If you’ve noticed a dull ache, a feeling of heaviness, or a soft lump above one testicle — usually the left one — you may be dealing with a varicocele, one of the more common yet least talked-about conditions in men’s health. Varicocele symptoms often show up gradually, and sometimes they don’t show up at all, which is part of why so many men live with the condition for years without realizing it’s there. A varicocele is essentially a cluster of enlarged veins inside the scrotum, similar in nature to the varicose veins that develop in the legs.
Researchers estimate that a meaningful share of adult men have a varicocele, and for most of them it never causes a real problem. For others, though, it can lead to persistent discomfort, a visibly smaller testicle on the affected side, or fertility struggles that eventually bring them into a doctor’s office. This article walks through what causes varicoceles, how to recognize the symptoms, how doctors diagnose and grade them, and what your treatment options look like if surgery becomes necessary — including what it might cost and how insurance typically handles it.
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What Is a Varicocele?
Inside the scrotum, a network of small veins called the pampiniform plexus carries blood away from each testicle. These veins have one-way valves that keep blood flowing in the right direction, back toward the heart. When those valves weaken or fail, blood can pool and back up, causing the veins to stretch and enlarge. That’s a varicocele.
Doctors sometimes describe the feel of a larger varicocele as a “bag of worms” because of how the twisted, dilated veins feel under the skin. Varicoceles show up on the left side far more often than the right, largely because of how the left testicular vein is positioned. It drains into the renal vein at a sharper angle than the right side does, which creates more resistance and more pressure on the valves over time. A varicocele on the right side alone, or one that appears suddenly later in life, is less common and sometimes warrants extra imaging to make sure nothing else is going on.
Varicoceles are also one of the most frequently identified physical findings in men being evaluated for fertility problems. That connection doesn’t mean every man with a varicocele will have trouble conceiving, but it’s one of the more treatable causes when infertility is part of the picture — a topic covered in more depth in our guide to low sperm count and male infertility.
Causes and Risk Factors
The root cause of a varicocele is almost always the same: faulty vein valves that allow blood to flow backward and pool instead of moving efficiently toward the heart. What isn’t fully settled is why some men develop this valve weakness and others don’t, though genetics and anatomy both appear to play a role.
- Family history — varicoceles tend to run in families, suggesting an inherited tendency toward weaker vein valves.
- Puberty — varicoceles often first appear or become noticeable during the growth spurt of adolescence, when blood flow demands increase.
- Prolonged standing or heavy physical strain — this doesn’t cause a varicocele outright, but it can increase pressure in the pelvic veins and make symptoms more noticeable.
- Anatomy of the left testicular vein — its steeper drainage angle into the renal vein is the main reason left-sided varicoceles are so much more common.
- Rarely, a mass or tumor pressing on a vein in the abdomen or pelvis can cause a sudden varicocele, which is why new onset in an older man, especially on the right side, deserves a closer look.
Symptoms of a Varicocele
Varicocele symptoms can be easy to miss, and many men with a varicocele have no symptoms at all and only find out about it during a routine physical or a fertility workup. When varicocele symptoms do appear, they tend to build slowly rather than show up overnight
- A dull, aching, or heavy sensation in the scrotum, often worse after standing or exercising for long periods and better when lying down.
- A visible or palpable soft mass above the testicle that some describe as feeling like a “bag of worms.”
- Noticeable shrinkage of the testicle on the affected side over time, related to reduced blood flow and a slightly elevated scrotal temperature.
- A visible size difference between the two testicles.
- Discovery of a varicocele during an infertility evaluation, even without any pain or discomfort.
The discomfort tends to be more of a dragging heaviness than sharp pain, and it typically eases when you lie down because gravity is no longer pulling blood downward into the pooled veins.
How Varicoceles Are Diagnosed
Diagnosis usually starts with a simple physical exam. Your doctor will check the scrotum both standing and lying down, and may ask you to perform a Valsalva maneuver — bearing down as if straining — which makes a varicocele more prominent by increasing pressure in the abdominal veins.
Varicoceles are typically graded on a scale:
- Grade I — only detectable during a Valsalva maneuver.
- Grade II — palpable without straining but not visible.
- Grade III — large enough to be visible through the skin.
If the exam suggests a varicocele, a scrotal ultrasound with Doppler imaging is usually the next step. This confirms the diagnosis, measures the size of the dilated veins, checks testicular size and blood flow, and rules out other causes of scrotal swelling. If fertility is a concern, a semen analysis is often ordered alongside the ultrasound to see whether sperm count, motility, or shape have been affected.
Treatment Options
Not every varicocele needs to be treated. The right approach depends on symptoms, testicular size, age, and whether fertility is a current concern.
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Watchful Waiting
If a varicocele isn’t causing pain, isn’t shrinking the testicle, and fertility isn’t a concern, most doctors recommend simply monitoring it with periodic exams. This is the most common approach for men who discover a small varicocele incidentally.
Conservative Measures
For mild discomfort, supportive underwear or an athletic supporter, over-the-counter anti-inflammatory medication used as directed, and avoiding long periods of standing or heavy lifting can meaningfully reduce day-to-day symptoms without any procedure.
Surgical Repair (Varicocelectomy)
When pain persists despite conservative care, when a teenager’s testicle isn’t growing normally, or when a couple is dealing with infertility linked to a varicocele, surgery becomes a reasonable option. A varicocelectomy involves tying off or removing the affected veins so blood reroutes through healthy vessels. It can be performed as an open microsurgical procedure through a small incision, or laparoscopically through a few tiny incisions. Microsurgical repair, done under magnification, tends to have the lowest rates of recurrence and complications.
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Percutaneous Embolization
This is a less invasive, catheter-based option performed by an interventional radiologist. A thin catheter is threaded through a vein, usually in the groin or neck, up to the affected testicular vein, where small coils or a sclerosing agent are used to block off the abnormal vein from the inside. It’s done under local anesthesia with sedation, usually as an outpatient procedure, and generally allows for a quicker return to normal activity than open surgery, though outcomes and recurrence rates are broadly comparable to surgical repair depending on the case.
Costs and Insurance Considerations
Varicocele treatment costs vary quite a bit depending on the surgical approach, the facility, and your geographic location, but outpatient repair often runs from several hundred dollars up to a few thousand dollars out of pocket after insurance, with embolization sometimes priced similarly depending on imaging and facility fees. Because a varicocele is a recognized medical condition — not a cosmetic one — treatment is generally covered by insurance when it’s linked to pain, testicular atrophy, or documented infertility, though prior authorization is common.
Before scheduling anything, it’s worth understanding your specific plan’s deductible, copay, and out-of-pocket maximum, which our guide to deductibles, copays, coinsurance, and out-of-pocket maximums breaks down in plain language. If your insurer denies coverage or classifies the procedure as elective, you have the right to push back and appeal that decision through your plan’s formal process.
Recovery After Varicocele Surgery
Recovery time depends on the technique used. Embolization typically allows for a return to light activity within a day or two and full activity within a week. Open or laparoscopic varicocelectomy usually involves a few days of rest, with a gradual return to normal activity over one to two weeks and a longer wait — often four to six weeks — before resuming heavy exercise or sexual activity.
Some swelling and bruising in the scrotum is normal in the first week or two. If fertility was the reason for treatment, semen analysis is usually repeated around three to six months later, since sperm production takes roughly that long to fully reflect any improvement in blood flow.
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Prevention and Lifestyle Tips
There’s no proven way to prevent a varicocele from forming, since it largely comes down to vein anatomy and valve function you’re born with. That said, a few habits can reduce discomfort and support overall reproductive health:
- Wear supportive underwear during exercise or long days on your feet.
- Avoid prolonged heavy lifting or straining when possible.
- Maintain a healthy weight, since excess abdominal pressure can worsen pelvic vein congestion.
- Avoid smoking, which is independently linked to lower sperm quality.
- If you notice any change in testicle size, new lumps, or persistent discomfort, get it checked rather than waiting it out.
When to See a Doctor
If you’re experiencing varicocele symptoms that persist or worsen, don’t wait it out. See a doctor if you notice a new lump or swelling in the scrotum, a dragging or aching sensation that doesn’t improve with rest, a visible difference in testicle size, or if you and your partner have been trying to conceive for a year (or six months if your partner is over 35) without success. Sudden, severe testicular pain is a different situation entirely and needs emergency evaluation to rule out testicular torsion, which is a time-sensitive condition unrelated to varicoceles.
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Frequently Asked Questions
Can a varicocele go away on its own?
No. Once the vein valves have weakened enough to cause a varicocele, it doesn’t reverse itself without treatment. Small, asymptomatic ones simply don’t need treatment, but they won’t disappear on their own.
Does a varicocele always affect fertility?
No. Many men with a varicocele have completely normal sperm counts and father children without any issues. It’s simply one of the more common and treatable findings in men who are evaluated for infertility.
Is varicocele surgery painful?
Most men describe post-surgical discomfort as mild to moderate, similar to a pulled muscle, and it’s generally manageable with rest, ice, and over-the-counter pain relief as directed by your surgeon. Embolization tends to involve even less post-procedure discomfort.
Can varicoceles come back after treatment?
Recurrence is possible but relatively uncommon, particularly with microsurgical repair, which has the lowest reported recurrence rates among the available techniques.
Are varicoceles linked to low testosterone?
In some men, especially those with larger or longstanding varicoceles, testosterone production can be modestly affected due to changes in blood flow and testicular temperature. If you’re also noticing fatigue, low libido, or mood changes, it’s worth having your testosterone levels checked alongside your urology follow-up.
Can teenagers get varicoceles?
Yes. Varicoceles often first appear during puberty, and doctors monitor adolescent boys with a varicocele for signs of slowed testicular growth on the affected side, since that’s one of the main reasons to consider earlier treatment in younger patients.
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The Bottom Line
A varicocele is common, usually harmless, and often doesn’t need anything more than periodic monitoring. But when it causes ongoing discomfort, visible testicular shrinkage, or shows up during a fertility workup, effective treatments exist, from minimally invasive embolization to microsurgical repair, both with solid track records.
If you notice symptoms or you’re curious after a self-exam, don’t sit on it out of embarrassment — a scrotal exam and ultrasound are quick, low-stress ways to get clarity. Related conditions like vasectomy and vasectomy reversal involve similar scrotal anatomy and are worth understanding if you’re navigating men’s reproductive health more broadly, as is the closely related condition covered in our guide to hydrocele causes, diagnosis, and treatment, since the two are sometimes confused with each other.
This article is for informational purposes only and isn’t a substitute for professional medical advice — talk with a urologist or your primary care doctor for guidance specific to your situation.
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