Varicoceles and Sexual Dysfunction

Varicoceles can cause sexual dysfunction through hormonal alterations, particularly decreased testosterone levels in affected men. 1

Relationship Between Varicoceles and Sexual Function

Varicoceles are present in approximately 15% of the normal male population, 25% of men with abnormal semen analysis, and 35-40% of men presenting with infertility 2
The pathophysiological mechanisms by which varicoceles affect testicular function include higher scrotal temperature, hypoxia, and reflux of toxic metabolites that can cause testicular dysfunction 2
These mechanisms can lead to both impaired spermatogenesis and hormonal alterations that may affect sexual function 3

Men with varicoceles and sexual dysfunction have been found to have decreased plasma testosterone levels (mean 346.2 ng/100 ml) compared to men with varicoceles but without sexual disturbances (mean 567.8 ng/100 ml) 1
There is a significant inverse correlation between age and plasma testosterone concentration in varicocele patients, which is not observed in normal men or patients with purely psychogenic impotence 1
Other hormonal alterations may include:
- Lower dihydrotestosterone levels due to decreased activity of epididymal 5-α-reductase 3
- Higher FSH and LH levels that may normalize after varicocelectomy 3
- Lower circulating Anti-Müllerian Hormone and Inhibin-B levels, indicating decreased Sertoli cell function 3

Decreased testosterone production in men with varicoceles can contribute to impairment of sexual function 1
The secretion products of secondary sex glands are often in the lower range in ejaculates of men combining varicocele with sexual disturbance, proving that decreased testosterone levels can induce deficient function of these glands 1
Sexual dysfunction may manifest as decreased libido, erectile dysfunction, or other sexual performance issues related to hormonal imbalances 1

Surgical correction of varicoceles has been shown to normalize plasma testosterone levels in patients with low preoperative concentrations 1
Adequate surgical treatment has resulted in complete recovery of sexual potency in the majority of patients with varicocele and sexual inadequacy 1
The main procedures for varicocele repair include:
- Microsurgical subinguinal or inguinal varicocelectomy (optimal treatment in most cases) 4
- Laparoscopic varicocelectomy 4
- Radiological percutaneous embolization 4
Hormonal improvements typically parallel improvements in semen parameters, which take up to two spermatogenic cycles (approximately 3-6 months) to show improvement 5

Perform a thorough physical examination to confirm the presence of a clinical (palpable) varicocele, conducted in both supine and standing positions with Valsalva maneuver 2, 6
Only clinical (palpable) varicoceles should be treated; routine use of ultrasonography to identify non-palpable varicoceles is discouraged 7, 8
Consider hormonal evaluation including serum testosterone, FSH, and LH levels, particularly if sexual function is impaired 2
For patients with confirmed clinical varicocele, abnormal semen parameters, and/or low testosterone levels with sexual dysfunction, consider varicocelectomy 2, 1
Monitor improvements in hormonal levels and sexual function following varicocele repair, recognizing that changes typically occur over 3-6 months 5

Not all men with varicoceles will experience sexual dysfunction or hormonal alterations 1
The presence of a varicocele does not always affect testicular function, as only a percentage of men with documented varicoceles suffer fertility or hormonal problems 4
Due to their relatively high prevalence among the general population, varicoceles can occur concomitantly with other conditions that cause impaired spermatogenesis or sexual dysfunction 4
Varicocele treatment should be targeted primarily to men with clinical varicoceles and documented hormonal abnormalities or sexual dysfunction 8