Varicocele and Premature Ejaculation

Varicocele and Premature Ejaculation

Varicocele and Premature Ejaculation: How Are These Linked?

Is There an Association Between Varicocele and Premature Ejaculation Along with Prostatitis Symptoms?

Men with untreated varicoceles often show up with the complaint of “premature ejaculation,” or ejaculating too soon (abbreviated as PE). In fact, PE appears to be the only and major sexual complain in these men. Moreover, with varicocele, signs and symptoms of prostatitis (prostate inflammation) are also common. Likewise, prostatitis is also one of the root causes of PE. Hence, you can see how the three conditions are interlinked. This is what we are going to further explore in this article.

How Varicocele Leads to Prostatitis?

In varicocele, there’s a problem with the venous network draining the testicular blood. These veins also drain blood away from a walnut-shaped gland called prostate. The prostate sits just below the bladder in men. It encircles the urethra (the long tube that runs through the prostate and ends at the exterior of the penis as the pee-hole). Hence, with a faulty venous network, the blood not only pools within the testicles but also backs-up into the prostate. In addition, the pressure of blood within the engorged testicular venous network is high as compared to the low-pressure prostatic flow. Also, the veins draining the prostate specifically expand in varicocele. These factors further allow the backflow of blood into the prostatic veins, resulting in pelvic congestion and symptoms of chronic inflammation of the prostate.1

These men will complain of difficulty urinating, straining to urinate, frequent or urgent need to urinate, burning while urinating, and pain during ejaculation.

Men with severe varicocele also show ultrasound evidence of prostate inflammation. Of note, their semen also shows increased levels of a clinical marker of prostatitis called interleukin-8.2

Varicocele and Premature Ejaculation: How One Leads to the Other?

Now that we know how varicocele and premature ejaculation are connected, that is, varicocele results in prostatitis, let’s dig into the complex mechanisms linking varicocele and PE:

1. Prostatitis Triggers PE

A varicocele doesn’t have to be necessarily huge or present on both sides for a man to suffer from premature ejaculation. Prostate plays an important role in ejaculation. Millions of sperms swim from the testes into the prostate. Because the prostate is a muscular gland, it contracts to close off the opening between the bladder and urethra and instead pushes the fluid in the forward direction, which is finally expelled.

As mentioned above, a varicocele can cause prostate inflammation. Prostatitis, in turn, alters the sensations and tweaks the ejaculatory reflex1 in such a way that that the ejaculation occurs prior to or within about one minute of vaginal penetration, which defines PE. Remember the ejaculatory reflex is under control of the brain and spinal cord pathways, which get disrupted by a diseased prostate. The prostate can no longer perform its role in ejaculation effectively.

According to a study, about 64% and 52% of men with PE are found to have prostatic inflammation and chronic bacterial prostatitis respectively, further indicating the link between the two conditions.3

Varicocele and Premature Ejaculation

2. Antibiotics Can Help with Premature Ejaculation

Another factor that highlights the link between PE and prostatitis is the delay in ejaculation after antibiotic treatment in men with PE secondary to chronic bacterial prostatitis.

Wondering how antibiotics can help with PE? The mechanistic link is simple: Being a bacterial infection, prostatitis warrants antibiotic treatment and when this prostatic inflammation/infection keeps causing a man to ejaculate before time, antibiotic treatment can help delay the ejaculation.

A study that evaluated the outcomes of a 1-month antibiotic treatment in men with PE secondary to prostatitis found a fine control of ejaculation and a significant improvement in the ejaculation time.4

Managing the Three Conditions Together

All in all, these facts prove that varicoceles not only interfere with fertility but can also negatively impact the sexual function and quality of life in the affected men.

Since varicocele is the culprit for the other two conditions, i.e., prostatitis and premature ejaculation, getting the culprit condition treated on a timely basis is of utmost importance. Initially, your doctor will use medical (like antidepressants and antibiotics), behavioral, and psychosexual therapies to address the PE symptoms. However, for the premature ejaculation symptoms that do not respond well to medical treatments, a varicocele surgery such as varicocele embolization may work to cure the symptoms of venous congestion. A scientific study shows how varicocele surgery improves PE in men with clinically apparent varicoceles on both sides.5

Given the role of the prostate in the mechanism of ejaculation, your doctor will also carefully examine the prostate and treat any underlying pelvic congestion before implementing any medical or psychosexual therapy for premature ejaculation.3

Varicocele Consultation

Contact Precision Vascular and Vein to schedule an appointment for Varicocele consultation. Our top vascular specialists will take the time to answer your questions about our safe, effective, minimally-invasive procedures. Request an appointment for a varicocele evaluation by calling Precision at 214-382-3200 or completing the form below.

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Precision Vascular and Vein serves the DFW area including Dallas, Fort Worth, Carrollton, Richardson, Garland, Mesquite, Highland Park, University Park, Park Cities, Plano, Frisco, McKinney, Arlington, Irving, Grand Prairie, Denton, Lewisville and all of North Texas.

This information is not a substitute for professional medical advice. Prior to starting any new treatment or questions regarding a medical condition, always seek the advice of your doctor or other qualified health provider.


1. Lotti F, Corona G, Mancini M et al. The Association between Varicocele and Premature Ejaculation and Prostatitis Symptoms: Possible Mechanisms. J Sex Med. 2009;6(10):2878-87. doi: 10.1111/j.1743-6109.2009.01417.x.

2. Penna G, Mondaini N, Amuchastegui S et al. Seminal plasma cytokines and chemokines in prostate inflammation: interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia. Eur Urol. 2007 Feb;51(2):524-33; discussion 533.

3. Shamloul R, el-Nashaar A. Chronic prostatitis in premature ejaculation: a cohort study in 153 men. J Sex Med. 2006 Jan;3(1):150-4.

4. El-Nashaar A1, Shamloul R. Antibiotic treatment can delay ejaculation in patients with premature ejaculation and chronic bacterial prostatitis. J Sex Med. 2007;4(2):491-6.

5. Asadpour AA, Aslezare M, Nazari Adkani L, Armin M, Vojdani M. The effects of varicocelectomy on the patients with premature ejaculation. Nephrourol Mon. 2014;6(3):e15991. Published 2014.