Considering that Covid-19 is a respiratory disease, it can cause some peculiar symptoms. It can reduce the senses of smell and taste, leave patients with discolored toes — “Covid toes” — and even cause the so-called “Covid tongue,” in which the tongue becomes swollen and irregular.
Now scientists are examining a possible link to an entirely unexpected consequence of Covid: erectile dysfunction. A connection has been reported in hundreds of articles by scientists from Europe and North America, as well as Egypt, Turkey, Iran and Thailand.
Estimates of the magnitude of the problem vary widely. An article by Ranjith Ramasamy, director of reproductive urology at the Desai Sethi Institute of Urology at the University of Miami, concluded that the risk of erectile dysfunction increases by 20% after patients fall ill with Covid. Other researchers have reported substantially greater increases in this risk.
Ramasamy said that when patients started coming to his clinic complaining of erection problems, “we didn’t think it was too much. We thought it was psychological or stress-induced.”
But as time went on, he and other doctors began to detect a pattern. “Six months after the initial infection, the patients had generally improved, but they continued to complain of these problems,” including erectile dysfunction and low sperm count, said Ramasamy, who has written several scientific papers on the topic.
At the beginning of the pandemic Emmanuele Janini, professor of endocrinology and medical sexology at the University of Rome Tor Vergata, reported a strong link between erectile dysfunction and Covid-19. Comparing men who had contracted Covid with men who had not, he found that infected men were nearly six times more likely to complain of impotence than men who had avoided the coronavirus.
“Communicating that the disease can affect people’s sex lives is a tremendously powerful message,” Jannini said, especially for men who still resist getting vaccinated. “The evidence is very strong.”
Research based on imaging tests and biopsies indicates that the coronavirus can infect tissues in the male genital tract, where it can remain long after the initial infection. Scientists say it is not yet possible to say with certainty that the link between Covid and erectile dysfunction is causal, as there are many factors — psychological as well as physiological — that play a role in producing and maintaining an erection. The pandemic has led to social isolation and an increase in the prevalence of anxiety and depression, all of which can play a role.
“Male erection is more complex than people realize,” said Justin Dubin, co-author of a scientific paper on Covid’s adverse effect on men’s health.
“You need good blood flow, you need the nerves to be working well, and you need good levels of hormones, specifically testosterone,” he said. “But a man also needs to be in a positive frame of mind and he needs to be aroused. If any of those things go wrong, he might have a hard time getting an erection.”
According to Joseph Katz, a professor at the Florida College of Dentistry, in this sense, the pandemic represents a perfect confluence of converging factors suitable for causing erectile dysfunction. Katz came across the erectile dysfunction issue when he was researching the effects of Covid-19 on oral health.
Some researchers speculate that erectile dysfunction may be linked to the well-documented loss of taste and smell experienced by Covid patients, because these senses play an important role in sexual arousal. “It is through smell that the brain’s arousal mechanism is aroused,” three Italian urologists wrote last year in a letter in response to Jannini’s article.
To be able to develop and maintain erections, men need at the very least healthy blood vessels and good blood flow. The coronavirus can damage blood vessels and their lining, the endothelium, when it binds to molecular receptors that are abundant in epithelial cells.
Vessels may not contract and stretch as necessary to allow blood flow to the penis. Blood vessel injuries can also contribute to more serious complications from Covid, such as heart attacks, strokes and abnormal blood clots.
“Our entire vascular system is interconnected. There is no single problem of the penis,” commented Mike Hsieh, director of the Men’s Health Center at the University of California, San Diego.
But vascular problems may first manifest in Organs sexual organs, because the blood vessels in that region are so small. (Jannini says erectile dysfunction is a warning sign for cardiovascular disease.) Erectile dysfunction and cardiovascular disease share the same risk factors — such as severe obesity, metabolic diseases such as diabetes, smoking, and old age — that also increase the likelihood of a person get seriously ill with Covid.
“The penile artery is a tenth the size of the coronary artery, and when you have a narrower vessel, whether it’s a plumbing problem or a vascular problem, that’s where the problem will manifest itself first, before you even realize it. in the larger artery,” Hsieh said.
Erectile dysfunction can precede a heart attack by five years, he said, and could be an early sign of the presence of other underlying risk factors.
“When I treat a patient for erectile dysfunction, he’s not just prescribed Viagra or Cialis,” Hsieh said. “He is referred to a general practitioner or cardiologist to check that his cholesterol level is normal, that his diabetes is under control, to discuss weight management, lifestyle or dietary changes.”
Erectile dysfunction could point the way to a better diagnosis of persistent Covid, Jannini said, or even a deterioration in mental health.
“If you have a patient who has survived Covid and you want to know if he has persistent Covid or not, just ask him how his life is going between the sheets,” Jannini said. “If he is having a normal sex life, the chances of having serious persistent Covid are very small.”
If erectile dysfunction is not treated, it can end up leading to other complications. According to published research, cases of Peyronie’s disease, which causes curved, painful erections due to fibrous plaques that build up on the penis, and of orchitis, the inflammation of one or both testicles, have developed in men who have had Covid.
Men who do not have normal erections for months on end can develop scar tissue and fibrosis, which makes erectile dysfunction difficult to treat and can even lead to penis shortening.
Erectile dysfunction can resolve on its own, but Hsieh recommends that men who experience these symptoms see a doctor — and don’t take too long.
“If you’re having these problems, don’t wait,” he advised. “In most cases, we can restore men’s sex lives.”
Translation by Clara Allain
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