Hi, Varicocoele by itself does not need treatment unless it is proven to be the cause of low sperm count and male infertility. It usually never causes severe pain, so please do not consider surgery for varicocoele for pain relief alone. You can get a sperm count by a proper semen analysis done (after 3-4 days of abstinence) from masturbation at a good lab which specializes in infertility work. If the quality of sperm is poor, you may need to get a more detailed evaluation...Erectile dysfunction and premature ejaculation may be due to many causes as many physiologic, hormonal, and psychogenic factors are involved in the ability to obtain and maintain erections... most of the times it will be psychological but other conditions like
diabetes, hypertension, hormonal imbalances and intake of certain drugs can be the cause so these should be ruled out..treatment mainly depends upon underlying cause if its psychogenic counseling with psychiatrist with meditation, yoga etc will help...they may prescribe certain medication as well to maintain erections..if its organic cause it should be dealt accordingly....Consult nearest surgeon they will do the needful.