Varicoceles can cause discomfort and may be associated with fertility concerns in some men. If symptoms are persistent or affecting your quality of life—or if you’re exploring fertility options—an evaluation can help confirm the diagnosis and discuss treatment pathways such as varicocele embolization.
Scrotal aching, heaviness, or a feeling of enlarged veins can have several causes. One common cause is a varicocele, which is an enlargement of veins in the scrotum—often described as a ‘bag of worms’ feeling.
At a glance:
- A varicocele is an enlargement of veins in the scrotum that can cause aching, heaviness, swelling, or visible veins.
- Varicoceles may be associated with fertility concerns in some patients.
- Scrotal pain can have other causes (infection, hernia, torsion), so evaluation matters.
- Sudden severe testicular pain is an emergency—seek immediate care.
- Varicocele embolization is a minimally invasive, image-guided option for selected patients.
Common symptoms that may suggest a varicocele
- Aching or heaviness in the scrotum (often worse later in the day)
- Pain that worsens with standing or activity and improves when lying down
- Visible or enlarged veins
- Swelling or a ‘bag of worms’ sensation
- Discomfort during exercise
- Fertility concerns or abnormal semen analysis (in some cases)
Important: other causes of scrotal pain
Scrotal discomfort is not always a varicocele. Other conditions can cause similar symptoms and may require different treatment.
- Infection or inflammation (may include fever, burning with urination, redness)
- Inguinal hernia (bulge or pressure, often with activity)
- Kidney stone pain radiating to the groin
- Testicular torsion (a medical emergency—sudden severe pain)
- Other causes that require evaluation
Red flags: when to seek urgent or emergency care
- Sudden severe testicular pain (especially with nausea/vomiting) → go to the ER immediately (possible torsion).
- Fever, significant redness, or severe swelling → urgent evaluation (possible infection).
- Severe pain with a firm, tender lump or rapidly worsening symptoms → urgent evaluation.
- Any new mass that feels different than the other side should be evaluated.
How varicoceles are evaluated
Evaluation often starts with a symptom review and exam. Many patients also undergo a scrotal ultrasound to confirm findings and assess anatomy. If fertility is a concern, some patients coordinate evaluation with urology or fertility specialists.
- History and focused exam (pain pattern, swelling, activity effects)
- Scrotal ultrasound (commonly used to confirm diagnosis)
- Discussion of goals: symptom relief vs fertility goals
Next step: learn about varicocele embolization
If you have a confirmed varicocele and symptoms (or fertility concerns) that warrant treatment, varicocele embolization may be an option. It is a minimally invasive, image-guided approach designed to close the problematic veins and reroute blood through healthier pathways—without open surgery.
If sudden severe testicular pain: seek emergency care immediately
Medical information on this page is for general education and is not a substitute for personalized medical advice. If you believe you have an emergency, call 911.
FAQs
What is a varicocele?
A varicocele is an enlargement of veins in the scrotum. It can cause aching or heaviness and may be associated with fertility concerns in some patients.
Do all varicoceles need treatment?
No. Many are mild and don’t require treatment. Treatment is usually considered when there is persistent discomfort, testicular changes, or fertility concerns—based on evaluation.
Is scrotal pain always a varicocele?
No. Infection, hernia, and torsion can also cause scrotal pain. Evaluation is important—especially if symptoms are new, severe, or worsening.
What is varicocele embolization?
Varicocele embolization is a minimally invasive, image-guided procedure that closes the affected veins (often using coils or plugs) to reduce symptoms and reroute blood flow.
Is embolization surgery?
It is typically performed through a small catheter (no large incision). Most patients go home the same day, but recovery varies.
How long is recovery?
Many patients return to normal activities relatively quickly, but recovery depends on your situation. Your provider will review timelines and restrictions.
Can varicocele treatment help fertility?
Some patients may see improvements in semen parameters after treatment, but outcomes vary. If fertility is the main concern, coordination with urology/fertility specialists is often helpful.