Scrotal Pain? Why Your Varicocele Swells & Medically Approved Next Steps

Scrotal pain can be uncomfortable, distracting, and sometimes worrying. One common cause in teens and adult men is a varicocele—an enlargement of the veins inside the scrotum. While many varicoceles are harmless and painless, others can cause swelling, aching, or fertility concerns.

If you've noticed a dull ache, heaviness, or visible swelling in one side of your scrotum (most often the left), here's what may be happening—and what to do next.

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What Is a Varicocele?

A varicocele is similar to a varicose vein in the leg. It happens when veins in the scrotum (specifically the pampiniform plexus) become enlarged due to faulty valves. These valves normally help blood flow upward toward the heart. When they don't work well, blood can pool in the veins, causing swelling.

Varicoceles are common:

• Affect about 15% of adult men
• Occur in up to 35–40% of men evaluated for infertility
• Most often develop during puberty
• Usually appear on the left side

Many men with a varicocele never need treatment. But when pain or fertility issues develop, it's important to understand why.

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Why Does a Varicocele Swell?

Swelling from a varicocele happens because blood collects in the affected veins instead of flowing efficiently out of the scrotum.

Here's why that happens:

• Weak or damaged vein valves allow blood to flow backward (reflux).
• The left testicular vein drains at a sharper angle into a larger vein, making backflow more likely.
• Increased abdominal pressure (heavy lifting, straining) can worsen vein pooling.
• Standing for long periods may make symptoms more noticeable.

Over time, the backed-up blood stretches the veins, creating a soft, rope-like mass. Some describe it as feeling like a "bag of worms."

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Why Does a Varicocele Cause Pain?

Not all varicoceles cause pain. When they do, it's typically due to:

• Increased pressure in the veins
• Stretching of surrounding tissues
• Increased scrotal temperature
• Mild inflammation

The pain is usually:

• Dull or aching (not sharp)
• Worse after standing or physical activity
• Better when lying down
• Located on one side (often left)

Severe or sudden pain is not typical of a varicocele and may signal a different, more urgent condition.

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When Should You Be Concerned?

Most varicoceles are not dangerous. However, you should seek urgent medical care if you experience:

• Sudden, severe scrotal pain
• Rapid swelling
• Nausea or vomiting with testicular pain
• Fever
• A firm, painful testicle

These symptoms could point to conditions like testicular torsion, infection, or other emergencies that require immediate treatment.

If you're experiencing symptoms but aren't sure whether they require urgent care, you can quickly assess your situation using Ubie's free AI-powered Varicocele symptom checker to help guide your next steps.

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How Is a Varicocele Diagnosed?

A healthcare provider typically diagnoses a varicocele through:

1. Physical Exam

• Examined while standing and possibly during a Valsalva maneuver (bearing down).
• The enlarged veins may be visible or felt.

2. Scrotal Ultrasound

• Confirms enlarged veins.
• Measures blood flow and vein diameter.
• Rules out other causes of swelling.

Imaging is especially important if:

• The varicocele appears suddenly.
• It's only on the right side.
• It doesn't shrink when lying down.

In rare cases, additional imaging may be needed to rule out underlying abdominal issues.

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Can a Varicocele Affect Fertility?

Yes, it can.

A varicocele is one of the most common correctable causes of male infertility. It may affect fertility by:

• Raising testicular temperature
• Reducing oxygen supply
• Increasing oxidative stress
• Impairing sperm production

However, not every man with a varicocele will have fertility problems. Many men father children without treatment.

If you and your partner are trying to conceive and have concerns, a doctor may recommend:

• Semen analysis
• Hormone testing
• Ultrasound imaging

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Medically Approved Next Steps

Treatment depends on your symptoms and goals.

✅ If You Have No Pain and No Fertility Issues

You may not need treatment. Monitoring is often enough.

Supportive steps include:

• Wearing supportive underwear
• Avoiding prolonged standing
• Using over-the-counter pain relievers (if approved by your doctor)

Regular follow-ups may be recommended, especially for adolescents.

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✅ If You Have Mild Discomfort

Doctors may suggest:

• Scrotal support
• NSAIDs (such as ibuprofen, if medically appropriate)
• Activity modification

If pain persists or interferes with daily life, further evaluation is needed.

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✅ If You Have Fertility Concerns or Persistent Pain

Procedural treatment may be recommended.

1. Varicocelectomy (Surgical Repair)

• Performed by a urologist.
• Ties off the affected veins.
• Usually outpatient.
• Microsurgical approaches have the lowest complication rates.

2. Percutaneous Embolization

• Minimally invasive.
• A radiologist blocks the problematic veins using coils or a solution.
• No incision in the scrotum.

Both treatments aim to redirect blood flow to healthier veins.

Most men recover within days to weeks, depending on the procedure.

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What Results Can You Expect After Treatment?

• Pain relief in the majority of men treated for discomfort.
• Improved sperm parameters in many men treated for infertility.
• Gradual improvement (often takes 3–6 months for sperm changes).

No procedure guarantees fertility, but treatment can significantly improve the odds in appropriate cases.

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Can a Varicocele Go Away on Its Own?

In most cases, a varicocele does not completely disappear without treatment. However:

• Symptoms may remain stable.
• Some men never develop complications.
• Mild cases may not worsen.

Observation is often safe when guided by a doctor.

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Healthy Habits That May Help

While lifestyle changes cannot "cure" a varicocele, they may reduce discomfort:

• Maintain a healthy weight
• Avoid heavy straining when possible
• Stay physically active
• Manage constipation to reduce abdominal pressure
• Wear supportive underwear during exercise

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The Bottom Line

A varicocele is a common cause of scrotal swelling and aching. It happens when blood pools in enlarged veins due to faulty valves. Most cases are not dangerous, but they can cause discomfort or affect fertility in some men.

Key takeaways:

• Dull, aching pain that worsens with standing is typical.
• Sudden severe pain is not typical and needs urgent evaluation.
• Many men do not require treatment.
• Surgical or minimally invasive options are available if needed.
• Fertility often improves after appropriate treatment.

If you're experiencing scrotal discomfort and want to understand whether your symptoms align with a varicocele, a quick online assessment can help you determine if and when you should see a doctor.

Most importantly, speak to a doctor if you have persistent pain, fertility concerns, or any sudden or severe symptoms. Conditions affecting the testicles can sometimes be serious or even life-threatening, and early medical evaluation is always the safest step.

Scrotal pain is common. Ignoring it isn't the solution—but panicking isn't either. The right information, proper evaluation, and timely care make all the difference.