History and exam

Key diagnostic factors

common

presence of risk factors

Risk factors include affected first-degree relatives (especially brothers), and certain somatometric parameters (tall/low BMI).[11][12][13][15][16][17]

painless scrotal mass

Common reason for referral to a consultant.

left-sided signs/symptoms

Ninety percent of varicoceles are on the left side, while approximately 10% are bilateral.

A right-sided varicocele alone is rare and should raise suspicion for the presence of a retroperitoneal or pelvic compressive mass.[21]​

small testicle

Larger varicoceles are associated with higher incidence of testicular growth arrest.[4]

Other diagnostic factors

common

infertility

The prevalence of varicocele is greater in patients with subfertility.

Approximately 1 of 4 men with abnormal semen parameters and 40% of men presenting with infertility have a varicocele.[8] Furthermore, up to 80% of men with secondary infertility have a varicocele.[9]

uncommon

age over 12 years

Pre-pubertal (<12 years old) varicoceles are rare.[10]

Varicoceles occur in 15% of male adolescents.[4]

scrotal or groin pain

Approximately 3% of adolescent patients with varicocele complain of pain.[2]

Pain can occur in up to 30% of men with clinically significant varicoceles.[40]

Risk factors

weak

somatometric parameters (tall/low BMI)

Varicoceles have been reported to be more common in males who are taller and thinner, with lower BMI than age-matched controls.[11][12][13] One meta-analysis reported that underweight patients had a higher risk of varicocele, while patients with a BMI ≥25 had a lower risk.[14]

family history of varicocele

There is an increased incidence of varicocele in first-degree relatives, particularly brothers of affected males.[15][16][17]

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