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How is a varicocele diagnosed?

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A) Self Diagnosis

Many men know they have a varicocele because they can feel the mass of dilated veins in the scrotum. This feels like a sac of worms or spaghetti. These men have larger varicoceles. They may also notice: 1). The testicle is smaller on that side. 2) They have discomfort in that testicle or side of the scrotum.

B) Physician's Diagnosis

During a physical examination a physician may diagnose a varicocele. It can most clearly be felt when a man is standing and again, it will feel like a bag of spaghetti. It may disappear when a man lies down (as the weight of the blood and the veins is no longer pushing down past the malfunctioning valves into the scrotum). In a standing position, the man may also be asked to bear down (like he is having a bowel movement). The physician may feel an impulse as the blood pushes backwards (because of the increased pressure inside the abdomen) into the scrotum.

C) Sophisticated Testing

To confirm varicoceles, sophisticated tests are often used.

  1. A Doppler stethoscope will amplify the sound of blood moving past it. When the patient pushes down, more blood flows backwards into the scrotum and can be heard as a rushing sound.
  2. Ultrasound: The duplex ultrasound is currently considered the best non-invasive way to identify or confirm the presence of varicoceles. The duplex ultrasound has two parts. First a thorough ultrasound of the testis is performed. The diameter of the veins can be measured. Other abnormalities may be identified. A recent study found that 31% of men with infertility had an abnormal finding on the ultrasound that was not suspected by the physical examination.

The second part of the ultrasound evaluation measures the blood, which flows past the probe when the patient pushes down. This blood flow confirms the varicocele.

  1. A test which is rarely used anymore involves injecting a radioactive substance into the blood stream. This can then be seen collecting in the scrotum.

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