Can we cure erectile dysfunction (ED) by varicocele treatment? No, I cannot claim that if you acquired an ED due to your lifestyle gradually during a long time, one surgery can cure it. What I am claiming is that by varicocele repair you can kill one of the leading causes of ED and improve the overall background of your sexual life tremendously. Our body is a complex system, and if we support and care it, it always responds with positive changes of healing.
Let’s see how ED and varicocele are connected and how can we reverse the adverse conditions by varicocelectomy.
The prevalence of ED.
Erectile dysfunction (ED) is defined as the persistent failure to achieve and keep an erection adequate to allow satisfactory sexual performance.
ED is a widespread medical condition. The Massachusetts Male Aging Study, among many others, reported 52% of ED prevalence in men aged 40-70 years in the Boston area. Every fourth of patients seeking medical help was younger than 40 years, and 50% of them was complaining for severe ED.
How ED and varicocele are connected?
It has long been noticed that ED shares the main risk factors like obesity, abnormal levels of lipids in the blood, diabetes, lack of exercise and smoking with cardiovascular diseases. Why? Yes, erection itself is a complex phenomenon involving nervous, hormonal and cardiovascular systems coordinated interaction. It is evident that if the heart is not able to pump blood with sufficient force and the blood does not run fast and smoothly through the vessels, you cannot expect to have a good erection. But from the other side varicocele is a blockage of the testicle’ drainage veins. These veins drain the waste materials, and testosterone from the testes and hence such a blockage affect not only prostate as we discussed earlier but the functionality of testicles as well. Again, varicocele affects two essential organs of the man’s reproductive system, determining his sexual status:
- It promotes the overgrowth of the prostate causing benign prostatic hyperplasia and making the gland vulnerable to inflammations and bacterial attacks-prostatitis. And this, in turn, affects the penile erection of a man.
- It violates the natural cause of spermatogenesis and production of the male principal hormone testosterone in the testicles leading to decreased sexual desire.
How does a varicocele affect ED?
A recent study by Keller, JJ et al. (2012) used a large dataset of 32,856 cases and 98,568 controls to find the associations between varicocele, varicocelectomy, and ED. They discovered that varicocele patients who underwent a varicocelectomy had much lower risks of getting ED than those who did not. Men with varicocele repair still shared an association with ED, but this relation was much weaker than in untreated men. The youngest men with ED had the most robust degrees of association with varicocele.
ED, low testosterone, infertility, and hypogonadism are cut from the same cloth. Therefore it is reasonable to appeal some more studies dealing with these conditions.
As we discussed earlier, some studies have found a strong association between premature ejaculation and varicocele. Moreover, about 70% of men with varicocele and infertility reported reduced sexual desire. And we know that low levels of blood testosterone due to varicocele are responsible for the lack of libido.
Total blood testosterone is the most generally accepted indicative to prove the presence of hypogonadism. While there are no strict lower limits of normal, testosterone level lower 350 ng/dl should be an indicative signal for hypogonadism.
Numerous studies reported a strong association between varicocele and impaired testicular function. The three main types of cells in testicles are:
- Leydig cells, producing testosterone;
- Sertoli cells, nourishing and supporting sperm cells;
- Sperm cells themselves.
For the natural flow of events, the proliferation of sperm cells and the production of testosterone, the temperature of testicles must be somewhat lower than the body temperature. That’s why we have the testicles outside of the body, in the scrotum.
Varicocele results in increased testicular temperature, leading to
harmful effects on spermatogenesis, impaired Sertoli cell function, depressed testosterone synthesis, and Leydig cells atrophy.
Several reports evidenced a strong relation between varicocele treatment and an increase in testosterone levels. Summarised results of the relevant studies are presented in the table.
They suggest that varicocele repair improves testicular functionality: the blood testosterone level increases between 100 and 140 ng/dl in more than 80% of men. And what was interesting, the lower the levels of testosterone before varicocele repair, the more significant was its changes after the treatment. Moreover, in adult men of 50-60s, the total testosterone improved as much as younger men.
Although, the predominant part of men with varicoceles are fertile and no signs of ED, the factual data about the detrimental influence of varicocele on ED, fertility, premature ejaculation and testosterone levels continue to grow. Early repair of varicocele can prevent future infertility and hormonal disbalance; prevention of these conditions is easier and more effective than their treatment after they have occurred. In some men with a total testosterone level higher than 300 ng/dl, varicocelectomy may not result in a notable increase of the hormone level, but such surgery will preserve testicular function and prevent the decline in testosterone levels in the future.
Keller JJ, Chen Y‐K, and Lin H‐C. Varicocele is associated with erectile dysfunction: A population‐based case‐control study. J Sex Med 2012;9:1762–1769.
Ali A Dabaja, Marc Goldstein When is a varicocele repair indicated: the dilemma of hypogonadism and erectile dysfunction?
Asian Journal of Andrology (2016) 18, 213–216