Varicocele in Taichung: symptoms, fertility tests and when to treat

In short

• Common: about 15% of men (European Association of Urology, EAU); about 2–10% of them have pain.
• Fertility: most boys who have one from puberty have no fertility problems later (EAU). A semen test, reported here the same day, shows whether sperm are affected.
• What is checked: examination, grading and colour Doppler ultrasound; if you are trying for a baby, also semen analysis and blood tests (testosterone, LH, FSH).
• Surgery: mainly for infertility with a varicocele that can be felt and semen abnormal on a repeat test. If needed, the doctor writes a referral.
• Medicines: no major guideline lists any oral medicine as a treatment.

Sudden severe pain in the scrotum or testicle: go straight to an emergency department.

Do not send a message and wait for a reply. Time spent waiting is time the testicle has no blood supply. More: sudden testicular pain (Chinese).

What it is, and why it is usually on the left

Blood flows backwards in the scrotal veins, so they become wide and twisted. It is usually on the left, because the left vein drains into the kidney vein. How it affects the testicle is unclear; heat, lack of oxygen and harmful substances flowing back may play a part (EAU, 2026).

How common: about 15% of men; about 25% of men with abnormal semen; about 35–40% of men seeking care for infertility; about 35–44% in primary infertility (never fathered a child) and about 45–81% in secondary infertility (a pregnancy before, with the same or a different partner, but not now).

• Subclinical: seen only on ultrasound.
• Grade 1: felt only when you hold your breath and push (strain).
• Grade 2: felt without straining.
• Grade 3: visible.

Guidelines give different advice for subclinical and clinical (can be felt) varicoceles.

When not to wait

A dull ache, discomfort after standing or a “bag of worms” is not an emergency: book an assessment on LINE during consulting hours. Also book, and tell the doctor, if:

• It appeared recently and does not go down when you lie flat (especially a large one), on either side. The doctor assesses whether abdominal imaging is needed.
• It can be felt only on the right. The EAU advises further abdominal checks; the American AUA/ASRM guideline says a small or moderate one alone needs no routine imaging (expert opinion). The doctor decides.
• You feel a solid hard lump in the testicle itself. This is different from widened veins: book a check on LINE soon.

Symptoms, and other causes of scrotal ache

Pain is typically dull or heavy, worse after long standing or activity; sharp pain is less common (review article). The veins feel soft, more so when you strain.

A scrotal ache is not always a varicocele. A hernia, epididymitis (inflammation of the tube behind the testicle), a hydrocele (fluid around the testicle) and even a tumour must be ruled out. Varicoceles are common, so finding one does not prove it is the cause.

• A bulge in the groin or scrotum when you cough, lift or strain, which goes away lying down: think of a hernia.
• A small hard lump in the scrotal skin: maybe an epidermal cyst.
• Discomfort after long bike rides: see cycling and scrotal discomfort (Chinese).

Fertility and testosterone

There is a link, but a varicocele does not mean infertility. Poorer semen is linked with a higher grade and older age, and most boys with a varicocele from puberty have no fertility problems later (EAU).

When to get checked: infertility means no natural pregnancy after 12 months of sex without contraception (EAU). If the woman is over 35, assessment can start after 6 months of trying (AUA/ASRM).

Reading a semen report: the World Health Organization (WHO) manual, 6th edition (2021), sets lower reference limits at the lowest 5% of men whose partners became pregnant naturally within one year.

These are not a line between “can” and “cannot” have children, and no single value diagnoses infertility (EAU). Below the limit means more assessment, not that you cannot have children.

Testosterone: after surgery, testosterone rose about 34 ng/dL on average in men with a clinical varicocele and reduced fertility (meta-analysis); studies disagree about men with normal levels. Low testosterone is not a guideline reason for surgery; the EAU says surgery can be offered, with men told the benefit needs more research.

If you want children, do not take testosterone on your own (AUA/ASRM, clinical principle). See low testosterone: how it is tested.

How it is confirmed

Examination and colour Doppler ultrasound. Diagnosis is mainly by examination; ultrasound helps when that is unclear (EAU). The doctor measures the vein, backward flow while you stand and strain, and both testicles. A vein over 3 mm (European Society of Urogenital Radiology: 3 mm or more) with backward flow over 2 seconds is linked with a clinically important varicocele (EAU). Average testicle size in European men is about 20 ± 5 mL by orchidometer (comparison beads), which may read larger than ultrasound.

Semen analysis, if you are trying for a baby. It follows the latest WHO manual. If the first result is abnormal, at least one more test confirms it; if normal, one is enough (EAU strong recommendations).

Collect by masturbation into the clinic’s sterile container after 3–5 days without ejaculation (WHO range 2–7 days), with no condom or lubricant. You can collect here; results come the same day. From home, keep it against your body (20–37°C) and bring it within 30 minutes if possible, 50 at the latest. See preparing for a semen analysis (Chinese).

Blood tests. Men with low or no sperm should have total testosterone, FSH and LH tested (EAU strong recommendation). This clinic tests all three. Testosterone is higher in the morning, so blood is taken before 10:00 if possible. Testosterone and LH take about 1 working day.

Your partner too. The woman’s fertility, including ovarian reserve (how many eggs are left), should be assessed at the same time (EAU strong recommendation). This affects timing, and the choice between IVF and surgery. Bring her results and any reports from other hospitals.

When is surgery needed?

• Recommended. EAU (strong), for infertile men who want children: when the varicocele can be felt, semen is abnormal (confirmed by a second test), no other cause of infertility is found, and the partner has a good ovarian reserve. AUA/ASRM (moderate): similar, except men with no sperm (azoospermia).
• Not recommended for fertility: infertile men with normal semen, and subclinical varicoceles (EAU, strong; AUA/ASRM, strong, for subclinical). Pain is separate. Young adults with a subclinical varicocele and normal semen and testicles can have regular imaging instead (European Society of Urogenital Radiology).
• May be considered (EAU weak): high sperm DNA fragmentation (damaged genetic material) with unexplained infertility or failed assisted reproduction (including repeated miscarriage or failed implantation). With normal semen, it is unclear; discuss as a couple. If the woman is older or has low ovarian reserve, compare the wait after surgery with going straight to IVF (EAU).
• Non-obstructive azoospermia (no sperm because production is very low): some men have sperm after surgery, but evidence is low quality (EAU); repair before IVF is unproven (AUA/ASRM). A careful centrifuged (spun) test finds a few sperm in up to 35% of men first thought to have none (AUA/ASRM).
• Pain: start with conservative care (see below). If pain continues, the varicocele can be felt and it is the confirmed cause, surgery can be discussed. In studies, pain improved after surgery in about 50–90% (the EAU cites 48–90%), but being fully pain-free is less common: about 10–50% still had pain.

If surgery is needed: methods, risks and timing

Methods (the doctor explains them and writes a referral): microsurgery (a cut in or just below the groin), laparoscopy (keyhole surgery), a traditional groin cut, or high ligation from behind the abdomen (retroperitoneal). The vein can also be blocked from inside the blood vessel (embolisation or sclerotherapy).

The EAU says microsurgery has lower recurrence and fewer complications, but randomised trials have not settled this; other methods remain valid. Its pregnancy rates are only slightly higher (Cochrane, moderate certainty), and one randomised trial found no significant difference in 1-year pregnancy rates between three methods.

Studies used different definitions and follow-up times.

Anaesthesia and recovery: the operating surgeon explains these. Large case series did microsurgery below the groin under local anaesthesia (plus intravenous sedation if needed), but no guideline recommends it. There is no agreement on when to return to work or exercise.

What may improve: treatment may raise pregnancy rates. Cochrane 2021 estimated about 21% without treatment and about 22–48% with treatment (low certainty). Whether it increases live births is uncertain (very low certainty). Sperm concentration was on average about 12 million per mL higher than with observation (meta-analysis). The benefit is mainly with abnormal semen (EAU); effects on movement and shape are less clear.

When: sperm take a little over two months to form, so semen is usually retested about three months after surgery (you can do it here). Most improvement appears after 3 months and can continue to 12 months; natural pregnancy mostly happens at 6–12 months. Follow-up is by semen tests, not routine ultrasound; Doppler is used if semen stays poor, to look for remaining or returning veins.

Without surgery: do medicines help?

No major guideline lists any oral medicine as a treatment, and no medicine is approved in Taiwan for varicocele.

Diosmin is approved in Taiwan to help relieve local swelling or pain from chronic venous insufficiency, and haemorrhoid symptoms. Use for varicocele is off-label (outside the approved use). There are two small pain studies (40 people randomised; 16 without a control group), both using micronised purified flavonoid fraction (MPFF), a different preparation from diosmin alone. Both sets of authors said it cannot yet be recommended.

Taiwan product information (one diosmin product): not for people allergic to its ingredients, or with rare inherited problems such as galactose intolerance or lactase deficiency (the tablets contain lactose). Ask a doctor first if pregnant, possibly pregnant, breastfeeding or on other medicines. Side effects: headache, dizziness, nausea, stomach upset, itching, allergy; stop and see a doctor for palpitations or low blood pressure. Stomach upset is the most common side effect of this group (Cochrane 2020). The doctor decides; the Chinese product information approved in Taiwan applies.

Supplements (antioxidants, vitamins): the AUA/ASRM doubts their value, the EAU does not recommend routine use, and Cochrane 2022 found the evidence not enough. They are not a treatment for varicocele.

Lifestyle: obesity, little activity, smoking and alcohol harm sperm and testosterone. The EAU strongly recommends that infertile men change these to improve the chance of pregnancy.

If it aches: reviews suggest conservative care first: supportive underwear that lifts the scrotum, and less heavy lifting and hard activity. The doctor assesses whether an anti-inflammatory painkiller (NSAID) is needed. This is not a guideline statement and has not been formally studied.

Painkillers are medicines too. Taiwan product information for ibuprofen: do not use it after a stomach ulcer or stomach or bowel bleeding, with severe liver or kidney failure, or if aspirin or similar painkillers caused asthma or allergy. Tell the doctor first about heart disease, high blood pressure, asthma, bleeding problems or other medicines. No alcohol. Common side effects: stomach discomfort, bloating, headache, dizziness.

Frequently asked questions

Getting checked at this clinic

See a urologist: book on LINE, or tell the front desk you want a varicocele check. You can choose Dr. Chao-An Chen or Dr. Kai-Wu Yang, during that doctor’s sessions.

1. Before you come. For a semen test, no ejaculation for 3–5 days. Bring any earlier reports; if you have none, the clinic arranges tests. For a testosterone test, come in the morning, ideally before 10:00, or come to an evening session first.
2. Costs. Costs are explained at the consultation. You can also ask about costs on LINE before you come.
3. Hours. Monday to Friday 09:00–12:00, 14:30–17:30, 19:00–21:00; Saturday 09:00–12:00; closed Sunday. Check in at least 10 minutes before the session ends. Temporary changes: clinic announcements (Chinese).

Appointments and access

Consultations are conducted in Mandarin, and can also be conducted in English.

On LINE, write “varicocele assessment” (精索靜脈曲張評估) and say how it was found (felt yourself, aching, fertility tests or a health check). The clinic tells you what to prepare.

昭安泌尿科診所 (Morning Urology Clinic)
No. 98, Boguan 2nd St., West District, Taichung City 403, Taiwan（403 臺中市西區博館二街98號）
Consulting hours: Monday to Saturday (closed Sunday). Online booking is open 24 hours.

This page was produced by 昭安泌尿科診所 (Morning Urology Clinic). Medical content last updated: October 2026 (same as the Traditional Chinese version). English version published: 5 November 2026. Medically reviewed by Dr. Chao-An Chen, urologist.

Sources: EAU Guidelines on Sexual and Reproductive Health (2026) / AUA/ASRM guideline on male infertility (2020; amended 2024) / ESUR (2020) / WHO semen manual, 6th ed. (2021) / Cochrane (2021) / Taiwan FDA drug licence data.

This page provides general medical information and does not replace an individual diagnosis or treatment plan.