Varicocele is the medical term for the enlargement and dilation of the veins (pampiniform plexus) within the scrotum, the loose skin pouch that protects the testicles in males. Varicocele most commonly occurs on the left side. Its most significant adverse effect is male infertility. One frequently asked question is whether varicocele negatively impacts sexual function.

Historically, varicocele treatment was considered mainly for infertility, impaired sperm parameters, and prepubertal testicular atrophy. However, recent studies have shown that varicocele not only causes infertility in men but can also lead to sexual dysfunction. The adverse effects of varicocele on the testes are associated with the degree of varicocele. The higher the grade of varicocele, the greater the damage to the testicular tissue. Varicocele is classified into three grades during physical examination: Grade 1 is detected during standing examination when the patient increases intra-abdominal pressure by straining; Grade 2 is identified by palpating dilated veins during standing examination; and Grade 3 is when the dilated veins are visible to the naked eye while standing.

Chronic and high-grade varicocele is a predictor of testicular atrophy over time, especially in patients with grade 2 and grade 3 varicocele. As a result of testicular shrinkage, testicular function may deteriorate. Not only are the sperm-producing cells affected, but also the Leydig cells, which are responsible for testosterone production, may be damaged. Consequently, testosterone levels, the primary male sex hormone, may decrease. This condition is called hypogonadism. Since testosterone plays a crucial role in libido and erection, its deficiency can cause significant sexual dysfunction in men. When this occurs, libido decreases, as testosterone is closely linked to sexual desire. Studies in the literature have shown that hypogonadism due to varicocele is more common in patients with grade 2 and grade 3 varicocele, and these adverse effects can be corrected by varicocele surgery. Therefore, even if fertility is possible, surgery is recommended for patients with significant (grade 2 or 3) varicocele to preserve sexual function.

Varicocele generally causes various effects on sperm function. The venous dilation in this region impairs sperm function in the testis, but its effects on hormonal levels are also known. Although hormonal changes may potentially cause such effects, it cannot be routinely stated that varicocele always affects sexuality.

Large varicocele bundles may cause cosmetic dissatisfaction and a sense of inadequacy, leading to anxiety and potentially affecting sexual performance and desire. However, this is not an indication for varicocele treatment.

Reference: Görür, Y. D. D. S., & Çayan, S. Current status in the pathophysiology of varicocele. ANDROLOJI, 37.