Are there benefits of varicocelectomy beyond semen parameters? Effects on sexual function and psychological well-being

¿Existen beneficios de la varicocelectomía más allá de los parámetros seminales? Efectos sobre la función sexual y el bienestar psicológico

Background: Varicocele is a common condition associated with impaired spermato-genesis and reduced testosterone production. While varicocelectomy is primarily indicated for infertility, its effect on sexual function and psychological status are less clearly defined. This study aimed to evaluate the impact of varicocelectomy on sexual, hormonal, and psychological outcomes beyond conventional semen parameters. Methods: This single-center retrospective cohort study included 81 men who underwent open subinguinal + inguinal varicocelectomy between 2022 and 2025. Preoperative and 6-month postoperative assessments included the International Index of Erectile Function-5 (IIEF-5), intravaginal ejaculatory latency time (IELT), libido score, Premature Ejaculation Test (PET), nocturnal penile tumescence (NPT) grade, serum total testosterone, and Beck Depression Inventory (BDI). Paired non-parametric tests were used for analysis, and subgroup comparisons were performed according to varicocele laterality (unilateral vs. bilateral). Results: At 6 months, significant postoperative changes were observed in multiple domains. Median serum total testosterone increased from 13.42 (4.23) to 15.04 (1.27) ng/mL (p < 0.001). Median libido score increased from 5 (3) to 8 (2), and PET score increased from 3 (1) to 4 (1) (both p < 0.001). Median IIEF-5 and IELT values remained numerically unchanged, although statistically significant paired differences were observed (both p < 0.001), suggesting that the magnitude of change in these parameters may have been limited. Semen parameters improved significantly in both unilateral and bilateral groups (all p < 0.001), with a between-group difference observed only for postoperative progressive motility. Conclusions: Varicocelectomy was associated with statistically significant changes in multiple sexual, hormonal, psychological, and semen parameters at 6-month follow-up. However, some changes were modest in magnitude and should be interpreted cautiously, particularly given the absence of a control group and the subjective nature of several outcomes.

Resumen

Antecedentes: El varicocele es una condición frecuente asociada con alteraciones en la espermatogénesis y disminución de la producción de testosterona. Aunque la varicocelectomía se indica principalmente por infertilidad, sus efectos sobre la función sexual y el estado psicológico no están completamente definidos. Este estudio tuvo como objetivo evaluar el impacto de la varicocelectomía sobre los parámetros sexuales, hormonales y psicológicos más allá de los parámetros seminales convencionales. Métodos: Este estudio retrospectivo de cohorte unicéntrico incluyó a 81 hombres sometidos a varicocelectomía abierta entre 2022 y 2025. Se realizaron evaluaciones preoperatorias y a los 6 meses postoperatorios, incluyendo el índice internacional de función eréctil (IIEF-5), el tiempo de latencia eyaculatoria intravaginal (IELT), la puntuación de libido, el test de eyaculación precoz (PET), el grado de tumescencia peneana nocturna (NPT), los niveles séricos de testosterona total y el inventario de depresión de Beck (BDI). Se utilizaron pruebas no paramétricas para el análisis. Resultados: A los 6 meses se observaron cambios significativos en múltiples parámetros. Los niveles de testosterona, la puntuación de libido y el control eyaculatorio mejoraron significativamente (p < 0.001). Aunque se detectaron diferencias estadísticas en IIEF-5 e IELT, los valores medianos permanecieron prácticamente sin cambios, lo que sugiere un impacto clínico limitado a nivel poblacional. Los parámetros seminales también mejoraron significativamente. Conclusiones: La varicocelectomía se asoció con mejoras en parámetros hormonales, sexuales, psicológicos y seminales. Sin embargo, algunos cambios fueron de magnitud limitada y deben interpretarse con cautela, especialmente considerando la ausencia de grupo control y la naturaleza subjetiva de varios resultados.

Varicocelectomy; Sexual function; Erectile dysfunction; Testosterone; Psychological well-being; Ejaculatory latency

Palabras Clave

Varicocelectomía; Función sexual; Disfunción eréctil; Testosterona; Bienestar psicológico; Latencia eyaculatoria

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