Varicocele: Bringing Grown Men To Their Knees

Posted on by Paul Turek, MD

Name something utterly embedded in our lives, despite our tireless aversion to it. No one of sound mind seeks it out, although it commonly accompanies much of what we do. Yes, it’s pain.

The Dutch Scratch

And is there a particular pain that brings a man to his knees faster than scrotal pain? Nope. Just ask Daniel Craig in Casino Royale after his utterly simple chair torture (to end all tortures). Excuse me as I cringe and gasp just thinking about this.
Though uniformly despised, not all scrotal pain is the same. We’ve discussed post-vasectomy pain which is well known and related to a procedure. And you might expect some pain when you fly over the bicycle handlebars or get strategically elbowed in the groin playing basketball. But what about pain that just happens down there? No large dog landings, no targeted toddler ball butts; it just hurts, dammit.

Enter the Varicocele

One relatively common cause of mild to moderate scrotal pain is a pile of extra large veins within the scrotum called a varicocele. It is a benign anatomical disorder found under the skin in the spermatic cord and is unique to us humans. It all began when we decided to stop crawling on all fours and stand up and walk. Because of this evolutionary shift in posture, blood leaving the testes now has to drain up hill to the heart instead of taking an easier flat and level path. And that means that gravity rears its ugly head and, in some men, forces the blood back down toward the testicle where it pools and congests, similar to varicose veins on legs.

The Usual Suspect

Here are the characteristic features of varicocele-associated scrotal pain:

  • It is usually mild, localized pain that begins after puberty (when varicoceles first develop)
  • It is almost always on the left side and not on the right, because 95% of varicoceles occur only on the left side.
  • The pain is typically in the “nut,” around it, or above it. The scrotal skin does not hurt. There is usually no pain in the groin area, which is more typical of hernia.
  • Varicocele pain is achy or “congestive,” or may feel like a “heaviness” or just increased sensitivity. It is not sharp or stabbing.
  • The pain is worsened with physical activity (i.e. exercise, sex), standing, and even sitting. It is often present only at the end of the day.
  • Since it depends on gravity for its existence, varicocele pain resolves pretty much completely if you lie down. This makes it different from epididymitis which is a more constant, inflammatory pain.
  • As such, you may have pain during the day or in the evening, but never in the morning after lying flat all night. This is a defining characteristic.
  • Pain pills really don’t help as the pain is not really inflammatory in nature.

Please understand that my wish for you is that you never have scrotal pain. However if you do and it sounds like varicocele pain, realize that it can be eliminated pretty much 90% of the time with a fairly minor surgical procedure. I prefer a high scrotal approach using an operating microscope to repair varicoceles, a procedure routinely done on a “come and go” basis. Men average about 2-3 pain pills afterward while healing. And complications are highly unusual; after all, the goal is to make a healthy man with pain into a healthy man without pain. Bob Dylan, the eternal optimist, could have been thinking about just this thing when he said: “Behind every beautiful thing, there’s some kind of pain.”