Varicocele: A Comprehensive Guide
Medically reviewed by Andre Stone | MD, University of Pittsburgh School of Medicine on August 24th, 2026.
Published on April 10th, 2026. Updated on August 28th, 2026.
Key Takeaways
Varicocele is enlarged veins in the scrotum that affects about 15% of men
Most men have no symptoms, but it can cause dull aching or fertility problems
Left side is affected in 85% of cases due to anatomy differences
Treatment is often considered for pain, fertility concerns, or testicular size or growth concerns, especially in adolescents.
Surgery has high success rates with minimal complications
Overview
A varicocele is an enlargement of veins within the scrotum. These veins carry blood away from the testicles back to the heart. When they become enlarged, they look and feel like a bag of worms inside the scrotum.
Varicoceles are common, affecting about 15% of all men. They usually develop during puberty and are most common on the left side. Most varicoceles occur on the left side. They can also affect both sides, while an isolated right-sided varicocele is less common.
Most men with varicoceles have no symptoms at all. However, some may experience discomfort or fertility problems. The condition is one of the most common causes of male infertility, found in about 40% of men with fertility issues.
Many men discover they have a varicocele by accident during a routine doctor visit. They might find it when checking themselves or when a doctor finds it during an exam. Some varicoceles stay the same size for years, while others may get slightly bigger over time.
Symptoms & Signs
Many men with varicoceles have no symptoms. When symptoms do occur, they tend to worsen throughout the day and improve when lying down.
Primary Symptoms
Dull aching pain in the scrotum that gets worse with standing or physical activity
Feeling of heaviness or dragging sensation in the scrotum
Visible or palpable enlarged veins that feel like a "bag of worms"
Scrotal swelling, especially on the left side
Pain from a varicocele is usually mild and manageable. The discomfort often feels like a dull ache rather than sharp pain. Some men say it feels similar to a muscle strain or bruise that won't go away.
The symptoms can change with the seasons and your activity level. Hot weather and intense exercise might make symptoms worse. Resting and elevating your legs can help reduce discomfort.
When to Seek Care
You should see a doctor if you notice scrotal swelling, persistent pain, or have concerns about fertility. Any sudden, severe testicular pain requires immediate medical attention.
When to Seek Immediate Care
Contact a healthcare provider right away for sudden severe testicular pain, as this could indicate testicular torsion, which is a medical emergency.
Causes & Risk Factors
Varicoceles develop when valves in the veins that carry blood from the testicles don't work properly. These valves normally prevent blood from flowing backward. When they fail, blood pools in the veins, causing them to enlarge.
The left side is more commonly affected because of anatomy differences. The left testicular vein drains into the left kidney vein at a right angle, creating more pressure. The right testicular vein drains directly into the main vein carrying blood back to the heart, which creates less pressure.
Think of the valve like a door in a pipe. When it works right, blood flows one way only. When it breaks, blood backs up and causes the veins to swell like a water balloon.
Age
Most common during puberty (ages 12-16) when rapid growth occurs
Genetics
Family history of varicoceles increases risk
Lifestyle
Prolonged standing or heavy lifting may worsen existing varicoceles
Other Conditions
A new varicocele that appears suddenly, is only on the right side, or does not decrease when lying down may need prompt medical evaluation to look for an underlying cause.
Continue Learning
Related articles you might find helpful
Diagnosis
Doctors can usually diagnose varicoceles through physical examination. The enlarged veins are often visible or can be felt during examination.
Medical History & Physical Examination
Your doctor will ask about symptoms like pain, fertility concerns, and family history. During the physical exam, you'll stand while the doctor feels for enlarged veins in the scrotum. The varicocele may become more noticeable when you cough or strain, as this increases pressure in the abdomen.
Your doctor might also ask if you play sports or do heavy work. These activities can affect your symptoms. They want to understand how the varicocele impacts your daily life.
Diagnostic Testing
Scrotal ultrasound to measure vein size and confirm blood flow direction
Semen analysis if fertility is a concern to check sperm count and quality
Hormone testing to evaluate testosterone levels in some cases
An ultrasound uses sound waves to take pictures inside your body. It's painless and takes only 10 to 15 minutes. The images help the doctor see exactly how enlarged your veins are and whether they're affecting blood flow.
Get General Health Relief Today
Learn More
Treatment Options
Treatment may be recommended for persistent symptoms, fertility concerns after appropriate evaluation, or testicular growth concerns. Many men with varicoceles need no treatment at all.
Conservative Treatments
Pain medication like ibuprofen or acetaminophen for mild discomfort
Supportive underwear or athletic support to reduce dragging sensation
Ice packs applied to the area for 10-15 minutes to reduce swelling and pain
Conservative treatments work well for many men with mild symptoms. Supportive underwear and cold packs may help some people. Use pain medicines only as directed, and ask a clinician or pharmacist if you have kidney, liver, stomach-bleeding, heart, or medication-related concerns. Most insurance plans cover supportive underwear and over-the-counter pain relievers.
Keeping a symptom diary helps you track what makes your pain better or worse. This information helps your doctor decide if you need more advanced treatment.
Advanced Treatments
Varicocelectomy is surgery that closes off the enlarged veins. It may be considered for persistent pain, fertility concerns with appropriate evaluation, or testicular growth concerns.
Percutaneous embolization, a minimally invasive procedure that blocks blood flow to enlarged veins
Laparoscopic surgery for cases requiring minimal incisions and faster recovery
Surgery is very effective and fixes the problem in most men. After surgery, about 70% of men with fertility problems see their sperm count improve. The procedure takes less than an hour and most men go home the same day.
Treatment decisions should also consider any health conditions or medicines that could affect procedural safety or healing.
Living with the Condition
Most men with varicoceles can live normal lives without treatment. Simple lifestyle changes can help manage mild symptoms.
Daily Management Strategies
Wear supportive underwear to reduce the dragging sensation. Take breaks from prolonged standing when possible. Apply ice for 10-15 minutes if you experience discomfort. Avoid hot baths or saunas, which can worsen symptoms by increasing blood flow to the area.
Keep the area dry and clean to prevent infection or irritation. Choose breathable cotton underwear when possible. Some men find that sleeping with a pillow under their hips helps reduce symptoms at night.
It is understandable to have concerns. A healthcare professional can help you decide whether monitoring or treatment is appropriate. Many men stress about having a varicocele, but remember that most varicoceles are harmless. Focus on managing symptoms rather than the condition itself.
Exercise & Movement
Light to moderate exercise is generally safe and beneficial. Swimming and walking are excellent choices. Avoid heavy weight lifting or exercises that significantly increase abdominal pressure. Listen to your body and stop activities that cause pain or discomfort.
Cycling can sometimes worsen symptoms because of the pressure on the groin area. If cycling bothers you, try other activities like walking or swimming instead. Exercise helps your overall health and can improve blood circulation.
Prevention
There's no proven way to prevent varicoceles since they're largely related to anatomy and genetics. However, some steps may help reduce symptoms if you already have one.
Maintain a healthy weight to reduce pressure on abdominal veins
Avoid prolonged standing when possible, especially in hot environments
Wear supportive underwear during physical activities
Stay hydrated and maintain good overall vascular health through regular exercise
Staying hydrated supports general health, but it has not been shown to prevent or treat a varicocele. Eating healthy foods with fiber helps prevent constipation, which can add pressure to your veins.
Wearing compression shorts during sports and heavy work can help. These shorts provide gentle pressure that helps blood flow better. They're inexpensive and available at most sporting goods stores.
Seek medical care if you develop new symptoms or have concerns about pain, fertility, or testicular changes.
Frequently Asked Questions
Can a varicocele affect fertility?
Yes. Varicoceles are found in about 40% of men with fertility problems. They can reduce sperm production and quality by increasing testicular temperature and reducing blood flow.
Surgery may be considered when pain persists, fertility is a concern after appropriate evaluation, or testicular growth is affected.
Recurrence can occur after treatment, and the risk varies by the procedure and surgical approach. Follow-up after treatment can help identify recurrence or ongoing symptoms.
Varicoceles are generally not dangerous. They rarely cause serious complications, but they can affect fertility and cause discomfort in some men.
Most varicoceles develop during puberty, typically between ages 12 and 16. This coincides with rapid growth and hormonal changes that affect blood vessel development.
Still have questions?
Consult with a healthcare professional for personalized advice.