For a man, there’s no worse place to experience pain than in the genitals. A sudden blow – like getting strategically elbowed in the groin playing basketball or flying over the bicycle handlebars – will bring a man to his knees far faster than pain anywhere else in the body. There are also subtler types of genital pain – with less obvious causes.
One of most common causes of low grade, ongoing genital pain is the enlargement of several veins within the scrotum called a varicocele. These enlarged veins don’t cause cancer and aren’t life-threatening, but they can impact fertility and can act like a soft mass in the scrotum. The condition is unique to humans – it seems to have all began when we stopped crawling on all fours like other animals and stood up and walked. Because of this evolutionary shift in posture, blood leaving the testes now has to drain uphill to reach the heart instead of taking an easier flat and level path like that of our four-legged friends. And that means that gravity plays a role, and, in some men, forces the blood back down toward the testicle where it pools and congests, similar to varicose veins on legs.
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 testicle, around it, or above it. The scrotal skin does not hurt. There is usually no pain in the groin, 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 often occurs only at the end of the day.
- Since it depends on gravity, varicocele pain resolves completely if you lie down. This makes it different from inflammation which is a more constant nagging pain.
- As such, there can be pain during the day or in the evening, but never in the morning after lying flat all night.
- Pain pills really don’t help as the pain is not really inflammatory in nature.
The great news is that varicoceles can be eliminated at least 90% of the time with a fairly minor surgical procedure called a varicocele repair. This procedure is routinely performed as outpatient surgery with an operating microscope. Men average about 2-3 pain pills afterwards, and complications are highly unusual. Not all men experience pain with varicoceles, but if you do, there’s a solution.