Varicocele, a condition characterized by the enlargement of veins within the scrotum, is a common issue affecting male reproductive health. For athletes and active individuals, understanding the relationship between varicocele and physical activity is essential. While regular exercise offers numerous health benefits, certain sports and strenuous activities may influence the severity or symptoms of varicocele. Here we explores how sports can impact varicocele and what precautions can help maintain both performance and well-being.

Is there relation between sport activities and varicocele and how?

Yes, there is a relationship between sport activities and varicocele, though it varies depending on the type and intensity of the activity.

How sport activities relate to varicocele:

• Increased Intra-abdominal Pressure: Activities like heavy weightlifting, intense core workouts, or strenuous endurance sports can raise intra-abdominal pressure. This may worsen varicocele by impairing blood flow in the testicular veins, leading to further vein dilation.
• Aggravation of Symptoms: Some men with varicocele may experience increased scrotal discomfort, pain, or heaviness during or after high-impact or long-duration 0exercise.
• Circulation and Venous Return: On the other hand, light to moderate aerobic activities (like swimming, walking, or cycling in moderation) can improve overall circulation and might help manage symptoms without worsening the condition.
• Protective Measures: Proper technique, avoiding overexertion, and using supportive underwear can help reduce strain on the scrotal area during sports.

In summary, while not all sport activities cause or worsen varicocele, certain intense or high-pressure activities may contribute to symptom development or progression.

Relation between sport and varicocele grade

The relationship between sport activities and varicocele grade depends mainly on the intensity of the activity and the physical strain it places on the abdominal and pelvic areas.

How sports may influence varicocele grade:

• Progression from Lower to Higher Grades: High-impact or strenuous sports (e.g., heavy weightlifting, long-distance running, CrossFit) can increase intra-abdominal pressure. This pressure may worsen venous reflux and potentially lead to progression from Grade I (mild) to Grade II or III (moderate to severe) varicocele over time, especially in individuals predisposed to vein valve dysfunction.
  • Symptom Severity, Not Just Grade: Some men may have a high-grade varicocele (Grade III) with few or no symptoms, while others with a low-grade condition may experience significant pain or discomfort during intense physical activity.
  • Protective Effect of Light/Moderate Exercise: Regular moderate aerobic activity (e.g., walking, swimming, cycling) may improve circulation and reduce pressure on the testicular veins. This may help prevent worsening of varicocele in individuals with Grade I or II.
  • No Direct Causation Proven: There’s no definitive evidence that sports directly cause varicocele or always lead to grade progression. However, poorly managed physical strain may contribute to the worsening of existing varicocele.

Summary:

• Strenuous, high-pressure sports may worsen or progress varicocele grades.
• Moderate, low-impact exercise may help maintain or even improve venous health.
• The effect on grade progression varies based on individual anatomy, genetics, and technique.

Subclinical varicocele and sportive activities

Subclinical varicocele refers to a varicocele that is not detectable by physical examination but can be identified through imaging (usually Doppler ultrasound). It’s typically asymptomatic and doesn’t always require treatment unless it affects fertility or causes discomfort.

Relationship with Sportive Activities:

• No Strong Evidence of Risk: Subclinical varicoceles are generally not aggravated by most sport activities, especially if the individual is symptom-free. Since there’s no visible or palpable vein dilation, the risk of progression due to exercise is considered low, especially with moderate activity.
• Caution with High-Pressure Activities: Activities that significantly increase intra-abdominal pressure (e.g., heavy lifting, powerlifting, intense bodybuilding) may still theoretically worsen venous backflow, even in subclinical cases. While it may not progress to a clinical varicocele in everyone, those with a family history or anatomical predisposition might be at slightly higher risk.
• Benefits of Moderate Exercise: Aerobic and low-impact sports (walking, swimming, cycling in moderation, yoga) can help promote good venous return and circulation. These activities are generally safe and may even be beneficial for overall vascular health.
• Monitor for Symptoms: Athletes with subclinical varicocele should be aware of new symptoms (e.g., scrotal discomfort, testicular heaviness, fertility concerns) and seek follow-up if they occur.

Summary:

• Subclinical varicocele is not a contraindication to sport.
• Moderate exercise is safe, and heavy lifting may require some caution.
• Periodic monitoring is advised if the individual engages in intense or high-impact training.

Do sportive activities aggravate varicocele?

Yes, certain sportive activities can aggravate varicocele, but this largely depends on the type, intensity, and duration of the activity.

How sportive activities may aggravate varicocele:

• Increased Intra-abdominal Pressure: Exercises like heavy weightlifting, intense resistance training, or high-impact sports (e.g., martial arts, CrossFit) can raise abdominal pressure. This pressure may impair venous return from the testicles, potentially worsening vein dilation and aggravating symptoms.
  • Worsening of Symptoms: Common symptoms that may worsen include scrotal pain, heaviness, or discomfort, especially after prolonged or intense workouts. For some men, these symptoms may limit their ability to train at full intensity.
  • Not All Sports Are Harmful: Moderate aerobic activities (walking, swimming, cycling in moderation, yoga) do not aggravate and may even help improve circulation. These exercises are often recommended for people with varicocele.
  • Individual Differences: Some individuals may tolerate high-intensity sports without symptom progression. Others may see worsening even with moderate strain, depending on vein anatomy and severity of varicocele.

Summary:

• Yes, intense or improper sport activity can aggravate varicocele.
• Moderate, low-impact sports are safe and often beneficial.
• Wearing supportive underwear, avoiding straining, and using proper technique can help reduce the risk of aggravation.

What types of physical activities agravates symptoms and grade of varicocele?

Certain types of physical activities are more likely to aggravate the symptoms and potentially worsen the grade of varicocele due to increased intra-abdominal pressure, strain, and prolonged standing. Here’s a breakdown:

Activities that may aggravate varicocele;

• Heavy Weightlifting / Powerlifting: Causes sharp increases in intra-abdominal pressure (Valsalva maneuver). Can worsen venous reflux and pressure in testicular veins.
• High-Intensity Strength Training: Squats, deadlifts, leg presses (especially with heavy loads) may strain the pelvic region.
• Prolonged Running or Jogging (esp. on hard surfaces): Repetitive bouncing motion and scrotal impact may irritate veins and cause discomfort.
• High-Impact Sports: Martial arts, boxing, football, basketball – these involve sudden movements, jumping, or hits to the groin area.
• CrossFit and HIIT with Core Strain: These workouts often involve repeated abdominal straining, which increases pelvic vein pressure.
• Cycling (long duration or without proper seat): Can cause direct compression on the perineum and affect blood flow, especially if done frequently and without padding.

Activities less likely to aggravate varicocele (generally safe):

• Swimming
• Walking
• Light to moderate cycling (with proper seat support)
• Yoga or Pilates (avoiding core-intensive moves)
• Recreational sports at a light intensity

Is the prevalance of varicocele among athletes higher?

Yes, studies suggest that the prevalence of varicocele may be higher among athletes, especially those involved in intense physical activity or sports that increase intra-abdominal pressure.

Key findings on prevalence among athletes:

• Higher Prevalence in Certain Sports: Sports like weightlifting, long-distance running, gymnastics, and cycling are associated with a higher incidence of varicocele due to the repetitive stress and pressure placed on the abdominal and pelvic veins.
• Mechanisms Behind Increased Risk: Increased intra-abdominal pressure during training can impair venous return from the scrotum, especially in individuals with weak or absent vein valves.
• Prolonged standing or upright posture (common in running or field sports) can increase pressure in the testicular veins.
• Research Evidence: Some studies report a varicocele prevalence of up to 30–35% in athletes, compared to around 15–20% in the general male population. The difference is more notable in elite or high-intensity athletes.
• Age and Activity Duration Matter: Younger male athletes, especially in their teens or early 20s, may be more prone due to developing anatomy and intense training schedules.

Summary:

• Yes, athletes—especially those in high-intensity or high-pressure sports—appear to have a higher prevalence of varicocele.
• Proper training technique, support garments, and early screening can help reduce the impact.

How many days after varicocelectomy we can do sport?

After varicocelectomy (surgical repair of varicocele), the timeline for returning to sports depends on the type of surgery, the intensity of the sport, and individual healing. Here’s a general guideline:

Return to sport after varicocelectomy:

🔹 1–2 Weeks: Light walking is usually allowed within a few days post-op. No lifting, running, or abdominal strain.

🔹 3–4 Weeks: Gradual return to light activities, such as gentle cycling, stretching, or yoga. Avoid high-impact or high-intensity workouts.

🔹 4–6 Weeks: Moderate sports may be resumed if there’s no pain or swelling. You can typically start light gym workouts, avoiding core strain and heavy lifting.

🔹 6–8 Weeks: Most patients can return to full sports activities, including running, weightlifting, and contact sports, with doctor approval.

Factors That Affect Recovery Time:

• Type of surgery:
  • Microsurgical varicocelectomy (inguinal or subinguinal) usually has faster recovery.
  • Laparoscopic or open surgeries may take longer.
• Individual healing:
  • Pain, swelling, or complications may delay return to sport.
• Doctor’s advice:
  • Always get clearance from your urologist or surgeon before resuming training.

Summary:

• Light activity: 1–2 weeks
• Moderate sports: 3–4 weeks
• Full sports: 6–8 weeks (if healed well)

Summary

Varicocele, a condition involving enlarged veins in the scrotum, can be influenced by physical activity. While moderate aerobic exercise is generally safe and may support circulation, intense sports that increase intra-abdominal pressure—such as heavy weightlifting or long-distance running—may aggravate symptoms or contribute to progression. Athletes, particularly those in high-intensity sports, may have a higher prevalence of varicocele. Proper training techniques, supportive clothing, and avoiding overexertion can help manage the condition and reduce the risk of complications.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul – TURKIYE