Varicocele: The Bag of Worms Vein, Fertility and When Surgery Helps
Run your fingers above the left testicle while standing, and something feels like a soft bag of worms. That’s the classic varicocele: swollen veins in the scrotum, a bit like varicose veins in the leg. Most need nothing. Some cause a dull ache that builds through a long day on your feet, and some quietly sit behind a low sperm count that only turns up when a couple goes for fertility tests. This guide explains how doctors grade it, when surgery is worth it, and the one pattern that needs a scan quickly.
Quick facts
- What it is: enlarged veins (the pampiniform plexus) that drain the testicle.
- How common: roughly 1 in 7 men, and far more common in men being checked for infertility.
- Which side: left in the large majority, because of how the left vein joins the kidney vein.
- Usual symptoms: none, or a dull, dragging ache that gets worse standing and eases lying down.
- Act fast if: it’s only on the right, appears suddenly after 40, or doesn’t shrink when you lie flat.
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What is a varicocele, in plain words?
Blood flows into the testicle through an artery and leaves through a web of small veins. Those veins have one-way valves, and when the valves leak, blood that should be heading back up towards the heart slips backwards and pools, so the thin-walled veins slowly stretch and twist into the lumpy bundle you can feel. Simple plumbing.
The left testicle’s main vein runs a long way up the body and joins the left kidney vein at a sharp right angle, so the column of blood it has to push against is taller and the pressure inside it higher than on the right, which is why about nine in ten varicoceles sit on the left.
Pooled blood is warm. The testicle likes to be a couple of degrees cooler than the body, so a large varicocele can gently heat it. Doctors think that’s one way it affects sperm.
Most varicoceles are found, noted, then left alone.
What does a varicocele feel like?
- A soft, lumpy, twisted feel above the testicle, like a bundle of cords or worms.
- A heavy or dragging ache after long standing, exercise or a hot day.
- Relief when lying down, because the veins drain.
- Sometimes a testicle that is smaller on that side, especially in teenagers.
Many men notice nothing. The varicocele turns up during a fertility check or a routine exam. Our testicular self-check guide shows how to tell normal cords from a new lump.
How do doctors grade a varicocele?
| Grade | How it’s found |
|---|---|
| Subclinical | Seen only on ultrasound |
| Grade 1 | Felt only when you bear down (like straining) |
| Grade 2 | Felt while standing, without straining |
| Grade 3 | Visible through the skin |
The grade matters less than three questions: does it hurt, is the semen abnormal, and is the testicle shrinking? Those decide.
Does a varicocele cause infertility?
It can contribute. Plenty of men with a varicocele father children without any trouble at all, while in others it lowers the count, the movement or the shape of their sperm, sometimes enough to make conceiving slow.
The honest summary: repair tends to improve semen numbers in men who have a varicocele you can feel and an abnormal semen analysis. Whether it improves the chance of a baby is clearest when the wife’s tests are normal. Repairing a varicocele that only shows on ultrasound, or in a man with a normal semen report, isn’t usually advised. For the bigger picture, see our male infertility guide, and for reading the report itself, our semen analysis guide.
When does treatment actually help?
A urologist usually suggests treatment for one of these reasons:
- Pain: a persistent ache that supportive underwear and rest haven’t settled after a few months.
- Fertility: a palpable varicocele, an abnormal semen analysis, and a couple trying to conceive. All three.
- Teenagers: a testicle on the varicocele side that is clearly smaller and staying smaller on repeat checks, often measured by ultrasound every 6 to 12 months.
What are the options?
- Microsurgical repair: a small cut in the groin and an operating microscope to tie off the leaking veins while sparing the artery and lymph vessels. Usually a day case.
- Laparoscopic repair: through small holes in the abdomen.
- Embolisation: a radiologist threads a thin tube through a vein and blocks the leaking vessel from inside. No cut in the groin.
Possible downsides include the varicocele coming back, a fluid collection (hydrocele) and, rarely, damage to the testicle’s artery, and because sperm take around three months to grow, semen is usually rechecked about three to six months later.
What people say, what tradition says, and our honest take
What people say
Online forums say a varicocele causes impotence, that tight underwear gave it to you, and that a herbal “vein” capsule or cold compress will melt it away.
Traditional Unani and Ayurvedic writing describes swollen scrotal veins under broader headings of heaviness and swelling, and recommends rest, cooling and astringent herbs. These descriptions predate ultrasound and semen testing, and they’re tradition, not a test of what works.
Our honest take
Worth it Supportive, snug cotton underwear or an athletic supporter for the ache, lying down to ease it, and a urologist’s check if you’re trying for a baby.
Skip Herbal or “vein” products sold to shrink a varicocele. Nothing swallowed or rubbed on repairs a leaking valve. Some “herbal” men’s capsules have been found to contain undeclared sildenafil, tadalafil or steroids, which can be dangerous, and deadly with nitrate heart medicine.
Myth: a varicocele causes erection problems
A varicocele doesn’t directly cause erection trouble. If you notice weak erections, mention them to the doctor separately. They can be an early sign of heart disease or diabetes and deserve their own check.
Myth: tight underwear or cycling caused it
Varicoceles come from vein valves and anatomy, mostly showing up from puberty. Clothes don’t. In fact, supportive underwear usually makes the ache better.
Did you know?
The left testicle usually hangs a little lower than the right in most men, and the vein network around each testicle also works like a small radiator, cooling the blood that flows in. That’s partly why pooled blood in a varicocele is thought to warm the testicle.
See a doctor promptly, within days, if a varicocele is only on the right side, appears suddenly in a man over about 40, stays swollen when you lie flat, or comes with blood in the urine, back or side pain, or weight loss. These can mean something is pressing on the vein higher up, such as a kidney mass, and need an ultrasound. Go to emergency for sudden severe testicle pain, which could be torsion. Teenage boys with a lump or ache should be checked rather than left embarrassed. For painkillers, follow the pack or a pharmacist, and check with your doctor if you take other medicines.
Varicose veins in the legs are a cousin of this problem; see varicose veins from standing all day. More guides are in Desi Remedies.
Varicocele questions men ask
What is a varicocele?
A varicocele is a group of swollen veins in the scrotum above the testicle, usually on the left. It’s similar to varicose veins in the legs; many men have one without any symptoms or problems.
What are the symptoms of varicocele?
Often there are none. When there are, men feel a dull, heavy ache that worsens after standing or exercise and eases lying down, or a soft lumpy feel like a bag of worms above the testicle.
Can varicocele go away on its own?
It doesn’t usually disappear, because the leaking valves stay leaky. But many varicoceles never cause trouble and need no treatment; the ache often comes and goes with heat and standing.
Can varicocele be treated without surgery?
The ache can be managed without surgery using supportive underwear, rest and simple painkillers from the pack or a pharmacist. Embolisation closes the vein through a thin tube without a groin cut; no herb, cream or exercise repairs the veins.
Does varicocele cause infertility?
It can contribute, but many men with one father children normally. Repair is mainly advised when the varicocele can be felt, the semen analysis is abnormal and the couple is trying to conceive.
Is varicocele surgery worth it?
It depends on why. For persistent pain, a shrinking testicle in a teenager, or abnormal semen with a palpable varicocele, many men benefit; for a varicocele found only on ultrasound with normal semen, surgery usually isn’t recommended.
How long does recovery take after varicocele surgery?
Most men return to desk work within a few days and avoid heavy lifting and hard exercise for a couple of weeks, as their surgeon advises. Semen is usually retested about three to six months later.
Can varicocele come back after surgery?
Yes, a small number return. The chance varies with the method and the surgeon’s experience; microsurgical repair tends to have low recurrence and fewer fluid collections.
Is varicocele dangerous?
Usually not. The warning pattern is a varicocele only on the right, a sudden new one after 40, or one that doesn’t empty when lying down; those need an ultrasound soon because something higher up may be pressing on the vein.
Does varicocele cause erectile dysfunction?
No direct link. Erection problems have other causes and are worth checking on their own, because they can be an early sign of heart disease or diabetes.
Can I go to the gym with a varicocele?
Most men can. Heavy straining may make the ache worse, so wear supportive underwear and back off if it hurts; if you’re tempted by steroids for muscle, don’t: they can stop sperm production completely.
Does varicocele affect testosterone?
In some men a large varicocele is linked with lower testosterone, and repair may raise it a little. It isn’t a reason for surgery on its own; a urologist looks at symptoms and blood tests together.
Can teenagers get varicocele?
Yes. Varicoceles often appear around puberty; doctors watch the size of both testicles, and treatment is considered if the affected one stays clearly smaller or there’s ongoing pain.
Does a varicocele turn into cancer?
No. A varicocele is a vein problem and doesn’t become cancer; a firm lump in the testicle itself is different and needs checking within two weeks.