What investigations are recommended to confirm the diagnosis of varicocele in primary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 17 August 2025Updated: 17 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

The provided UK guidelines do not explicitly recommend specific investigations to confirm the diagnosis of varicocele in primary care . The diagnosis of varicocele, often described by grades (subclinical, Grade I, II, or III), appears to be based on clinical assessment .

However, certain investigations or referrals are recommended in specific circumstances:

  • Semen Analysis: If fertility is a concern for men with varicocele, semen analysis may be offered . This is for assessing fertility, not for confirming the varicocele diagnosis itself .
  • Referral for Uncertainty: If there is uncertainty about the nature of a scrotal swelling, referral to a urologist is recommended .
  • Direct Access Ultrasound Scan: For unexplained or persistent testicular symptoms in men, a direct access ultrasound scan may be considered .

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