A varicocele, which is present in 15-20% of post-pubertal men, is an enlargement of the veins within the scrotum. A varicocele is similar to a varicose vein that occurs in the legs. Although, the exact cause of a varicocele is unknown, the theory is that increased pressure in the veins causes them to dilate, leading to a defect in the vein's valve and a backflow of blood to the testes. A varicocele may cause symptoms such as dull aching, usually left-sided scrotal pain, swelling or a decrease in size of the left testicle, and/or decreased fertility. Men 21 years or younger with a varicocele should be evaluated for decreased testicular size on physical examination. Younger males who are post-pubertal should additionally undergo a semen analysis. Further management depends on those results. Men older than 21 years of age who desire continued fertility should be monitored with a semen analysis every 2 years. Conservative management with scrotal support and nonsteroidal antiinflammatory drugs (NSAIDs) may suffice for an older man who has completed his family and presents with minor scrotal discomfort as his only symptom. Surgery, which is the preferred treatment option for varicoceles, may be considered if causing significant pain.