Varicocelectomy
A varicocelectomy ties off the swollen veins above the testicle, called a varicocele. It is done to improve sperm in men trying to conceive, to relieve aching, or to protect the growth of the testicle in teenagers.
Also called Varicocele repair, Varicocele surgery, Microsurgical varicocelectomy, Subinguinal varicocelectomy, Microsurgical subinguinal varicocele ligation, Varicocele ligation, Varicose veins in the scrotum surgery, Bag of worms in scrotum
- Where
- Outpatient surgery center or hospital operating room
- Anesthesia
- General anesthesia; sometimes spinal anesthesia or sedation with numbing medicine
- Time in the room
- 1 to 2 hours for one side; longer for both sides
- Hospital stay
- Same day
- Back to normal
- 1 to 2 weeks
- Back to work
- Desk work in 2 to 5 days; heavy physical work after about 2 weeks
Overview
A varicocele is a group of swollen veins in the scrotum, above and behind the testicle, much like varicose veins in the legs. When it is large, it can look or feel like a bag of worms. About 15 in 100 men have one, and it is found in more than a third of men who are having trouble starting a pregnancy. Most are on the left side. Many cause no problems at all and need no treatment.
Blood pooling in these veins can warm the testicle and may harm sperm production. For men trying to conceive who have a varicocele that can be felt on exam and abnormal semen tests, repairing it is a recommended option. It is also done for a dull ache that does not settle with simple measures, and in teenagers whose testicle on that side is not growing as well.
The most common approach in the United States is a microsurgical subinguinal varicocelectomy. Through a small cut just below the groin crease, your surgeon uses an operating microscope to tie off the swollen veins one by one, while saving the testicle's artery, the lymph vessels and the vas deferens. This approach has the lowest chance of the varicocele coming back and of fluid building up afterward.
Sperm take about 3 months to develop, so the effect on semen is checked with semen tests at around 3 and 6 months. Another option is embolization, where a radiologist blocks the veins from the inside through a thin tube passed into a vein, without a cut in the groin.
The parts of your body involved
Blood leaves each testicle through a web of small veins in the spermatic cord, called the pampiniform plexus. These veins join into one testicular vein that travels up inside the belly. On the left, it drains into the kidney vein at a right angle, and on the right, it joins the body's main vein at a slant. The left side has more pressure, which is one reason most varicoceles are on the left. Normally, one-way valves keep blood moving up. When the valves fail, blood pools and the veins swell. The web of veins also normally works like a radiator, cooling the blood headed to the testicle, and this cooling is less effective when the veins are swollen.
- Testicle
Makes sperm and testosterone. It works best a few degrees cooler than the rest of the body.
- Pampiniform plexus
The web of small veins around the testicle's artery. These are the veins that swell to form a varicocele.
- Testicular artery
The small artery that brings blood to the testicle. Your surgeon protects it carefully.
- Lymph vessels
Tiny clear channels that drain fluid from the testicle. Saving them prevents a fluid buildup called a hydrocele.
- Vas deferens
The tube that carries sperm. It runs in the same cord and is left untouched.
Why it’s done
Many varicoceles never need treatment. Repair is considered when a varicocele can be felt on exam and is linked to a problem. Varicoceles seen only on ultrasound, too small to feel, are generally not repaired for fertility.
- Trouble conceiving with abnormal semen tests
For a couple trying to conceive, if the man has a varicocele that can be felt and his semen tests are abnormal, repair can improve sperm and the chance of a natural pregnancy.
- Aching or heaviness
A dull, dragging ache that is worse after standing or exercise and better lying down, and that does not settle with support underwear and anti-inflammatory medicine.
- A smaller testicle in a teenager
When the testicle on the varicocele side is clearly smaller than the other, repair may help it catch up. Your child's urologist follows growth with exams or ultrasound.
- Very low sperm production
In some men with no sperm in the semen because of low production, repair occasionally brings a small number of sperm back or helps sperm retrieval. Your urologist will discuss whether it makes sense for you.
Other options
- Embolization
An interventional radiologist passes a thin tube through a vein in the groin or neck to the testicular vein and blocks it with tiny coils or a medicine. There is no groin cut and recovery is quick. The varicocele comes back somewhat more often, and sometimes the vein cannot be reached.
- Laparoscopic repair
The vein is tied higher up, inside the belly, through keyhole cuts under general anesthesia. Fluid buildup around the testicle is more common unless the lymph vessels are spared.
- Open repair without a microscope
The veins are tied higher in the groin or lower belly without magnification. This is still used in some children. Recurrence and fluid buildup are somewhat more common.
- Watching
If the varicocele causes no pain, semen tests are normal, or you are not trying to conceive, no treatment is needed.
- Support and pain relief
Snug underwear and anti-inflammatory medicine help many men with mild aching.
- Going straight to IVF
If the female partner is older or has her own fertility issues, some couples move directly to IVF rather than waiting months to see if repair helps.
Getting ready
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Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
You lie on your back on the operating table. The anesthesia team puts you to sleep or gives you sedation. The groin and scrotum are cleaned and draped, and the operating microscope is positioned over the groin.
After the operation
Right afterward
- Recovery room
You wake up in recovery with a sore groin and a snug support. The nurses check your pain and the dressing.
- Ice
Ice packs are often started in recovery and continued at home.
- Going home
Most men go home 1 to 2 hours after surgery with a driver and written instructions.
- Pain plan
You will be told which pain medicines to take. Many men need only acetaminophen and ibuprofen.
At home
- Pain
The groin feels bruised and sore for 3 to 5 days, a bit like a pulled muscle. Acetaminophen and ibuprofen usually control it. A few doses of stronger medicine are sometimes prescribed.
- Ice and support
Use ice on and off for the first 48 hours. Wear snug briefs or a supporter for about 2 weeks.
- The incision
Keep it clean and dry. Skin glue peels off on its own in 1 to 2 weeks. Do not pick at it.
- Showering
Usually allowed after 24 to 48 hours. Pat the incision dry. No baths, hot tubs or swimming for 2 weeks.
- Activity
Walk around from the first day. Avoid running, cycling and sports for about 2 weeks.
- Lifting
Avoid lifting more than about 20 pounds for 2 weeks. Your surgeon may give a different limit.
- Sex
Most men can resume sex or ejaculation after about 1 to 2 weeks, when comfortable.
- Driving
Once you are off strong pain medicine and can brake hard without pain, usually after 2 to 3 days.
- Work
Desk work in 2 to 5 days. Physical work usually after about 2 weeks.
- Semen tests
If fertility was the reason, the first semen test is usually about 3 months after surgery, then again at about 6 months.
Recovery timeline
- Day 0Home the same day
You go home a few hours after surgery. Rest, ice and pain medicine for the evening.
- Days 1 to 3Sore groin
The incision is tender and the scrotum may be a little swollen or bruised. Walking is slow but fine.
- Week 1Back to desk work
Most men are back at work or school and moving normally.
- Weeks 2 to 3Normal activity
Exercise, lifting and sex are usually back to normal.
- About 3 monthsFirst semen test
A full cycle of new sperm has been made since surgery. Many men see improvement on this test.
- About 6 monthsSecond semen test
Improvements often continue to build. Your urologist reviews the trend with you and your partner's fertility team.
- 6 to 12 monthsPain and growth
For men with aching, relief is usually clear by now. In teenagers, testicle growth is rechecked.
- Long termFollow-up as needed
If a pregnancy has not happened after a year of trying with improved semen, both partners are usually reassessed.
What it feels like
Most men describe the recovery as easier than they expected: a sore groin for a few days and then back to normal. The harder part, for men having it for fertility, is waiting months to learn whether it helped.
Deciding
Learning that you may be part of the reason a pregnancy has not happened can bring guilt, frustration or embarrassment.
What helpsInfertility is common and is nobody's fault. Bring your partner to the visit, and ask how the repair fits into the overall plan with the fertility team.
Waking up
The groin feels sore and tight, and the scrotum can feel heavy. Some men are surprised how small the cut is.
What helpsIce, the support and pain medicine on a schedule for the first day.
The first few days
Getting in and out of bed or a car pulls at the incision. Some bruising or swelling in the scrotum is common.
What helpsRoll onto your side before sitting up. Keep a pillow handy to press over the incision when you cough or laugh.
Back at work
Most men feel almost normal within a week, though a long day on your feet can bring back an ache.
What helpsWear support underwear and take short breaks to sit.
Waiting for the semen test
Three months can feel like a long time, especially if you are watching the calendar.
What helpsKeep trying for a pregnancy in the meantime. Ask your urologist what changes would count as a good result for you.
If you had it for pain
The dragging ache often fades over weeks. Some men notice relief right away, others more gradually.
What helpsLet your urologist know at follow-up if the old ache is not improving.
How well it works
Success depends on why you had the repair. For fertility, it is measured with semen tests and, ultimately, pregnancy. For pain, it is measured by how you feel.
- Semen improvement
Sperm count, movement and shape improve in many men, often more than half. Changes usually show by 3 to 6 months, and some keep improving for up to a year.
- Pregnancy
For couples where the man has a varicocele that can be felt and abnormal semen, studies show repair improves the chance of a natural pregnancy. It is not guaranteed, and the female partner's age and fertility matter a great deal.
- Pain relief
Most men with a typical varicocele ache feel better after repair, though not everyone does.
- Recurrence
After microsurgical repair, the varicocele comes back in about 1 to 2 in 100 men, the lowest of the available methods.
- In teenagers
The testicle on the repaired side often catches up in size. Growth is followed with exams or ultrasound.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
A bruised, pulled-muscle feeling in the groin for several days.
Mild swelling or bruising of the scrotum is common and fades within 1 to 2 weeks.
A small patch of numb skin near the incision is common and usually improves over weeks to months.
Less common
Semen results or pain may not improve even after a technically good repair.
Some swollen veins remain or new ones form.
Fluid can collect if lymph vessels are tied. This is uncommon with microsurgery because the lymph vessels are seen and saved.
Wound infection or a collection of blood under the skin is uncommon and usually treated simply.
Rare
If the artery is damaged, the testicle can shrink. Using the microscope and Doppler is meant to prevent this.
Damage to the sperm-carrying tube is rare.
Ongoing pain after healing is rare.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Swelling in the groin or scrotum that keeps getting bigger, or a tense, very bruised scrotum
- Bleeding that soaks through the dressing and does not stop after 10 minutes of firm pressure
- Redness spreading from the incision, warmth, or pus
- Sudden, severe pain in the testicle, or pain not controlled by your medicine
- Swelling, warmth or pain in one calf, or shortness of breath
Questions to ask your surgeon
- Can you feel my varicocele on exam, and what grade is it?
- Do my semen tests and hormone levels suggest repair could help?
- Do you use a microscope and spare the artery and lymph vessels?
- How often does the varicocele come back after your repairs?
- Would embolization be a reasonable option for me?
- Should my partner see a fertility specialist at the same time?
- Given my partner's age, should we wait for the semen results or go straight to IVF?
- Do I have a varicocele on both sides, and would you repair both?
- When will my semen be retested?
- How long should I avoid lifting, exercise and sex?
- What results would you expect for my pain?
Words you may hear
- Varicocele
- Swollen veins in the scrotum around and above the testicle.
- Varicocelectomy
- Surgery that ties off the swollen veins of a varicocele.
- Subinguinal
- Just below the groin canal. The incision is made here for microsurgical repair.
- Pampiniform plexus
- The web of small veins that drains blood from the testicle.
- Testicular artery
- The small artery that supplies the testicle.
- Lymph vessels
- Tiny channels that drain clear fluid from tissues.
- Hydrocele
- A buildup of fluid around the testicle.
- Doppler probe
- A small ultrasound pen that lets the surgeon hear blood flowing in an artery.
- Embolization
- Blocking a blood vessel from the inside with coils or medicine passed through a thin tube.
- Semen analysis
- A lab test that checks sperm count, movement and shape.
- Spermatic cord
- The bundle of vessels, nerves and the vas that holds up the testicle.
- Valsalva
- Bearing down as if straining, which makes a varicocele easier to feel.
Common questions
Do I need surgery if my varicocele does not bother me?
Usually not. Most varicoceles cause no problems. Repair is considered when there is pain, trouble conceiving with abnormal semen tests, or a testicle that is not growing well in a teenager.
Why is it usually on the left?
The left testicular vein is longer and joins the kidney vein at a right angle, which puts more pressure on its valves. Right-sided or new varicoceles in older men are sometimes checked with imaging to make sure nothing is pressing on the veins higher up.
Will repair guarantee a pregnancy?
No. It improves sperm in many men and raises the chance of natural pregnancy in the right couples, but the female partner's fertility matters just as much.
Is embolization better than surgery?
Both are reasonable. Embolization avoids a groin cut and has a quick recovery. Microsurgery has the lowest chance of the varicocele coming back. Your urologist and a radiologist can help you compare.
Can it come back?
Yes, but uncommonly after microsurgical repair, in about 1 to 2 in 100 men.
My teenage son has a varicocele. Does he need surgery?
Not always. Many are simply watched with yearly exams. Repair is usually suggested when the testicle on that side is clearly smaller, when there is pain, or when older teens have abnormal semen tests.
Will it raise my testosterone?
Some studies show a modest rise in testosterone after repair, but low testosterone alone is not a standard reason for this surgery in the United States. Ask your urologist about your levels.
Sources this page draws on
- American Urological Association and American Society for Reproductive Medicine, Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020)
- American Society for Reproductive Medicine, Report on varicocele and infertility: a committee opinion
- European Association of Urology, EAU Guidelines on Sexual and Reproductive Health
- Urology Care Foundation, Varicocele
- MedlinePlus (U.S. National Library of Medicine), Varicocele
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.