Varicocele and erectile dysfunction: can varicocele cause ED?

If you’ve felt something that feels like a bag of worms in your scrotum, you might understandably be concerned. It could be a varicocele, or an enlargement of the veins in the scrotal sac. While varicoceles are often harmless, in some cases, they can contribute to pain, discomfort, and even infertility. But can a varicocele cause erectile dysfunction (ED)? 

The short answer: We don’t know yet. For the longer answer — plus a deep dive into varicoceles and erectile dysfunction — read on.

A varicocele is an enlargement of the veins in your scrotum and spermatic cord (the tissues connecting your testicles to your body). They’re similar to varicose veins in your legs, except that they occur in the pouch of skin that holds your testicles.

Varicoceles are common, affecting 15%--20% of men. They may develop when the valves that manage blood flow to the testes stop working properly, allowing blood to pool and swell. 

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Varicoceles are usually symptomless. If you notice any of the following, they could be signs of a varicocele:

• Dull ache, pain, or discomfort in the scrotum or testicles

• Veins in the scrotum that feel like a bag of worms or spaghetti

• Swelling in the scrotum or testicles

• Shrinking of the testicles (aka testicular atrophy)

• A small lump on the testicle, usually on the left side

• Infertility (although there are other causes of infertility in men)

A healthcare provider can determine if these symptoms are due to a varicocele. To diagnose a varicocele, they’ll typically perform a physical exam. They may also order a pelvic ultrasound, semen analysis, or blood tests. There are different grades of varicocele, from those that can only be seen on an ultrasound to those that are big and easily felt.

Sometimes, but not always. A varicocele doesn’t directly cause ED, but there’s solid evidence that it can contribute to it in some men. Studies show men with varicoceles are more likely to have ED, especially younger men and those with more severe (higher-grade) varicoceles.

The main link isn’t pain — it’s testosterone. Varicoceles can disrupt testicular function and lower testosterone levels, which play a key role in sex drive and erections. That’s why men with varicoceles and ED often have lower testosterone than those without symptoms.

There’s also some evidence that treating a varicocele can help address ED symptoms. In certain cases, repair can improve testosterone levels and erectile function, but individual experiences may vary.

Varicoceles can also contribute to premature ejaculation, low testosterone, or infertility, which can all be underlying causes of ED. 

For example:

• Premature ejaculation (PE): PE and ED often overlap, with estimates suggesting 30%–60% of men have both. PE can cause performance anxiety, which can lead to trouble getting and staying hard.

• Low testosterone (hypogonadism): Low T and ED also overlap, with around a third of men with ED also having low testosterone levels. And research shows that men with larger varicoceles are more likely to have lower T levels and worse erectile function.

• Infertility: Infertility and ED are not directly related, but they tend to go hand in hand. Reason being, trouble conceiving can decrease sexual satisfaction, lower your sex drive, and cause performance anxiety or depression — all of which can make it harder to get, well, hard.

In fact, varicoceles have a strong association with infertility. Up to 40% of men with infertility have a varicocele. This link makes sense for numerous reasons. Varicoceles can lower testosterone levels, which can reduce sex drive. They can also raise your scrotum's temperature, which can affect sperm count or production. 

Yes, it can. 

Many studies have found that varicocele surgery (known as varicocelectomy) can improve erectile dysfunction. However, these studies were typically done in men who also had infertility or low testosterone levels. There is very little research on the impact of varicocele surgery on ED in men without infertility or low T.

Varicocele surgery for ED: what research shows 

Research on varicocele surgery specifically for ED is limited. Typically, the studies focus on the impact of varicocele surgery for infertility or hypogonadism (low testosterone levels). 

However, multiple studies have found that when men have these underlying issues and get a varicocelectomy, they report stronger erections afterward. Additional research has shown that men who have varicocele and ED are less likely to have ED after surgery.

Variocelectomy can have other benefits for men’s sexual health, according to research. For example, studies show that it can improve:

• Low testosterone levels in men with low T or infertility

• Semen quality in men with low T or testicular atrophy (shrinkage)

• Sex drive in men with low T

• Premature ejaculation

Yes, you can generally take Viagra (sildenafil) if you have a varicocele. There is no research indicating that Viagra wouldn’t work in men with ED who have a varicocele. Viagra tends to be safe and effective for most men. 

Still, it’s best to check with a healthcare provider first in case you have a health condition (e.g. heart problems, high blood pressure) or take medications that can interact with sildenafil, Viagra’s active ingredient.

If you believe you have ED caused by a varicocele, make an appointment with a healthcare provider. They can confirm whether or not you have a varicocele and recommend appropriate treatment options, which may include:

• Getting a varicocelectomy

• Taking ED medications like Viagra or Cialis

• Making lifestyle changes like diet, exercise, or quitting smoking

Varicocelectomy

Varicocele surgery may be recommended if your healthcare provider confirms you have a varicocele, and you also have infertility, hypogonadism (low T), or significant pain due to the condition. 

During the procedure, a surgeon will tie off the affected veins and redirect blood to other healthy veins in the scrotum. It’s typically an outpatient surgery, so you can go home afterward to recover.

PDE5 inhibitors

PDE5 inhibitors are a class of prescription medications that includes Viagra (sildenafil), along with Cialis (tadalafil), Stendra (avanafil), and vardenafil (formerly Levitra). These oral ED medications are often the first-line treatment for ED because they’re safe and well-tolerated by most men. 

If you’re looking for a pill-free alternative, you can find some PDE5 inhibitors in other formulations, such as:

• Ro Sparks, which combines sildenafil and tadalafil in a dissolvable lozenge

• Daily Rise Gummies, which contain a daily dosage of tadalafil

These last two options are made by compounding pharmacies, so they aren’t specifically FDA-approved for the treatment of ED as finished products. That being said, their active ingredients have been individually FDA-approved for ED treatment.

Lifestyle changes

Lifestyle changes can also be effective for both preventing and treating ED. These include: 

• Weight loss: If you’re overweight or have a weight-related condition like diabetes, losing weight can improve erectile function and testosterone levels.

• Diet: Switching to a heart-healthy eating plan, like the Mediterranean diet, has been shown to lower the risk of ED.

• Exercise: Regularly engaging in moderate- to high-intensity exercise can both prevent and improve symptoms of ED. 

• Quitting smoking: More than 25% of men who quit smoking experience improvement in ED symptoms within a year.  

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Varicoceles are often painless and can even be harmless. But for some men, they become a problem that causes pain, affects fertility, and possibly contributes to erectile dysfunction. Here’s what to keep in mind on the topic:

• Varicoceles can cause swelling, aches, pain, or discomfort in the scrotum or testicles.

• Varicoceles can contribute to ED, but they don’t directly cause the condition. 

• They can also contribute to premature ejaculation, low testosterone, or infertility.

• Varicocele surgery can improve ED, according to studies of men with ED and infertility or low T.

• Treatment options for ED related to varicocele include varicocelectomy, PDE5 medications like Viagra, and lifestyle changes.