The Sagging Scrotum Cure

Man covering groin with hands - sagging scrotum

Low hanging balls are usually caused by varicoceles. Although not life-threatening, a varicocele is a cause for concern for men and adolescents. The main reason is fertility – now or in the future – with around 17 to 21 percent of all male infertility cases due to varicocele. This makes varicocele the single most common cause of male infertility issues. In fact, about 15 to 20 percent of the male population suffers from varicocele, which can be completely asymptomatic. However, many patients may notice that their scrotum hangs low, or as they describe it, they have low hanging balls.

So what is a varicocele? Simply put, it is a swelling of the veins in the scrotum. This phenomenon is due to a backflow of blood into the scrotum, similar to varicose veins in the legs. Since blood cannot flow properly, the blood vessels dilate resulting in increased scrotal temperature. Varicoceles are sometimes obvious but other times are difficult to diagnose. Here is a summary of varicocele symptoms and diagnostic techniques.

From the Patient’s Point of View: Low Hanging Balls and a Bag of Worms

While a varicocele may be completely asymptomatic, some have distinct manifestations. For instance, patients may notice that their scrotum hangs low. Along with this occurrence, many patients find that their scrotum is asymmetric with one side hanging lower than the other. The vast majority of the time it is the patient’s left testicle that hangs lower.

Additionally, patients often describe their varicocele as feeling like “a bag of worms.” They may have a sensation of shifting inside their scrotum and may cause pain. About ten percent of varicocele patients report pain associated with this condition.

Scrotal temperature is another clue to a possible varicocele. A male’s scrotum is typically a few degrees cooler than their body temperature since the scrotum hangs away from the torso. But a varicocele can cause the scrotum to become warmer than normal due to warm blood refluxing from the abdomen.

Physical Examination

A thorough physical examination is the first step in a varicocele diagnosis. An urologist palpates – or feels with the fingers – the patient’s scrotum, searching for dilated veins and other signs. The patient may need to perform a maneuver intended to cause blood to reflux into the scrotal veins. Many varicoceles can be discovered in this manner, but sometimes the urologist will be unable to feel a small varicocele. Such varicoceles are called “subclinical” and may require investigation by ultrasound or other diagnostic tools.


An urologist can use specialized ultrasound to determine whether there are swelling and reflux in the scrotal veins. Ultrasound imaging is completely noninvasive and painless. The results are typically available the same day as the procedure, and the urologist can make their recommendation.

Seminal Fluid and Sperm Morphology

Analysis of the seminal fluid and sperm cell morphology – or structure – is another method of varicocele diagnosis. Varicoceles may cause abnormalities in semen composition. Additionally, it is possible to look at the patient’s sperm under a microscope to determine what percentage of the sperm cells are properly formed. A low proportion of normal sperm could indicate a varicocele that may cause fertility problems.

Varicocele Diagnosis as a Sagging Scrotum Cure

A varicocele can be a danger to fertility. For this reason, adolescent males should always be checked for a varicocele diagnosis during sports physicals and pediatric checkups. Furthermore, varicocele should be considered any men of any age who are experiencing fertility difficulties.

I always inform my patients that if a varicocele is diagnosed, surgery is the definitive treatment. A microsurgical varicocelectomy has few risks and a good success rate. Patients owe it to themselves and parents owe it to their sons to explore varicocelectomy as a means of resolving both the varicocele itself and the fertility impairments it may cause.

For more information on varicocele, download The Patient Guide to Varicocele from Dr. Fisch.

If you have any testicular symptoms, or are contemplating Varicocele surgery in New York, please contact Dr. Fisch at 212-879-0800 or 

Request a Consultation with Dr. Fisch