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Can Varicocele Cause ED? What to Know About Varicocele & Erectile Dysfunction

Kelly Brown MD, MBA

Reviewed by Kelly Brown MD, MBA

Written by Erica Garza

Published 03/09/2023

Updated 10/07/2024

Bulging veins in your biceps may be a sign of a bodybuilder physique. But when veins in your scrotum become too prominent, it could point to a condition called a varicocele.

A varicocele is an enlargement of the veins in the scrotal sac that can cause swelling and pain. But can a varicocele cause ED?

There isn’t enough evidence to prove varicoceles cause erectile dysfunction (ED), but some research shows varicocele treatment improves erectile function, suggesting there may be a connection.

We’ll explain what a varicocele is and whether it’s linked to sexual function issues. We’ll also discuss treatments and medications like Viagra® to improve sexual performance.

A varicocele is swelling that affects veins inside the scrotum — the sac of skin located below the penis containing the testicles and spermatic cord. A varicocele can develop when the valves inside these affected testicular veins stop blood from flowing normally.

This reduction in blood flow can cause blood to pool inside the vein, making the scrotal sac resemble a bag of worms. The process is similar to how varicose veins form, which usually develop on the legs and feet.

Varicoceles can affect men of all ages, but most varicocele patients are adolescents and young adults.

It’s far from uncommon to develop a varicocele. Research suggests that around 15 to 20 percent of men will have a varicocele at some point in life. Risk factors for varicocele aren’t currently known.

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Not all men experience noticeable symptoms from a varicocele. This might be because these partially blocked, enlarged veins can form over time as blood flow gradually slows.

But some men may notice:

  • Dull pain or discomfort in the scrotum

  • Swelling

  • Lumps

  • Visible enlargement of dilated veins (commonly on the left side of the scrotum)

It’s possible to experience more significant issues and complications from varicocele, such as:

  • Testicular atrophy

  • Low testosterone

  • Premature ejaculation

Keep scrolling for details.

Testicular Atrophy

Some research suggests varicoceles may cause testicular atrophy (shrinkage). This could affect sperm production and sperm quality (like sperm count and motility).

These findings could mean varicoceles are a potential cause of male infertility. Men with this condition can do a semen analysis to assess their fertility health.

Low Testosterone

There’s also some evidence suggesting a varicocele might affect testosterone production, leading to low testosterone (aka hypogonadism).

One study found that men with varicoceles had lower testosterone levels than guys without these enlarged veins, regardless of age. The study also pointed out that 70 percent of men who had varicocele repair surgery saw their testosterone levels increase. 

Premature Ejaculation

Premature ejaculation (PE) is a type of sexual dysfunction where you climax too early to have satisfying sex. It can lead to low self-esteem and relationship problems.

Some research suggests a link between varicocele and premature ejaculation. And surgical repair has been shown to improve sexual performance and satisfaction for men with PE.

If you think you might have a varicocele, let your healthcare provider know. They can perform a physical exam to see if you have healthy veins or signs of varicocele that may affect your physical comfort, sexual wellness, fertility, or overall health.

If you have erectile dysfunction, you might find it harder to get or maintain an erection firm enough for sexual activity. In some cases, you may not be able to get an erection on a consistent basis or get an erection at all.

Currently, varicocele isn’t viewed as a common cause of erectile dysfunction. 

That said, a study from 2012 found that men with varicoceles may have an elevated risk of developing ED, especially if they’re under 60 years old. Varicocele patients who underwent repair surgery had lower rates of ED than those who didn’t seek surgical repair.

At the moment, it’s unclear if the varicocele itself causes erectile dysfunction or if varicocele and erectile dysfunction share risk factors.

Common risk factors for erectile dysfunction include:

  • Diseases and conditions that affect blood flow. This includes heart disease, atherosclerosis (clogged arteries), type 2 diabetes, and high blood pressure (hypertension).

  • Conditions affecting nerve function. This includes multiple sclerosis (MS), injuries to the penis and the surrounding area, and surgical complications.

  • Medications affecting blood flow, sex drive, or sexual function. These meds may include tranquilizers, antiandrogens, antidepressants, ulcer medications, and appetite suppressants.

  • Unhealthy lifestyle habits. Smoking, tobacco use, illicit drugs, poor diet, and not getting enough physical activity are all linked to ED.

Certain mental health conditions — like depression, sexual performance anxiety, and chronic stress — may also play a role in the development of erectile dysfunction. However, there’s no research suggesting mental health issues lead to or exacerbate varicoceles.

Avaricocele often gets better with a few simple changes, such as wearing snug underwear or a jock strap to reduce pain or discomfort. But in some cases, medical treatment might be necessary, like varicocele repair surgery or a varicocele embolization to treat a blocked, dilated vein in your scrotum.

Varicocelectomy is a common choice for the treatment of a varicocele. The surgical procedure involves making a small cut in the lower abdomen and disrupting blood flow from the abnormal veins allowing it to redirect into healthy veins that supply the testicles.

A varicocelectomy is usually an outpatient procedure. This means you can leave the hospital the same day your surgery is performed and recover at home.

Research on Varicocele Surgery to Help With ED

Right now, there isn’t much research on the link between varicocele surgery and erectile function. We definitely can’t say with confidence that varicocele surgery stops erectile dysfunction from happening or makes it easier to get or maintain an erection. But the existing research is promising.

We already mentioned that 2012 study, where men who underwent surgical repair for varicocele saw improvements in ED.

Other research shows that a varicocelectomy increases testosterone levels and erectile function scores in varicocele patients with low testosterone. This makes sense, as low testosterone is often linked to erectile dysfunction.

Another study from 2022 found that varicocele patients who underwent varicocelectomy surgery saw increases in testosterone and erectile function that lasted up to 60 months, suggesting long-term improvement.

Whether you should get surgical repair for your varicocele depends on your symptoms and your urologist’s recommendations.

If you previously had pain or discomfort from a varicocele, surgery could make it easier to have sexual intercourse. Your provider can do a physical examination to determine the right treatment plan for your needs.

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Can you use Viagra if you have a varicocele? At the moment, no high-quality evidence suggests that Viagra or similar ED medications are dangerous if you have a varicocele. But as always, this is something to discuss with your healthcare provider before starting treatment.

Sildenafil, the active ingredient in Viagra, is a prescription medication often used to treat erectile dysfunction. It belongs to a class of drugs called PDE5 inhibitors and works by increasing blood flow to the erectile tissue inside the penis.

Your medical provider might recommend taking Viagra or a similar type of ED medication if you often find it difficult to get or maintain an erection.

Viagra is safe and effective for most men. However, it may not be safe to use Viagra or similar medications if you have:

  • Recently had a heart attack, stroke, or life-threatening heart arrhythmia (irregular heartbeat)

  • Hypotension (low blood pressure) or hypertension (high blood pressure)

  • Heart failure, coronary artery disease, or other cardiovascular diseases

  • Risk factors for non-arteritic anterior ischemic optic neuropathy (NAION)

Some medications, including nitrates and alpha-blockers, can interact with Viagra and other ED medications. To keep yourself safe, make sure to tell your healthcare provider about any other medications you currently use or have recently used before taking Viagra.

Currently, the FDA (U.S. Food and Drug Administration) doesn’t warn against taking Viagra or similar medications for erectile dysfunction if you have varicocele.

Let your healthcare provider know you have a varicocele. They can inform you about any risks to be aware of before using Viagra and how to take it safely.

Besides Viagra, several other FDA-approved medications are available to increase blood flow to the penis and make getting and maintaining erections easier.

These include other oral medications for ED, such as:

If you’re looking for something more discreet, you may want to try Hims hard mints. These conveniently chewable ED meds contain the same active ingredients as Viagra and Cialis at customized dosages.

To access these treatments, you’ll first need to do an online consultation with a healthcare provider who’ll determine if a prescription is appropriate.

Medication usually has the biggest impact on erectile function and sexual performance in men with ED. But other things, such as making changes to your habits and daily life, could also make it easier to get and stay hard during sex.

For example, your healthcare provider may suggest limiting alcohol consumption, keeping yourself physically active, eating a balanced diet, maintaining a healthy body weight, and giving up smoking to improve your cardiovascular health and erections.

If your erectile dysfunction is caused by stress, depression, or anxiety, seeing a therapist in your area or doing online talk therapy might also help.

Our guide to natural methods for maintaining an erection goes into greater detail about changes you can make to your habits and lifestyle for healthier erections and better sex.

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Varicoceles are a common problem. For most men, they’re a harmless annoyance that leads to mild discomfort. But for some guys, varicoceles could contribute to other issues — maybe even ED.

Erectile dysfunction affects around 30 million U.S. men, and it can have many causes. Can a varicocele cause ED? Here’s what we know:

  • Varicoceles may cause health issues beyond pain and swelling. Testicular atrophy, fertility issues, low testosterone, and premature ejaculation are all linked to varicoceles.

  • The link between varicoceles and ED isn’t totally clear. Still, if you have a varicocele that’s making sex uncomfortable, let your healthcare provider know. They may recommend surgery, varicocele embolization, medication, or making changes to your habits to reduce pain and discomfort.

  • Surgical repair for a varicocele may improve testosterone and ED. Some studies show that surgical repair for a varicocele leads to improvements in erectile function and testosterone levels. But more research is needed.

If you have erectile dysfunction or another form of sexual dysfunction and think it may be linked to a varicocele, see a urology specialist or another healthcare provider. After assessing your condition and symptoms, they might suggest using Viagra or similar medication.

Find out more about how Viagra and similar medications work in our detailed guide to the most common treatments for ED.

Explore our men’s sexual health platform to see what options are available to you.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

12 Sources

  1. Asadpour A, et al. (2014). The effects of varicocelectomy on the patients with premature ejaculation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090664/
  2. Çayan S, et al. (2020). Effect of varicocele and its treatment on testosterone in hypogonadal men with varicocele: review of the literature. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161614
  3. Chung J, et al. (2018). Current Issues in adolescent varicocele: pediatric urological perspectives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924953/
  4. Kavoussi P, et al. (2021). The impact of ipsilateral testicular atrophy on semen quality and sperm DNA fragmentation response to varicocele repair. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991813/
  5. Keller J, et al. (2012). Varicocele is associated with erectile dysfunction: a population-based case-control study. https://pubmed.ncbi.nlm.nih.gov/22524472/
  6. Leslie S, et al. (2022). Varicocele. https://www.ncbi.nlm.nih.gov/books/NBK448113/
  7. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2017). Definition & facts for erectile dysfunction. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
  8. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2017). Symptoms & causes of erectile dysfunction. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
  9. Panchatsharam P, et al. (2022). Physiology, erection. https://www.ncbi.nlm.nih.gov/books/NBK513278/
  10. Park Y, et al. (2022). Long-term efficacy of varicocele repair in middle-aged men with erectile dysfunction (ED) and low testosterone: five cases with follow-up from 16 to 60 months. https://journals.sagepub.com/doi/abs/10.1177/20514158221078724
  11. VIAGRA- sildenafil citrate tablet, film coated. (2017). https://www.accessdata.fda.gov/spl/data/40578e70-350a-4940-9630-55d90989c146/40578e70-350a-4940-9630-55d90989c146.xml
  12. Zohdy W, et al. (2011). Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility. https://pubmed.ncbi.nlm.nih.gov/20722780/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown MD, MBA

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown was previously Medical Director of a male fertility startup where she lead strategy and design of their digital health platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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