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Since the start of the pandemic, it seems impossible to turn on the news without being bombarded with the latest facts on COVID-19. But new research has discovered a complication you may not have heard about—erectile dysfunction. Here’s what you should know about how COVID-19 can impact your sex life and the steps you can take to prevent it.
What is erectile dysfunction?
Erectile dysfunction (ED) is the inability to get or maintain an erection firm enough for sex. Some reports estimate 52% of men between the ages of 40 and 70 have difficulties—although even more men are likely affected given some people’s reluctance to seek treatment (Sooriyamoorthy, 2021)
For an erection to occur, the smooth muscles in the penis must relax and allow blood to flow through the blood vessels and fill the penis. Any condition that interferes with this process can lead to erectile problems. Psychological conditions, such as depression or performance anxiety, can also affect sexual activity (Sooriyamoorthy, 2021).
How might COVID-19 cause ED?
Researchers believe that coronavirus targets endothelial cells—the cells that line the inside of your blood vessels. Damage to these cells is thought to be responsible for many COVID-19 symptoms (Sansone, 2021-a). Endothelial dysfunction can lead to inflammation, blood clots, and tightening of the blood vessels (Hadi, 2005). This can decrease the blood supply to different areas of the body, including the penis (Kresch, 2021).
In addition to endothelial dysfunction, COVID-19 can produce several other problems that may contribute to ED:
- Decreased testosterone levels: COVID-19 can target the cells in the testicles that produce testosterone (Sansone, 2021-a). Low testosterone can affect your sex drive and contribute to erectile dysfunction (Sooriyamoorthy, 2021). Low testosterone also increases substances in your body that produce inflammation, further damaging the lining in your blood vessels and worsening ED (Sansone, 2021-a).
- Long-term lung problems: COVID-19 has the potential to cause long-term effects on the lungs, even after the infection has cleared (Wang, 2020). Impaired lung function can cause chronically low levels of oxygen in your body. Because oxygen is involved in the erection process, ED can worsen in this setting (Sansone, 2021-a).
- Loss of smell and taste: Smell and taste play a role in the sexual experience and help many people become aroused. If COVID-19 has left you with these senses impaired, you may have difficulty getting in the mood (Bertolo, 2021).
- Psychological stressors: The stress of the pandemic has taken a toll on all of us. Between lockdowns, the loss of loved ones, and social isolation, it comes as no surprise that our mental health may be suffering. People who have recovered from COVID-19 may have added stress and anxiety, which could impact sexual dysfunction (Sansone, 2021-a).
What does the research show?
A recent study (appropriately called “Mask up to keep it up”) evaluated the rate of ED in people who had recovered from COVID-19. The study showed that people with a history of COVID-19 infection were significantly more likely to develop ED than those who had never contracted the illness. The researchers also speculated that even people who test positive for COVID-19 without symptoms could be at an increased risk of developing erectile problems (Sansone, 2021-b).
One limitation of the study was that researchers did not consider if the participants had other conditions that would increase their risk of ED, such as diabetes, high blood pressure, smoking, or the use of antidepressants. This could make it seem like COVID-19 played a more significant role in developing ED when these other health problems were also likely contributing factors (Sansone, 2021-b).
Another small study looked at two men with a history of COVID-19 and ED. Both men had normal erectile function before developing COVID-19 but later experienced severe ED symptoms requiring surgery. During the surgery, tissue samples of the penis were collected and analyzed. Researchers discovered that parts of the SARS-CoV-2 (the virus that causes COVID-19) were present in the penile tissue. This indicated that: 1) COVID-19 targets areas of the penis involved in erections, and 2) the virus remains present in the body long after the infection has passed (Kresch, 2021).
Is ED a risk factor for COVID-19?
The same study that showed COVID-19 could cause ED (“Mask up to keep it up”) also evaluated the reverse—could having ED increase your chances of catching the virus? The study found that yes—participants with ED were significantly more likely to develop COVID-19 (Sansone, 2021-b)
But the researchers offer a likely explanation for this finding. ED is often the symptom of another condition rather than a disease itself. People with high blood pressure, high cholesterol, diabetes, or heart disease can develop ED since these conditions affect blood vessels and blood flow. Therefore, the participants in the study that had ED likely had other health problems that increased their chances of contracting COVID-19 (Sansone, 2021-b).
What can we take away from all of this?
First, if you have symptoms of ED, get evaluated by your healthcare provider. ED doesn’t just impact your sex life and relationships—it’s often an early warning sign of heart disease, increasing your chances of heart attack and stroke later in life.
Work with your healthcare professional to ensure your blood pressure, cholesterol, and blood sugar are in healthy ranges. Not only will you improve your heart health and sexual health, but you’ll also decrease your risk of developing severe COVID-19 symptoms (Sooriyamoorthy, 2021).
Second, if you haven’t done so already, get vaccinated! This new research adds yet another potential side effect of COVID-19, which can likely be avoided through vaccination. Encourage others to receive the COVID-19 vaccine and continue to follow CDC guidance for masking and social distancing. These measures can help keep yourself and others healthy and get us all back to normal as quickly as possible.
- Bertolo, R., Cipriani, C., & Bove, P. (2021). Anosmia and ageusia: a piece of the puzzle in the etiology of COVID-19-related transitory erectile dysfunction. Journal of Endocrinological Investigation, 44(5), 1123–1124. doi: 10.1007/s40618-021-01516-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33512687/
- Hadi, H. A., Carr, C. S., & Al Suwaidi, J. (2005). Endothelial dysfunction: cardiovascular risk factors, therapy, and outcome. Vascular Health and Risk Management, 1(3), 183–198. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17319104/
- Kresch, E., Achua, J., Saltzman, R., Khodamoradi, K., Arora, H., Ibrahim, E., et al. (2021). COVID-19 endothelial dysfunction can cause erectile dysfunction: histopathological, immunohistochemical, and ultrastructural study of the human penis. The World Journal of Men’s Health, 39(3), 466–469. doi: 10.5534/wjmh.210055. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33988001/
- Sansone, A., Mollaioli, D., Ciocca, G., Colonnello, E., Limoncin, E., Balercia, G., et al. (2021-b). “Mask up to keep it up”: Preliminary evidence of the association between erectile dysfunction and COVID-19. Andrology, 9(4), 1053–1059. doi: 10.1111/andr.13003. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33742540/
- Sansone, A., Mollaioli, D., Ciocca, G., Limoncin, E., Colonnello, E., Vena, W., et al. (2021-a). Addressing male sexual and reproductive health in the wake of COVID-19 outbreak. Journal of Endocrinological Investigation, 44(2), 223–231. doi: 10.1007/s40618-020-01350-1. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32661947/
- Sooriyamoorthy, T., & Leslie, S. W. (2021). Erectile dysfunction. In StatPearls [Internet]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32965924/
- Wang, F., Kream, R. M., & Stefano, G. B. (2020). Long-term respiratory and neurological sequelae of COVID-19. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 26, e928996. doi: 10.12659/MSM.928996. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33177481/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.