Many men are surprised to learn they have a varicocele, because varicocele symptoms are often mild or absent. When symptoms do appear, the most common are a dull ache in the scrotum that builds as the day goes on and a soft, lumpy swelling above the testicle. This guide explains what a varicocele can feel like, which signs point to it, what else could be going on and when to see a doctor.
If you are new to the condition, start with our overview of what a varicocele is.
Do varicoceles always cause symptoms?
No. Most varicoceles cause no symptoms at all. They are often found by chance, during a routine examination, a sports medical or tests for fertility problems.
A varicocele is a group of widened veins in the cord that holds up the testicle. The veins widen because small valves inside them do not close properly, so blood falls back and pools instead of draining up towards the heart. Because the left testicular vein is longer and drains at a sharper angle, most varicoceles are on the left.
Pooled blood does not always cause discomfort. Whether you notice anything depends on how large the varicocele is and how your body responds to it.
The main symptoms of varicocele
When a varicocele does cause symptoms, they usually include one or more of the following:
- A dull ache or heaviness in the scrotum or groin, usually on the left
- Discomfort that builds after standing, walking, exercise or heavy lifting, or by the end of a long day
- Relief when lying down, often within minutes
- A soft, lumpy swelling above or behind the testicle
- A swelling that changes with position: bigger when you stand or strain, smaller when you lie flat
- A smaller testicle on the affected side
- Difficulty conceiving, sometimes picked up first on a semen test
Varicocele pain: what it feels like
Varicocele pain is usually described as dull, dragging or throbbing, rather than sharp. Some men say it feels like a weight hanging from the testicle. Only a small minority of men with a varicocele have pain. In one review, the figure was roughly 2 to 10 in 100.
The pattern matters as much as the feeling. Because gravity adds to the pressure in the veins, the ache tends to be worst late in the day or after standing still for a long time, and it settles overnight. Hot weather, long periods of sitting upright and intense workouts can make it worse for some men.
Testicular varicocele pain that is sudden, severe or constant does not fit this pattern. That needs prompt medical attention (see the warning signs below).
The “bag of worms” feel
A large varicocele can be felt, and sometimes seen, through the skin of the scrotum. It feels soft and twisted, a bit like a bundle of cords or noodles. This is why doctors often call it a “bag of worms”. It is most obvious when you stand up and may almost disappear when you lie down.
Smaller varicoceles cannot be seen. Some can only be felt when you hold your breath and bear down, and the smallest show up only on an ultrasound scan. Doctors use these differences to grade a varicocele. Our guide to what your varicocele grade means explains the grading system.
A smaller testicle
Over time, a varicocele can affect the growth or size of the testicle on that side. In teenagers, doctors watch for a testicle that is not growing as well as the other one. In adults, a noticeable difference in size is one of the reasons a doctor may suggest further tests.
Fertility clues
A varicocele may affect sperm production, probably because pooled blood warms the testicle. For some men the first sign is an abnormal semen test after months of trying for a baby. Having a varicocele does not mean you are infertile, and many men with one father children without treatment.
Varicocele symptoms and causes: what makes it worse?
The symptoms follow the cause. Faulty valves let blood pool in the scrotal veins, and anything that raises the pressure in those veins can make the ache worse:
- Standing or sitting upright for long periods
- Exercise, especially heavy lifting or straining
- Hot conditions, such as hot weather, saunas or long hot baths
- A long day on your feet
Lying down, supportive underwear and resting usually help. The causes are covered in more depth in our overview of the condition.
How to relieve varicocele pain
For a mild ache, simple measures help many men:
- Supportive underwear or an athletic supporter during sport or long days on your feet
- Lying down for a while when the ache builds
- A cold pack wrapped in a cloth, for short periods
- Over-the-counter pain relief, if it is safe for you (ask a pharmacist or doctor)
- Adjusting activities that bring on the ache
If the pain keeps coming back and affects work, exercise or sleep, talk to a doctor about varicocele treatment. Surgery or varicocele embolisation helps most men whose pain is caused by the varicocele, but not everyone.
Warning signs that need a prompt check
Some features suggest something other than a simple varicocele, or a problem further up in the tummy pressing on the veins. See a doctor promptly if:
- The varicocele appeared suddenly, especially if you are over about 40
- It is on the right side only
- It does not shrink when you lie down
- You also have pain in your tummy, side or back, or blood in your urine
- The testicle itself feels hard or has a firm lump
These are uncommon. Most turn out to have a simple explanation, but a doctor may arrange an ultrasound of the scrotum and sometimes a scan of the tummy to be sure.
What else could it be?
Several other conditions can cause a scrotal lump or ache:
- Hydrocele: a smooth, fluid-filled swelling around the testicle
- Epididymal cyst: a small, smooth lump above or behind the testicle
- Inguinal hernia: a bulge in the groin that may extend into the scrotum
- Epididymitis or orchitis: infection or inflammation, usually with tenderness, redness or fever
- Testicular torsion: a twisted testicle, causing sudden severe pain (an emergency)
- Testicular cancer: usually a painless, hard lump in the testicle itself
Only an examination, and often an ultrasound, can tell these apart. We compare the two most common swellings in hydrocele vs varicocele.
When to see a doctor
Always get a new lump or swelling in the scrotum checked by a doctor. Most lumps are not serious, but cancer and other conditions need to be ruled out. Also see a doctor if you have an ache in the scrotum that keeps coming back, a testicle that looks or feels smaller, or you have been trying for a baby for a year without success. Our pelvic symptom check can help you organise your symptoms before an appointment.
Sudden, severe pain in a testicle is an emergency. It may be testicular torsion, where the testicle twists and loses its blood supply, and it needs treatment within hours. Get urgent help too for testicle pain with vomiting or tummy pain, or a hot, red, swollen scrotum with fever. In Singapore, call 995 in an emergency.
Frequently asked questions
Is a varicocele painful?
Usually not. Most men with a varicocele have no pain at all. Studies suggest only a small minority, roughly 2 to 10 in 100, have pain. When it does hurt, it is normally a dull ache or heaviness rather than a sharp pain.
What does varicocele pain feel like?
Men often describe a dull, dragging or throbbing ache in the scrotum or groin, usually on the left. It tends to build through the day, after standing for a long time or after exercise, and gets better when you lie down.
How long does varicocele pain last?
It varies. The ache often comes and goes, building during the day and settling overnight. It can carry on like this for months or years. Simple measures help some men; if the ache keeps affecting daily life, treatment can be discussed with a doctor.
Can a varicocele cause stomach pain?
A varicocele itself does not usually cause tummy pain. Pain in the lower tummy together with testicle pain can be a sign of testicular torsion, which is an emergency. A new varicocele with tummy or back pain, especially on the right side, should be checked promptly so a doctor can look for a problem higher up.
What are the clinical features of a varicocele?
Doctors look for soft, twisted veins above the testicle that are easier to feel when you stand and bear down, and that shrink when you lie down. They also compare the size of the two testicles. An ultrasound scan can confirm the diagnosis.
Sources and further reading
This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.
