Why Erectile Dysfunction Can Be a Complication of Having COVID-19

Here are some reasons for the link, according to doctors and researchers.

We're all familiar with the common symptoms of COVID-19: fever, shortness of breath, fatigue, and loss of smell or taste. But the impact of the illness doesn't end there. On December 4, 2020 infectious disease expert Dena Grayson, MD, told Chicago TV station NBCLX that one of the potential complications of the virus is erectile dysfunction (ED).

"We…know that people can have long-term health effects from this virus, neurologic complications, and…for men who are watching this—there is some real concern here that men could have long-term issues of erectile dysfunction from this virus, because we know that it causes issues in the vasculature," said Dr. Grayson.

A November 2021 study from the Journal of Endocrinological Investigation supported this commentary. The study focused specifically on the correlation between ED and patients with COVID-19. The researchers used data pulled from Informatics for Integrating Biology and the Bedside, analyzing information for 1,066,108 patients with and without reports of COVID-19 infection. They found that ED was 3.68 times more likely to be a diagnosis for patients with COVID-19 compared to patients who had not been infected with the disease. They also discovered that COVID-19 preceded the ED diagnosis in those patients.

The Connection Between ED and COVID-19

"Our research shows that ED is a perfect biomarker of general physical and psychological health," Emmanuele A. Jannini, MD, professor of endocrinology and medical sexology in the department of systems medicine at the University of Rome Tor Vergata, told Health.

It makes sense, then, that there are many facets to the link between ED and COVID-19. "Erectile dysfunction is a complex physiologic and psychologic disorder," Jesse N. Mills, MD, associate clinical professor of urology and director of The Men's Clinic at UCLA, told Health. "A man has to have good nerve function, hormone (testosterone) levels, adequate blood flow, and a willing mind to have normal erections. COVID-19 causes severe physiologic and psychologic stress, which leads to lower testosterone levels and increased stress hormone release."

General Health Issues and Comorbidities

Because ED is usually a symptom of an underlying health issue, men with poor health may be more likely to develop ED and also experience COVID-19-related complications. "The same people who are at major risk for COVID-19 complications are exactly the same people who have risk factors for ED, such as diabetes, cancer, respiratory problems, and cardiovascular disease," said Dr. Jannini. "The virus hits these patients hard and is expected to exacerbate equal dysfunction after recovery."

COVID-19 can also worsen an already existing heart condition, such as heart inflammation or an irregular heartbeat. Many of the medications used to treat heart conditions—like beta-blockers—can cause erectile dysfunction as a side effect. "So there are potentially two things going on here: The COVID-19 virus and inflammatory molecules damaging the blood vessels, and medications causing side effects," Mike Bohl, MD, MPH, from digital men's health clinic Roman, told Health.

Bodily Responses to COVID-19 Infection

Another factor could stem from the effects of inflammation. "In many people, the damage to the body that occurs with COVID-19 isn't from the virus itself but from the body's response to the virus; COVID-19 triggers a state of 'hyperinflammation,'" said Dr. Bohl. Hyperinflammation can cause small blood clots to form as well as inflammation of the endothelium, the lining of the blood vessels. "This endothelial dysfunction, plus the presence of blood clots, ultimately disrupts blood flow—and blood flow is of the utmost importance when it comes to getting an erection," explained Dr. Bohl.

Additionally, Dr. Bohl pointed out that for the vast majority of patients, COVID-19 manifests as a respiratory illness, which includes difficulty breathing, coughing, and shortness of breath. "For those who become more severely ill, these issues can make it difficult to get enough oxygen into the bloodstream," said Dr. Bohl. "And when this happens, it can be harder to get an erection as well—oxygen is required to make nitric oxide, an important molecule in the sequence of steps required to achieve an erection."

Hormonal Changes with Testosterone

There's also evidence to suggest that SARS-CoV-2, the virus that causes COVID-19, has an impact on the testes. "SARS-CoV-2 enters cells with the help of a protein called ACE2—and ACE2 is prevalent in the testes," said Dr. Bohl. Since the majority of testosterone is made in the testes, COVID-19 may therefore cause a decrease in the amount of testosterone in the body.

"This is significant for two reasons," said Dr. Bohl. "First, low testosterone itself can contribute to erectile dysfunction. And second, testosterone normally helps suppress inflammation in the body. But with lower testosterone, inflammation may not be as suppressed anymore. Therefore, the damage caused to blood vessels by pro-inflammatory molecules may be worsened because testosterone levels are decreased."

Psychologically-Based Factors Related to COVID-19

Researchers of a February 2022 study published in the International Journal of Impotence Research noted that psychological stressors due to COVID-19—instances of social isolation and distancing, financial concerns worries, and relationship and intimacy concerns, for example—may play a role in the development of ED too.

"Being in the right mindset is an important part of engaging in sexual activity and achieving an erection," said Dr. Bohl. "Stress, anxiety, and depression have always been potential causes of erectile dysfunction." As rates of those go up due to the presence of COVID-19, rates of erectile dysfunction may rise as well, added Dr. Bohl.

Further Investigation of the Link Between ED and COVID-19

Researchers of a September 2021 study from Sexual Medicine Reviews noted that, in order to get a full understanding of the connection between ED and COVID-19, biological impact, mental health impact, health disparities, and COVID-19's impact on ED treatment need to be taken into account.

For instance, when it comes to treatment, it might be worth looking into how medications work to help those with ED following infection with COVID-19. "Drugs like sildenafil (Viagra) were used in clinical trials in China to mitigate the pulmonary damage [caused by COVID-19], so it will be interesting to see if men that took the drug will have a lower rate of erectile dysfunction than men that did not take the drug," said Dr. Mills.

Of course, if you have ED, that doesn't mean you have—or have had—COVID-19. "Erectile dysfunction is actually pretty common, more common than people think," said Dr. Bohl. "Estimates vary widely, but the Massachusetts Male Aging Study suggested that 52% of men between the ages of 40 and 70 experience some degree of erectile dysfunction."

If you or your partner is dealing with it, scheduling a checkup with a healthcare provider is the first step to take to address the cause. Furthermore, it is still important to stay protected from COVID-19 as well, so make sure to engage in practices like social distancing, wearing a mask, and getting vaccinated against COVID-19 as well as staying up to date on your vaccines.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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