Varicocele is a common cause of male infertility and is traditionally diagnosed by physical examination. However, earlier research demonstrated physical examination has limited reliability. This study investigated the accuracy of Doppler ultrasound (DUS) for varicocele diagnosis compared to the standard physical exam. In a cohort of 200 patients with possible varicocele, sensitivity and specificity of physical examination alone were 61.4% and 71.4%, respectively, versus DUS at 91.7% and 94.3%, respectively. When combining physical exam findings with DUS, sensitivity and specificity increased to 92.9% and 95.7%. These findings suggest DUS should replace physical exam as the primary diagnostic tool given its much higher accuracy. Widespread adoption of DUS would enable earlier diagnosis and treatment of varicocele, improving patient outcomes and advancing our understanding of varicocele etiology.