Can bilateral varicocele affect erection?

Varicocele: Usually no but it does decrease sperm count.

Varicocele: Erectile dysfunction is not directly related to the presence of varicocele. Abnormal dilatation of spermatic vein in scrotum rises the temperature of scrotum, this in turn gives rise to abnormal sperm. The testicular size also get smaller which affects fertility. Can some urologist comment: if b/l smaller testes will affect overall sexual function including ed?

Rarely, if ever: There is emerging evidence that varicoceles may be a cause of low testosterone levels and low testosterone levels have been associated with erectile dysfunction (although it is typically not a common cause of ed).