Which Specialist Should You See for Varicocele?

Men experiencing symptoms suggestive of varicocele—such as a dull, aching discomfort or heaviness in the scrotum, visible or palpable enlarged veins resembling a “bag of worms,” or concerns about fertility—should consult a urologist. Varicocele is an abnormal dilation and tortuosity of the pampiniform plexus veins within the spermatic cord, most commonly occurring on the left side due to anatomical differences in venous drainage. While many cases are asymptomatic and discovered incidentally during routine physical exams or fertility evaluations, symptomatic or clinically significant varicoceles may contribute to testicular atrophy, impaired spermatogenesis, and reduced semen quality.

Urology is the appropriate specialty because urologists are trained to diagnose and manage disorders of the male reproductive system and urinary tract—including structural, functional, and hormonal aspects of male infertility. During evaluation, the urologist typically performs a physical examination with the patient standing and performing a Valsalva maneuver to detect reflux; scrotal ultrasound with Doppler imaging may be used to confirm diagnosis, assess vein diameter, and quantify venous reflux. Treatment decisions—ranging from observation to surgical ligation (e.g., microsurgical varicocelectomy) or percutaneous embolization—are based on symptom severity, testicular volume discrepancy, semen analysis findings, and reproductive goals.

In adolescents, varicocele evaluation is especially important, as early-onset cases may affect testicular development and future fertility potential. Referral to a pediatric urologist is recommended for patients under 18 years of age. Primary care providers or general practitioners can initiate assessment and refer appropriately but do not manage varicocele definitively.