Can Covid lead to impotence?

For a respiratory disease, Covid-19 causes specific symptoms. It can diminish the senses of smell and taste, leave patients with discol...


For a respiratory disease, Covid-19 causes specific symptoms. It can diminish the senses of smell and taste, leave patients with discolored “Covid toes” or even cause a swollen, bumpy “Covid tongue”.

Now scientists are examining a possible link to a completely unexpected consequence of Covid: erectile dysfunction. A connection has been reported in hundreds of papers by scientists in Europe and North America, as well as Egypt, Turkey, Iran and Thailand.

Estimates of the extent of the problem vary widely. A paper by Dr. Ranjith Ramasamy, director of reproductive urology at the University of Miami’s Desai Sethi Urology Institute, and colleagues found that the risk of erectile dysfunction increased by 20% after a bout with Covid. . Other researchers have reported substantially higher increases in this risk.

When patients started coming to Dr. Ramasamy’s clinic complaining of erection problems, “We dismissed it, thinking it was all psychological or stress-induced,” he said.

But over time, he and other doctors began to see a trend, he said. “Six months after the initial infection, the patients had improved overall, but they continued to complain of these issues,” including both erectile dysfunction and low sperm count, Dr. Ramasamy, who has written several articles on the subject.

At the start of the pandemic, Dr. Emmanuele Jannini, professor of endocrinology and medical sexology at the University of Rome Tor Vergata, reported a strong link between erectile dysfunction and Covid. When he compared men who had been sick with Covid with those who had not, he found that those who had been infected were nearly six times more likely to report impotence like those who had avoided the coronavirus.

“Communicating that the disease can affect your sex life is an extremely powerful message,” especially for men who are still resistant to vaccination, Dr. Jannini said in an interview. “The evidence is very strong.”

Research from imaging scans and biopsies indicates that the coronavirus can infect tissue in the male genital tract, where it can linger long after initial infection. Scientists say it’s too early to be sure the link to erectile dysfunction is causal, as many factors – psychological and physiological – play a role in producing and maintaining an erection. The pandemic has led to social isolation and an increase in anxiety and depression, all of which may play a role.

“Men’s erections are more complicated than people think,” said Dr Justin Dubin, who co-authored a paper on the negative impact of Covid on men’s health.

“You need good blood flow, you need nerves working, and you need good hormone levels, especially testosterone,” he said. “But you also have to be in a good frame of mind and you also have to be excited. If any of these things go wrong, you may have trouble getting an erection.

In that sense, the pandemic is the perfect confluence of converging factors to cause erectile dysfunction, said Dr. Joseph Katz, a professor at Florida College of Dentistry. Dr Katz came across the issue of erectile dysfunction while investigating the effects of Covid on oral health.

Some researchers believe erectile dysfunction may be linked to the well-documented loss of the ability to taste and smell experienced by Covid patients, as these senses play an important role in sexual arousal. “It is through odors that the excitation mechanism in the brain is triggered”, three Italian urologists wrote last year in a letter responding to Dr. Jannini’s article.

At the very least, men need healthy blood vessels and good blood flow to develop and maintain erections. The coronavirus can damage blood vessels and the vessel lining, called the endothelium, because it binds to molecular receptors that abound on endothelial cells.

The vessels may not constrict and stretch as needed to allow blood flow to the penis. Blood vessel damage can also contribute to more serious complications of Covid, such as heart attacks, strokes and abnormal clotting.

“Our whole vascular system is connected — it’s not an isolated penis problem,” said Dr. T. Mike Hsieh, director of the University of California San Diego Men’s Health Center.

But vascular problems may first show up in the sex organs, because the vessels there are so small. (Dr. Jannini calls erectile dysfunction “the canary in the coal mine” for cardiovascular disease.) Erectile dysfunction and cardiovascular disease share risk factors – such as being severely overweight, metabolic diseases like diabetes, smoking and advanced age – which also increase the chances of having severe Covid.

“The penile artery is one-tenth the size of a coronary artery, and when you have a narrower vessel, whether it’s a plumbing problem or a vascular problem, it will show up there in first, before you even see it in a bigger artery,” Dr. Hsieh said.

Erectile dysfunction can precede a heart attack by about five years, he said, and may be an early signal that there are other underlying risk factors.

“When I see a man with erectile dysfunction, he doesn’t just get a prescription for Viagra or Cialis,” Dr. Hsieh said. “They are referred to a primary care colleague or cardiologist to make sure their cholesterol is under control, their diabetes is under control, to discuss weight management, lifestyle or dietary changes.”

Erectile dysfunction may pave the way for better diagnosis of long Covid, Dr Jannini said, or even deterioration in mental health.

“If you have a patient who survived Covid, and you want to know if they have Covid for a long time or not, just ask them how they are doing in bed,” Dr Jannini said. “If he has a normal sex life, the possibility of him having a long severe Covid is very, very low.”

Untreated, erectile dysfunction can lead to further complications. The cases of Peyronie’s diseasea condition that causes curved, painful erections due to the buildup of fibrous scar tissue in the penis, and orchitis, inflammation of one or both testicles, have developed in men who have had Covid, according to published research.

Men who don’t have normal erections for several months in a row can develop scar tissue and fibrosis, which makes erectile dysfunction more difficult to treat and can even lead to penis shortening.

Erectile dysfunction can resolve on its own, but Dr. Hsieh encouraged men with symptoms to see their doctor, and as soon as possible.

“If you’re having these issues, don’t wait,” he said. “For the most part, we can get guys’ sex lives back.”

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