Varicocele Guide: Symptoms, Causes, and Treatment for Men
A varicocele is a swollen vein in the scrotum, similar to varicose veins in the leg. This guide explains what causes varicoceles, common symptoms, diagnosis, and treatment options to help you manage the condition.
Varicoceles are swollen veins in the scrotum that are common and often cause no symptoms. They may lead to testicular discomfort or infertility in some people, and can be diagnosed with a physical exam and ultrasound. Treatment ranges from watchful waiting to surgery, depending on symptom severity and fertility concerns.
Overview
A varicocele is an enlargement of the pampiniform venous plexus, the network of veins that drains blood from the testicles. It is similar to varicose veins that can form in the legs, and occurs when the valves in these veins weaken, causing blood to pool and the veins to swell. Varicoceles are very common, affecting about 1 in 10 men, and up to 35% of men with primary infertility.
Signs & Symptoms
Many people with varicoceles have no symptoms at all, and the condition is found incidentally during a routine physical exam or fertility testing. When symptoms do occur, they may include:
- A dull, aching pain or discomfort in the scrotum that gets worse with standing or physical activity and improves when lying down
- A visible or palpable swollen vein in the scrotum, often described as feeling like a 'bag of worms'
- Shrinking of the affected testicle (atrophy) over time
- Infertility or low sperm count, which may be the first sign of a varicocele in people with no other symptoms
Sudden, intense scrotal pain is not a typical varicocele symptom. If you experience this, seek emergency care immediately, as it may be a sign of testicular torsion, a medical emergency that requires prompt treatment to save the testicle.
Causes & Risk Factors
Varicoceles most often develop when the valves in the veins of the pampiniform plexus fail to function properly, preventing blood from flowing efficiently back to the heart, leading to swelling. They almost always form on the left side of the scrotum, due to the left testicular vein draining into the left renal vein at a right angle, making it prone to blockage. Risk factors for developing a varicocele include:
- Age (most common between 15 and 25 years old)
- Family history of varicoceles
- Congenital abnormalities of the renal vein or other pelvic veins
Diagnosis
Varicoceles are usually diagnosed with a physical exam, where your healthcare provider will feel the scrotum while you are standing and lying down. They may ask you to perform a Valsalva maneuver (holding your breath and bearing down) to make the swollen veins more prominent. If the physical exam is inconclusive, a scrotal ultrasound may be ordered to confirm the diagnosis and rule out other causes of scrotal swelling, such as a tumor or hydrocele.
| Diagnostic Tool | Purpose |
|---|---|
| Physical exam | To feel for swollen veins and assess size/grading of the varicocele |
| Scrotal ultrasound | To confirm the diagnosis, measure vein size, and rule out other scrotal abnormalities |
| Semen analysis | To assess fertility impact if infertility is a concern |
Treatment & Management
Treatment for a varicocele depends on the severity of your symptoms, whether you are experiencing fertility issues, and the size of the varicocele. Many people with mild or no symptoms do not require treatment and can manage the condition with self-care strategies. Treatment options include:
- Watchful waiting: Regular follow-up exams to monitor the varicocele for changes in size or symptoms
- Pain management: Over-the-counter pain relievers like ibuprofen or acetaminophen for mild discomfort
- Surgical repair (varicocelectomy): A procedure to tie off or block the affected veins, redirecting blood flow to healthy veins. This is the most common treatment for symptomatic varicoceles or those causing infertility
- Embolization: A minimally invasive procedure where a small coil or solution is inserted into the affected vein to block blood flow, reducing swelling
Surgical repair and embolization have high success rates for relieving pain and improving fertility in people with symptomatic varicoceles. Your healthcare provider will help you decide which treatment option is right for you based on your individual needs.
Living With It
Most people with varicoceles live full, active lives with minimal disruption to their daily routine. With proper monitoring and self-care, you can reduce discomfort and protect your long-term testicular health.
Medical Review Team
WellAlly Medical Editorial Team
This content is not a replacement for professional medical advice.
Recovery & management timeline
Ongoing, often starting in adolescence
Initial Development
Monitor for symptoms like scrotal discomfort or swelling; wear supportive underwear if you experience mild pain
1-2 weeks from initial appointment to confirm results
Diagnosis
Complete any recommended imaging (ultrasound) or semen analysis; discuss symptom severity and fertility goals with your provider
1-2 weeks for initial recovery, 4-6 weeks for full activity resumption
Post-Surgical/Embolization Recovery
Rest and avoid heavy lifting for 1-2 weeks; wear supportive underwear; follow your provider's instructions for wound care and pain management
Ongoing, annual check-ups recommended
Long-Term Monitoring
Schedule annual physical exams to monitor testicular health and varicocele size; report any new or worsening symptoms to your provider promptly
Self-care steps
1Wear supportive underwear
Choose snug, breathable underwear (like briefs or athletic supporters) to reduce scrotal movement and alleviate mild discomfort during daily activities or exercise.
2Manage mild pain
Use over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen as directed for mild aching pain. Apply a cold pack wrapped in a cloth to the scrotum for 10-15 minutes at a time to reduce swelling.
3Avoid symptom triggers
Limit prolonged standing, heavy lifting, or intense physical activity that worsens scrotal pain. Take breaks to sit or lie down if you experience discomfort during the day.
4Monitor for changes
Check your scrotum monthly for changes in size, shape, or tenderness. Note any new pain, swelling, or changes in testicle size, and report these to your healthcare provider.
5Support fertility if needed
If you are trying to conceive, discuss semen analysis results with your provider. Avoid smoking, excessive alcohol, and recreational drugs, which can further impact sperm health.
When to seek medical help
Seek emergency medical care immediately if you experience sudden, severe scrotal pain, as this may be a sign of testicular torsion, a medical emergency that requires treatment within hours to prevent permanent testicle damage. Also contact your provider promptly if you notice rapid swelling of the scrotum, a hard lump in the testicle, fever, or redness/warmth in the scrotum, as these may signal infection or other serious conditions.
Frequently asked questions
Are varicoceles dangerous?
Can varicoceles go away on their own?
Will a varicocele affect my sex life?
Is varicocele surgery covered by insurance?
Sources
- 1Mayo Clinic: VaricoceleSource
- 2NHS: VaricoceleSource
- 3
- 4NIDDK: VaricoceleSource
Click any link to access the full source. PubMed Central (PMC) links provide free full-text access.
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Medical Editorial Team · Last reviewed October 9, 2026. · Read our editorial policy