For a respiratory disease, Covid-19 causes some peculiar symptoms. It can diminish the senses of smell and taste, leave patients with discolored “Covid toes” or even cause a swollen and bumpy “Covid tongue”.
Scientists are now examining a possible link to a completely unexpected consequence of Covid: erectile dysfunction. A connection has been reported in hundreds of articles by scientists in Europe and North America, as well as in Egypt, Turkey, Iran and Thailand.
Estimates of the extent of the problem vary widely. A document by Dr. Ranjith Ramasamy, director of reproductive urology at the Desai Sethi Urology Institute of the University of Miami, and his colleagues found that the risk of erectile dysfunction increased by 20% after a Covid attack. Other researchers have reported substantially higher increases in that risk.
When patients started coming to Dr. Ramasamy’s clinic he complained 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 pattern, he said. “Six months after the initial infection, patients had improved overall but continued to complain of these problems,” including both erectile dysfunction and low sperm count, said Dr. Ramasamy, who has written several articles on the subject, said.
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 the men who had been sick with Covid with those who hadn’t, he found that those who had been infected they 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 a tremendously powerful message,” especially for men who still resist vaccination, Dr. Jannini said in an interview. “The evidence is very strong.”
Research from image scans and biopsies indicates that the coronavirus can infect tissues within the male genital tract, where it can linger long after the initial infection. Scientists say it is too early to be certain that the link with erectile dysfunction is causal, as so many factors – psychological and physiological – play a role in producing and maintaining an erection. The pandemic has led to social isolation and a wave of anxiety and depression, which may play a role.
“Men’s erections are more complicated than you think,” says Dr. Justin Dubin, who co-wrote an article on Covid’s negative impact on men’s health, said.
“You need good blood flow, you need your nerves to fire up, and you need good levels of hormones, 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 this 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, said. Dr. Katz stumbled upon the issue of erectile dysfunction while investigating the effects of Covid 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 smells that the arousal mechanism in the brain is activated”, three Italian urologists wrote in a letter last year responding to Dr. Jannini’s newspaper.
At the very least, men need healthy blood vessels and good blood flow to develop and sustain an erection. Coronavirus can damage blood vessels and the lining of vessels, called the endothelium, as it binds to molecular receptors that are abundant on endothelial cells.
The vessels may not narrow and stretch as needed to allow blood flow to the penis. Injuries to blood vessels can also contribute to more serious complications of Covid, such as heart attacks, strokes, and abnormal clotting.
“Our entire vascular system is connected – it’s not an isolated penis problem,” says Dr. T. Mike Hsieh, director of the University of California, San Diego, men’s health center, said.
But vascular problems can manifest themselves first in the sexual organs, because the vessels 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, having metabolic diseases such as diabetes, smoking, and older age – which also increases the likelihood of having severe Covid.
“The artery for the penis is one-tenth the size of a coronary artery and when you have a narrower vessel, whether it’s a plumbing or vascular problem, it will appear there first, even before you see it in a larger vessel a ‘artery “, Dr. Hsieh said.
Erectile dysfunction can precede a heart attack by about five years, he said, and can be an early sign that there are other underlying risk factors.
“When I see a guy for erectile dysfunction, he doesn’t just get a prescription for Viagra or Cialis,” said Dr. Hsieh said. “They refer a primary care colleague or a 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 point the way to a better diagnosis of the long Covid, said Dr. said Jannini, or even worsening of mental health.
“If you have a Covid survivor patient and you want to know if he has had Covid for a while or not, ask him how he is going to bed,” said Dr. Jannini said. “If he has a normal sex life, the chance of having a serious long-term Covid is very, very low.”
If left untreated, erectile dysfunction can lead to further complications. Cases of Peyronie’s diseasea condition that causes curved and painful erections due to the fibrous scar tissue accumulated in the penis e orchitis, inflammation of one or both testicles, developed in men who have had Covid, according to published research.
Men who don’t have normal erections for several months at a time can develop scar tissue and fibrosis, which makes erectile dysfunction more difficult to treat and can even lead to penis shortening.
Erectile dysfunction can go away on its own, but Dr. Hsieh encouraged men with symptoms to see their doctors, and sooner rather than later.
“If you have these problems, don’t wait,” he said. “For the most part, we can get the boys’ sex lives back.”