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What is the most likely diagnosis? The patient has a varicocele, which is an abnormal, tortuous dilatation of the pampiniform plexus of testicular veins. It occurs in 10%–15% of men, rising to about 25% of men with an abnormal semen analysis. Many varicoceles develop in adolescence, and up to 90% are leftsided. Most varicoceles are painless and idiopathic. It has been postulated that they arise because of a lack of venous valves, subsequent reflux and raised testicular venous pressure. Increased spermatic DNA damage has been shown in patients with varicoceles.

Painful varicocele in an infertile man