When observation is appropriate

• Reassurance and periodic follow-up
• Supportive underwear
• Avoiding activities that provoke discomfort
• Simple pain relief such as acetaminophen/paracetamol or an NSAID if safe for you

When repair is usually considered

1. Persistent bothersome scrotal pain despite conservative measures
2. Infertility when there is a palpable (clinical) varicocele and abnormal semen analysis
3. Testicular shrinkage or poor growth, especially in adolescents
4. Sometimes, abnormal sperm DNA fragmentation or repeated assisted-reproduction failure in selected couples

Definitive treatment options

• Microsurgical varicocelectomy: The dilated veins are tied off through a small groin or lower-groin incision. It is commonly preferred because it can preserve the artery and lymphatic vessels, reducing recurrence and hydrocele risk.
• Laparoscopic or open ligation: Alternatives in some settings.
• Percutaneous embolization/sclerotherapy: An interventional radiologist blocks the abnormal veins through a catheter, avoiding an incision. It can be useful for recurrence after surgery or when a less invasive approach is preferred.

What to expect after repair

• Pain may improve, but it is not guaranteed. A different cause of scrotal pain should be excluded first.
• Semen parameters, if they improve, generally take about 3 months or longer to show change.
• Possible complications: hydrocele (fluid around the testis), recurrence/persistence, infection, bleeding, arterial injury, and persistent pain.

Get prompt medical assessment if

• The swelling appears suddenly, is only on the right, does not reduce when lying down, or begins later in life.
• You have severe sudden testicular pain, fever, vomiting, a hard testicular lump, or significant trauma. Sudden severe pain can be testicular torsion, which is an emergency.

Treatment is more likely appropriate if you have:

• Persistent pain or heaviness that continues despite supportive underwear, activity adjustment, and simple pain medicines. Repair can help pain, but it does not guarantee it, so other causes of scrotal pain should be ruled out first.
• Difficulty conceiving with a partner, plus:
  • a palpable varicocele on examination, and
  • an abnormal semen analysis such as low sperm count or reduced movement.
• A smaller testicle on the affected side, or impaired testicular growth. This is particularly important for adolescents.
• In selected infertility cases, raised sperm DNA fragmentation or unsuccessful assisted reproduction may make repair worth discussing after a full fertility assessment.

Observation is often reasonable if:

• You have no pain or only minor occasional discomfort.
• You are not trying to conceive, or your semen analysis is normal.
• Both testicles are normal in size and development.
• The varicocele was found only on ultrasound and cannot be felt on examination.

If you are an adolescent

Practical next steps

1. See a urologist for a standing scrotal examination.
2. If fertility matters, obtain at least one semen analysis, often repeated if abnormal.
3. Consider a scrotal ultrasound if the examination is uncertain, to measure testicular size, or to exclude another issue.
4. Discuss observation versus microsurgical repair or embolization based on your results and goals.

What needs checking

• Scrotal Doppler ultrasound: confirms the varicocele, checks blood flow, measures both testicular volumes, and excludes a mass or other cause.
• Physical examination, standing and during straining.
• Semen analysis if you are post-puberty and fertility matters now or in the future. It is usually repeated if abnormal.
• Sometimes blood tests such as testosterone, FSH, and LH if there are concerns about hormonal function.