A varicocele is a cluster of enlarged veins in the scrotum, similar to varicose veins in the leg. Most cause no symptoms, and many never need treatment. When one does ache, the usual comfort advice is snug supportive underwear or a jockstrap, an over-the-counter pain reliever and lying down. Surgery or embolization comes up when pain won’t settle, when fertility is affected, or when a teenager’s testicle isn’t growing as it should. After surgery, most people are fully recovered within about six weeks. Sudden, severe testicle pain is the exception, and it needs an emergency room.
The short version
- Most varicoceles cause no symptoms, and many need no treatment.
- For minor aching, Mayo Clinic suggests an athletic supporter or snug briefs and a nonprescription pain reliever (Mayo Clinic: Varicocele treatment). Cleveland Clinic adds a wrapped ice pack.
- Treatment is considered for pain that medicine doesn’t control, fertility problems with an abnormal semen analysis, or a teenager’s testicle that isn’t growing.
- Most people recover fully from surgery within six weeks.
- Sudden, severe testicle pain is an emergency. Go to an emergency room.
What is a varicocele?
A varicocele is an enlargement of the veins in the loose skin that holds the testicles. Blood pools in them instead of draining out. They usually form during puberty, most often on the left side. The cause isn’t known, though faulty valves inside the veins may play a part (Mayo Clinic: Varicocele symptoms and causes).
They’re common. Cleveland Clinic puts it at 15 to 20 percent of men in the US (Cleveland Clinic: Varicocele), and the American Society for Reproductive Medicine (ASRM) at 20 to 25 percent. ASRM adds that in most of them it causes no symptoms or problems (ASRM: Varicocele fact sheet).
What does a varicocele feel like?
Often, nothing. When there are symptoms, Mayo Clinic describes a dull, aching pain or discomfort that is more likely when you’re standing or late in the day, and that lying down often relieves. A large one can feel like a “bag of worms” above the testicle, which is unsettling to find. Cleveland Clinic adds scrotal swelling, a shrinking testicle and trouble conceiving after a year of trying. Mayo also warns that testicle pain in someone with a varicocele can come from something else. See chronic testicle pain and epididymitis for other causes.
What helps varicocele pain at home?
For minor discomfort, Mayo Clinic and Cleveland Clinic name four things:
- Support: an athletic supporter or snug briefs (Mayo). Cleveland Clinic adds tighter-fitting underwear or a jockstrap while exercising or standing for long periods.
- A pain reliever: acetaminophen or ibuprofen (Mayo). Cleveland Clinic says to check with a provider first, because not everyone can take NSAIDs.
- Ice: a cold pack wrapped in a towel, no more than 15 minutes at a time, may help (Cleveland Clinic). Mayo’s list leaves ice out, so this rests on one source.
- Lying down, which Mayo says often relieves the pain.
These ease symptoms. They don’t change the veins or address fertility.
What kind of underwear helps with varicocele pain?
A jockstrap or snug briefs, the two options the sources name. Pick one that holds the testicles still without digging in at the legs or waist. Neither will win a style award, but holding things still is the whole job. Our jockstrap vs. briefs comparison covers the trade-offs, and the sizing guide helps if you’re between sizes.
Snug is for comfort. The evidence on underwear fit and sperm is smaller and more debated than it is for hot tubs (heat exposure and sperm health).
Our recovery briefs and recovery jockstrap each have a pocket that holds an ice pack in place, and our Nutsicle ice packs are shaped to fit them. We built all three for vasectomy recovery, not for varicoceles, and they aren’t a treatment, so check with your doctor first. One customer wrote in a review that he wears the jockstrap for a varicocele. We can’t say how it will work for you.
When do doctors consider treatment?
ASRM says to consider treatment when pain or infertility comes with an abnormal semen analysis. Men with a normal semen analysis don’t need it, and neither does a varicocele that shows on ultrasound but can’t be felt.
For teenagers and young adults not seeking fertility treatment, Mayo says a provider may suggest annual checkups. Surgery might follow for a testicle with delayed development, a low sperm count or other sperm problems, or chronic pain that medicine doesn’t manage. Cleveland Clinic adds low testosterone (Cleveland Clinic: Varicocelectomy).
Surgery for pain alone is the least certain case. Cleveland Clinic says about 8 out of 10 people have less pain afterward. Mayo says the balance of benefit and risk shifts when pain is the only reason, and the pain could worsen or change. Ask your surgeon what result they expect for you.
What is the difference between varicocele surgery and embolization?
Varicocele surgery (a varicocelectomy) and embolization both close off the enlarged vein so blood flows through healthy veins instead. ASRM calls surgery the most common treatment. A laparoscopic version, done through a few tiny cuts in the lower abdomen, exists but is uncommon, according to Cleveland Clinic.
| Option | How it works |
|---|---|
| Microsurgical varicocelectomy | A small cut in the groin, and the veins are tied off under a microscope with general anesthesia. Cleveland Clinic calls it the most common approach and says it takes one to three hours. |
| Embolization | A radiologist guides a thin tube through a vein in the groin or neck and places coils or a liquid to block the vein, usually in about an hour with no stitches (RadiologyInfo.org). |
Embolization has the shorter recovery. RadiologyInfo says you should be able to resume normal activities within 24 hours, with scrotal discomfort possible for up to a week. Cleveland Clinic lists swelling, bruising, a blood collection (hematoma), a hydrocele and infection among surgery risks. Ask which procedure your doctor does most often and why.
What does varicocelectomy recovery look like?
Surgeons’ sheets differ. Four patient guides line up like this.
| When | What to expect |
|---|---|
| Day of surgery | Home within a few hours with a driver. No driving for 24 hours (UW Health). |
| Days 1 to 3 | Pain at the incision and scrotum, fading by about day 3. Showers after 24 hours (UW Health). |
| Days 2 to 7 | Back to work in 2 to 3 days (Kaiser), a few days (Cleveland Clinic) or about a week (Mayo), longer for physical jobs. |
| About 1 week | Scrotal swelling. No swimming or soaking (UW Health). No sex for at least a week (Cleveland Clinic). |
| 2 weeks | No lifting over 10 pounds (UW Health, Kaiser). Snug underwear or compression shorts (Kaiser). Exercise resumes (Mayo), though Kaiser says intense activity waits 2 to 3 weeks. |
| 3 to 8 weeks | Bruising fades in 3 to 4 weeks. Groin tenderness lasts up to 6 weeks, swelling up to 8. Most people are fully recovered within 6 weeks (Cleveland Clinic). |
The ice advice differs. Kaiser says 10 to 20 minutes every 1 to 2 hours while awake, for the first day (Kaiser Permanente: Varicocele repair at home). Cleveland Clinic says up to 10 minutes, repeated through the day. That’s shorter than the 20 minutes we use after a vasectomy, so follow your surgeon’s number, with cloth between pack and skin (frostbite warning).
Constipation can strain the incision, so UW Health suggests a stool softener or laxative for about two weeks (UW Health: Home care after varicocelectomy). Similar recoveries: hydrocele surgery, hernia surgery and the scrotal support guide.
Can a varicocele affect fertility?
Sometimes. ASRM says less than half of men with a varicocele have a reduced sperm count or quality, and the most popular theory is that pooled blood warms the scrotum. Mayo says about 40 percent of men with fertility problems have a varicocele.
After surgery, ASRM says two thirds of men see improvement in their semen analysis and about 40 percent achieve a pregnancy. Cleveland Clinic says you may need a follow-up visit for a semen analysis, so ask your surgeon when to retest. Changes take a few months to show up, as our page on how to improve sperm count explains. The male fertility testing guide covers what a semen analysis measures.
When should you call your doctor?
Go to an emergency room now for sudden, intense testicle pain. It can be testicular torsion, a twisted cord that cuts off blood supply. Cleveland Clinic says almost everyone keeps the testicle if treated within four to six hours, and the symptoms won’t go away if you lie down, rest or ice your groin (Cleveland Clinic: Testicular torsion).
Make an appointment for:
- A new lump or swelling in the scrotum. MedlinePlus says a swollen testicle with little or no pain may be a sign of testicular cancer and should have an ultrasound (MedlinePlus: Orchitis).
- Pain that medicine and support don’t control.
- A shrinking testicle, or no pregnancy after a year of trying.
After surgery, call your surgeon for any of these (UW Health, Cleveland Clinic, Kaiser):
- Heavy bleeding, or a dressing soaked within an hour
- A fever of 100°F (38°C) or higher, chills or a headache
- Pus, discolored or foul-smelling drainage, or stitches that come apart
- Scrotal swelling that lasts longer than 5 days or isn’t going away
- Pain that doesn’t improve with rest, ice and medicine
- Trouble urinating
Your surgeon’s discharge sheet is the final word. It’s written for your operation. If you need a urologist, Find a urologist near you.
FAQ
What is the best underwear for varicocele pain? Mayo suggests an athletic supporter or snug briefs. Cleveland Clinic adds tighter-fitting underwear or a jockstrap while exercising or standing for long periods. Pick the one you’ll keep wearing.
Does ice help varicocele pain? Cleveland Clinic says it may, wrapped in a towel for no more than 15 minutes at a time. Mayo’s home-care list doesn’t mention ice.
Does a varicocele go away on its own? Not usually. ASRM says varicoceles usually develop at puberty and persist unless treated. Many don’t need treatment.
Does varicocele surgery relieve pain? Often, but not always. Cleveland Clinic says about 8 out of 10 people have less pain afterward. Mayo says that when surgery is mainly for pain, the pain may worsen or change.
How long does it take to recover from varicocele surgery? Cleveland Clinic says most people recover fully within six weeks. Bruising fades in three to four weeks, and swelling can last six to eight.
Can a varicocele cause infertility? It can contribute. ASRM says less than half of men with a varicocele have a reduced sperm count or quality. A semen analysis shows whether yours is.
Sources
- Mayo Clinic: Varicocele, symptoms and causes
- Mayo Clinic: Varicocele, diagnosis and treatment
- Cleveland Clinic: Varicocele
- Cleveland Clinic: Varicocelectomy
- ASRM: Varicocele fact sheet
- RadiologyInfo.org: Varicocele embolization
- UW Health: Home care after adult varicocelectomy
- Kaiser Permanente: Varicocele repair, what to expect at home
- Cleveland Clinic: Testicular torsion
- MedlinePlus: Orchitis
Editorial and informational. Not medical advice. Read the full disclaimer.
