Varicocele accounts for 15% of the male population and 40% of the male infertility population. Clinical and animal data show that varicocele has an impairing effect on spermatogenesis. Although the mechanisms need to be further elucidated, it is generally accepted that elevated testicular temperature and venous reflux are among the important damaging factors. Clinical evaluation of varicocele should include a careful medical and reproductive history and a physical examination that includes both supine and standing positions. Distinctive “worm-like” varicose veins are present in the standing position and usually disappear or resolve significantly in the recumbent position. When suspected varicose veins are palpated, a valsalva maneuver is performed in the standing position, and ultrasound is performed to check for reflux in the veins for a clear diagnosis. Semen examination should be performed at least twice to accurately evaluate reproductive function. According to current literature, palpable varicocele (clinical type) is more correlated with infertility. Ancillary tests such as scrotal ultrasound, scrotal thermometry, Doppler ultrasound, nuclear scan, and spermatic venography are performed when clinical physical examination is suspicious. Spermatic venography is used in patients with postoperative recurrence to determine the exact site of blood reflux.