Should Schedule A Visit
You Should Schedule An Appointment With Riverstone Urology If
- A pediatrician or school physical mentions a varicocele
- Your son feels a lump, ropey veins, or a size difference between testicles
- He reports a heavy or aching feeling in the scrotum
- There is concern about future fertility
- You are unsure whether a new scrotal change is a varicocele or something else
Any new lump in the scrotum deserves an exam by a urologist to rule out other causes, including testicular cancer.
How Dr. Libby Evaluates A Varicocele
Evaluation Aims To Keep Things Simple While Answering Key Questions.
History And Exam
Dr. Libby will ask about
- When the swelling or ache started
- How often discomfort shows up and what makes it better or worse
- Sports and activity level
- Any history of trauma, infection, or surgery in the groin
He will then examine the scrotum while your son is standing and then lying down. During the exam, he checks
- Size and position of each testicle
- Presence and grade of the varicocele
- Any separate mass or concern that does not fit a routine varicocele
Scrotal Ultrasound
A scrotal ultrasound often follows. This painless test
- Confirms the diagnosis
- Measures testicle size on each side
- Looks for other causes of swelling or pain
The information helps decide whether simple observation is enough or whether treatment should be considered.
Treatment Options At Riverstone Urology
Not Every Varicocele Needs Treatment. The Plan Depends On Testicle Growth, Pain Level, And Future Fertility Goals.
Observation And Follow Up
Observation is often the first choice when
- Both testicles are growing normally
- There is little or no pain
- There are no clear fertility concerns yet
Observation usually includes
- Regular exams with size measurements
- Periodic ultrasound when needed
- Education on self exam and what changes to report
The goal is to watch for any lag in growth of the affected testicle or any new symptoms.
Support And Pain Relief
For teens and young men with mild aching or heaviness, simple steps often help
- Supportive underwear or an athletic supporter for sports and long days standing
- Rest lying on the back to let the veins drain and relieve pressure
- Nonprescription pain relievers, as long as a doctor agrees they are safe for your son
These measures may control symptoms well enough that surgery is not needed.
Surgical Repair
Surgery becomes a stronger option when
- The affected testicle is clearly smaller
- Pain interferes with daily activity or sports
- Semen testing in an older teen shows a problem
- There is worry about long term fertility and conservative care has not helped
Surgical repair, called varicocelectomy, closes off the enlarged veins so blood no longer pools in them. Healthy veins then carry blood away from the testicle.
Approaches include
- Microsurgical varicocelectomy through a small groin incision
- Laparoscopic repair through tiny incisions in the abdomen
During surgery, care is taken to protect the testicular artery and lymph channels while tying off the problem veins.
Most patients go home the same day. Soreness is usually mild to moderate and improves over a few days. Your son will receive clear instructions about activity limits, sports, and follow up visits.
Embolization
Embolization is a non-surgical option in selected patients. An interventional radiologist
- Inserts a small catheter into a vein in the groin or neck
- Threads it to the veins that form the varicocele
- Blocks those veins from the inside using tiny coils or special material
Blood then reroutes through other veins. Recovery is usually quick. This option is useful for some patients whose anatomy or health makes surgery less ideal.
Dr. Libby will explain both surgery and embolization and help you choose the approach that fits your son best.
Common Questions From Families
What Happens If We Choose No Treatment
Many males with a varicocele never develop serious problems. If both testicles grow normally and there is no pain, careful follow up is often enough. Regular exams and occasional ultrasound check that growth stays on track.
Does My Teenage Son Need Surgery Right Away
Not always. Surgery is usually considered when
- The affected testicle falls behind in size
- Pain is frequent or limits sports and daily activity
- A semen test in an older teen shows a clear problem
Each case is unique. A visit with a urologist who sees adolescents is the best way to decide.
What Helps With Pain At Home
Supportive underwear, taking breaks from prolonged standing, and safe over the counter pain medicine can ease discomfort. Any sudden increase in pain, new swelling, or a new lump should be checked quickly.
Is A Varicocele The Same As Testicular Cancer
No. A varicocele involves veins, not a tumor. That said, any new lump or change in the testicle itself needs an exam, since testicular cancer is most common in young men. A careful evaluation separates common conditions like varicocele from more serious problems.
Varicocele Care At Riverstone Urology
Varicoceles are common in teens and young men and often cause more worry than harm. At the same time, they deserve a thoughtful plan so growth and fertility stay on course.
At Riverstone Urology In Cypress, Families Receive
- Clear, age appropriate explanations
- Careful tracking of testicle growth over time
- Practical strategies for symptom relief
- Surgical and interventional options when treatment is needed
If you or your son has been told you have a varicocele, or if you notice a new scrotal change that concerns you, contact Riverstone Urology to schedule a visit with Dr. Libby. A focused exam and a simple plan often replace worry with clear next steps.