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I am 25 years old, male, I live in Lake Jackson, TX. No medications being taken.

I've been diagnosed with a very large Varicocele on the left side of testicle, also a small inguinal hernia on left and right side(no bulge). I am experiencing a lot of pain in the left groin/testicle. My question is, is the Varicocele causing my pain, or is it the hernia? I've never experienced pain until the Varicocele showed up.

Thank you, any answer is much appreciated.

Joshua, it is difficult for me to determine this without being able to examine you personally.  However, in my experience, varicoceles do not cause pain very often and when they do, it is generally mild.  Pain in the groin is common with hernias but can also be due to referred pain to this area from a distant site.  Clues to the etiology of the pain can often be determined with a good history and physical exam.  Pain increasing with lifting or strenuous physical activity or tenderness on palpation of the inguinal ring suggest a hernia as the cause of the discomfort.  Probably the most common cause of referred pain is from prostatitis, an inflammation of the prostate gland.  For your information, to follow is a "macro" I have written on varicoceles.

A varicocele is a collection of varicose veins of the spermatic cord (the rope-like structure that suspends each testicle).  They occur in about 15% of the population.  More than 90% occur on the left, 5% on the right and the rest are bilateral.  Varicoceles are due to a defective valve in the vein that drains blood from the testicle.  They fill by gravity and, therefore, are not detectable while recumbent but apparent when upright.  They may be more pronounced with coughing, straining or sexual arousal.  On examination, the lesion feels like a bag of worms.  Small varicoceles may only be detected by imaging studies such as ultrasound.  A varicocele that does not disappear when lying down may indicate a tumor in the abdomen (but this is quite unusual).  Varicoceles are generally painless.  Often men present to the doctor with pain in the testicle and the varicocele is discovered at that time.  In my experience, the pain is infrequently due to the varicocele and usually due to prostatitis (an inflammation of the prostate gland).  In other words, the varicocele is often an incidental and unrelated condition.   Other urologists, however, state that varicoceles can cause pain and that the pain is relieved by varicocelectomy in about 85% of cases.  However, surgery for relief of this type pain alone is usually a last resort treatment.

Varcioceles may cause an infertility problem manifest by lower sperm counts and increased numbers of immature sperm in the semen on analysis.  However, the majority of men with varicoceles do  NOT have infertility.  Of men who have abnormal semen analyses and varicoceles,  in about 70% of them, the 2 are related and fixing the varicolele often will improve their fertility.  The mean testosterone concentration of men older than 30 years of age with varicoceles was significantly lower than that of younger patients with varicoceles whereas this trend was not seen in men without varicoceles.  Repairing varicoceles appears to improve serum testosterone levels in most, but not in all men.  These findings indicate that varicoceles result in abnormal Leydig cell function (the testicular cells that produce testosterone) in some men, but these patients may also be the ones to most benefit from surgical repair.  Various studies cite the improvement in serum testosterone from 30-90%, most being in the 30-40% range.  

If a teenager or young men with a varicocele has a smaller than normal testicles on that side, there is an increase risk of infertility and many urologists consider this an indication to fix the varicocele surgically.   Other than for infertility, there are just a few indications for repairing a varicocele.  They can be fixed for cosmetic reasons or because they become too weighty.  There are several types of varicocele repair, but they all have in common occluding the vesssels supply in the varicocele rather than actually removing the veins.  This prevents blood from filling the varicocele.  Such techniques include formal open surgery, microsurgery, laparoscopic repair and venous embolization.  As with any procedure there are potential  complications.  These may include persistence of the varicocele, hematoma, hydrocele, damage to the ilioinguinal nerve and occasionally damage to the arterial supply of the testicle.  Because their is an accessory blood supply to the testes, there is controversy as to whether or not this definitively results in atrophy of the testis.  

To be sure about the diagnosis and get recommendations options for treatment (or not), consultation with a urologist is suggested.  Good luck.


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Arthur Goldstein, M.D.


Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.


I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

American Medical Association, American Urological Association, American College of Surgeons

College degree - BS Medical degree - MD Master of Science - MS

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