Pain Severity as a Marker of Semen Abnormalities in Adolescents with Varicocele

Abstract

Objective: Varicocele is one of the most common causes of potentially correctable male infertility, and its clinical significance during adolescence remains debated. While pain is frequently reported in adolescents with varicocele, the association between pain severity and semen quality is not well established. This study aimed to investigate the relationship between pain intensity, semen parameters, and varicocele grade in adolescent patients.

Methods: The data of 59 adolescent males (aged 12-19 years) diagnosed with varicocele at a tertiary care center were retrospectively reviewed. Scrotal pain severity was assessed using the Visual Analog Scale (VAS). Testicular volume was measured by ultrasonography, and semen analysis was performed according to the 2010 World Health Organization criteria. Correlations between VAS score, semen parameters, and varicocele grade were evaluated using Spearman’s correlation analysis.

Results: The mean VAS score was 4.9 ± 2.1. Higher pain scores showed significant inverse correlations with total sperm count (ρ = −0.48, P < .001), sperm concentration (ρ = −0.44, P = .001), Kruger morphology (ρ = −0.34, P = .009), and total motility (ρ = −0.26, P = .043), while ejaculate volume showed no correlation (ρ = 0.02, P = .86). Tanner staging was available for 39 patients, most of whom were in stages 4-5. Age did not correlate with semen parameters. Hormonal data were largely unavailable due to the retrospective design. Pain severity showed a positive but non-significant correlation with varicocele grade (ρ = 0.33, P = .071).

Conclusion: In adolescents with varicocele, increased pain severity is significantly associated with impaired semen quality, particularly in sperm count and concentration. Although varicocele grade tended to correlate with higher pain scores, statistical significance was not reached. Pain should not be considered solely a subjective symptom but may serve as an additional marker of fertility risk in this population.

Cite this article as: İlki FY, Topçu YK, Buyantemur MS, Bedir S. Pain severity as a marker of semen abnormalities in adolescents with varicocele. Cerrahpaşa Med J. 2026, 50, 0101, doi: 10.5152/cjm.2026.25101