Does varicocele surgery improve erectile dysfunction?

Erectile dysfunction occurs when a man cannot erect or maintain an erection. The condition is associated with many causes including diabetes, high blood pressure (hypertension), metabolic syndromes, and others.

In most cases, erectile dysfunction happens when the bulbocavernosus muscle is affected. This muscle has three important functions: it allows the penis to fill with blood during an erection, pumps during ejaculation, and empties the urethra after urination.

Does varicocele surgery improve erectile dysfunction?
Does varicocele surgery improve erectile dysfunction?

If erectile dysfunction is linked to varicocele, surgery may be recommended.

But again, how effective are these surgeries? Is having varicocele surgery a guarantee in curing erectile dysfunction? This blog aims at determining whether varicocele surgery improves erectile dysfunction.

Over the last decade, researchers have carried out hundreds of studies on varicocele and erectile dysfunctions. The primary aim of these studies has been to establish the relationship between erectile dysfunction and varicocele.

This has come because of a lack of medications that can treat varicocele. Ideally, medical professionals recommend acetaminophen or ibuprofen to reduce varicocele pain.

However, these medications only calm the pain for a moment but do not offer a permanent cure.

Varicocele is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum).

Varicocele is like varicose veins that are usually present on the legs. These veins carry deoxygenated blood from the testicles. A varicocele occurs when blood pools in these veins instead of efficiently circulating out of the scrotum.

The result is usually pain and discomfort, low sperm count, and infertility. Varicocele has been associated with testicular atrophy (shrinking of the testicles)  and even azoospermia (absence of sperms during ejaculation). There are four types of varicocele:

Grade 1: Here, the varicocele is usually small. It is also palpable only when the patient performs Valsalva Maneuver. Valsalva Manoeuvre plays an important role in the dilation of the pampiniform plexus. Pampiniform plexus (a network of many small veins found in the male spermatic cord).

Grade 2: This is a moderate-sized varicocele. It is easily palpable.

Grade 3: This is usually a large varicocele. It can be seen through the scrotal skin.

Grade 4: These are highly dilated and tortuous veins. They usually cause a lot of pain and can make activities of daily living difficult.

One study included 265 infertile males with varicocele. To make the study effective, patients were divided into three groups. Group 1 had 193 patients who did not receive surgery. Group 2 had 72 patients who underwent the surgical operation using the Palomo procedure. 1

The third group comprised 28 patients who were used as a control group. This last group never had a varicocele. All patients completed the International Index of Erectile Function IIEF-5 (German version).

They also underwent semen analysis. Serum testosterone, Follicle-Stimulating Hormone (FSH), and Luteinizing Hormone (LH) were measured within this study and even after surgery. At the end of the study, the results showed that semen quality had improved in 37.5% of the patients following varicocele surgery. The same study also showed that erectile dysfunction improved partly after varicocele surgery.

A different study was conducted to evaluate whether varicocelectomy improves both serum testosterone and sexual function.

Thirty-four patients were assessed using the Male Sexual Health Questionnaire (MSHQ). 50% (seventeen patients) were battling infertility problems. The remaining 13 had varicocele which was linked to hypogonadism (when sex glands called gonads produce little sex hormones).

A large percentage of men in the study had bilateral varicoceles. They also had left grade III varicoceles. After the surgery, the post-surgical follow-up was conducted after an average of one year. 2

The study found that microsurgical repair of varicocele improved testosterone levels. The surgery also indicated that patients reported improved erectile and ejaculatory functions. Therefore, patients can confidently undergo varicocele surgery because it has the potential to improve sexual function. In return, this has brought in a new hope for men battling erectile dysfunctions.

Varicocele can be treated using three distinct surgeries. Medical professionals have studied and often recommended these surgeries. They include:


This is usually an open surgery. It is done under either general or local anesthesia. The surgeon accesses the varicocele region through the groin. He/she can also go through the abdomen or upper thigh to access the region.

A surgical microscope accompanied by ultrasound helps the surgeon access and close the affected veins. This closure re-routes the blood from these defective vessels to other healthier blood vessels. This prevents blood pooling in the veins rather than circulating efficiently out of the scrotum.

Laparoscopic Surgery (High spermatic vein ligation)

Unlike varicocelectomy, laparoscopic surgery is usually non-invasive. The surgeon makes a small incision on the abdomen. He/she uses this opening to pass surgical instruments to access your abdomen.

The surgeon accesses the gonadal vessels (the blood vessel that carries blood away from the gonad (testis, ovary) toward the heart). The defective veins are cut, hence restoring the normal functioning of the male reproductive organs.

Percutaneous Embolisation

This is done by a radiologist who inserts a tube inside the body. This tube is usually inserted through the neck or the groin region. Surgical instruments are then passed through this tube, allowing the surgeon to scar the veins, hence blocking them.

Most of the time, chemicals or coils are used. This procedure takes a little time and can be performed in outpatient departments.

Even if there are many options to treat varicocele, there are some disadvantages too. First, the current studies have not provided clear evidence as to which technique provides the best outcomes. For this reason, microsurgery should be the first choice as it has minimal chances of complications and failure.

However, the only disadvantage of having microsurgery is the fact that it may cause spermatic artery injury resulting in testicle atrophy. If these problems are not addressed on time, they may trigger impotence and make erectile dysfunction even worse.

The Bottom Line

Varicocele happens when there is an enlargement of the veins within the scrotum. Its cause is usually unknown although there are various factors linked to it. When not treated on time, it can cause erectile dysfunction or even make it worse. Because there is no known medication to treat varicocele, surgery is usually recommended. From the studies above, it is clear that these surgeries can be used to treat erectile dysfunction.

Because varicocele is a common problem in some men having erectile dysfunctions, having surgery may help to restore erectile function.

Just like any other surgery, surgery of the varicocele can cause serious health problems. These problems may range from mild pain to severe atrophy of the reproductive organs. However, when done correctly, it is possible to still have a well-functioning penis. Would you like to know more about varicocele and how it’s related to erectile dysfunction? If yes, click here:

About the author

Deepanshu has a Master's in chemistry. He has worked extensively on research subjects regarding cancer and radio nuclear science and has continually reviewed nutrition science.

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