COVID-19 and Erectile Dysfunction: What Men Need to Know
How SARS-CoV-2 can infect your sexual health
The COVID-19 pandemic has changed our world forever. I know those words sound dramatic, but we’re a little over two years into this pandemic, and we’re still battling the virus. All of us feel confused. Changes to our lives no longer bear the sting of surprise, but rather the long, slow, dull ache of an ongoing monotony.
The disruptions in our lives have passed through the acute phase and have moved onto the chronic phase, as we’ve learned to live with various problems we thought unimaginable just a few short years ago, depending on where we live.
It’s safe to say that the past two years have been a total turn-off. And we have every reason imaginable for not feeling our sexiest. Not to mention, many people want to play it safe and try not to catch the virus, thus shielding themselves from human contact.
In the midst of a pandemic, it’s hard not to worry about the potential impacts on our lives. For many people, one of their biggest concerns is how COVID-19 might impact their sex life. In this article, we’ll explore some of the ways that COVID-19 could affect your sex life and what you can do to prepare for them.
COVID-19 Impact on Men’s Sexual Health
Initial studies showed that the virus had a significant impact on male sexual function. Men who contracted the virus experienced a decrease in libido, erectile dysfunction, and a decrease in semen volume.
Considering that SARS-CoV-2 has the capability to infect almost every tissue in the human body, it’s not too much of a stretch to assume it can wreak havoc on our reproductive systems and the systems that support them. Not to mention, SARS-CoV-2 disrupts the hormone systems almost globally as well, which are the support structures upon which our sexual health rests.
In some cases, the effects of the virus even led to complete impotence.
All of this happened before we learned about long covid. Long COVID also seems to impact our sexual health, in both men and women.
COVID-19 and Erectile Dysfunction
As the world deals with the pandemic of COVID-19, many men are wondering if they are at risk for developing erectile dysfunction (ED) as a result. ED is a common sexual dysfunction that affects men of all ages. It is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse.
Studies show that up to 50% of men experience some form of ED at some point in their lives. Although there is no one definitive cause for ED, several factors can contribute to it, including age, health problems, medications you’re taking, and your overall physical condition.
By late 2021, researchers began proposing ED as a biomarker for detecting Long COVID. In short, a man having COVID-19 and subsequent ED might be a sign that he’s one of the “COVID long-haulers” who experience symptoms months, and sometimes years after infection.
What’s Causing ED in COVID-19 Patients?
A study from September 2021, titled The Epidemic of COVID-19-Related Erectile Dysfunction: A Scoping Review and Health Care Perspective, explored all the possible causes for male erectile dysfunction in post-COVID patients.
The study noted an uptick in the prevalence of numerous andrological diseases, diseases that impact men’s sexual health. The rise from pre-COVID levels to the levels during the COVID-19 pandemic can be seen below.
At first, researchers supposed this had something to do with stay-at-home orders all over the world. Couples locked in together tend to have more hardships which could, theoretically, lead to more erectile dysfunction.
But an Italian survey compared men with and without COVID for ED. While other variables, such as age, BMI, and psychological health had no statistical significance to ED, past or present SARS-CoV-2 infection was highly statistically correlated. Men who’d been infected with SARS-CoV-2 were at a 5.66-fold increased risk of ED.
Even when you controlled for all the other factors, BMI, age, psychological health, etc., men who’d been infected with SARS-CoV-2 were still at a 5.27-fold increased risk of ED.
Physiological Mechanisms
The study authors also noted several underlying mechanisms through which SARS-CoV-2 infection might contribute to ED on a physiological level.
Researchers concluded:
Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health.
And it’s true.
While we still don’t know the full impact of SARS-CoV-2 infection on testosterone (or sperm, or the testes), we know that ACE2, the enzyme that plays a crucial role in the virus’ entry into human cells, was expressed in the testes of rats who’d been infected with SARS-CoV-2.
The pro-inflammatory cytokines, TNF-α, IL-6, and IL-1β, kick into overdrive during SARS-CoV-2 infection, causing hyperinflammation. These exact same cytokines have also been associated with erectile dysfunction. These cytokines, among others, are also tied to testosterone levels.
Now, that doesn’t automatically mean that such an immune response would result in lower testosterone levels and thus erectile dysfunction. Many men with low T experience erections just fine, while many men with high T have problems. Erections are complicated processes that require a multitude of different biological systems to function properly.
But throwing testosterone out of balance doesn’t help.
Some have theorized that for these men, Testosterone Replacement Therapy may be beneficial, but that hasn’t panned out in clinical trials yet.
In short, SARS-CoV-2 infection spawns a crazy inflammatory response in order for the body to fight off the virus, and this inflammatory response causes hormonal disruption, including hypogonadism, in some men.
COVID-19 & Circulatory Health
Beyond the reproductive organs, many other systems are responsible for sexual function in men. COVID-19 wreaks havoc on the vascular system, which is vital for achieving healthy erections.
SARS-CoV-2 damages the vascular endothelium, which are cells that line the blood vessels. It’s through these cells that SARS-CoV-2 is partially able to access host cells in order to spread throughout the body.
And, guess what, the human penis is loaded with these cells.
As the study authors note:
Endothelial dysfunction results in abnormal regulation of blood pressure, response to inflammation, impairment of the sensitive balance between the vasoconstricting and vasodilating agents and stimuli, and coagulation disorders. Vascular damage associated with COVID-19 is likely to affect the fragile vascular bed of the penis, potentially resulting in impaired erectile function. The recognized relationship between vascular health and ED suggests an important knowledge gap that could be addressed with translational research to elucidate the penile vascular effects of COVID-19 and their relationship to ED.
A Multitude of Foes
Beyond these mechanisms, there’s also the psychological aspect of COVID-19 and Long COVID, which cannot be ignored, as well as difficulties receiving treatment for ED during the lockdowns of the pandemic (though these are insufficient to explain all the cases of ED resulting from SARS-CoV-2 infection).
This has all created a perfect storm for a crisis in sexual health among men.
Still, more studies are needed to elucidate the exact mechanisms further and discover just how likely men are to suffer from sexual health repercussions as a result of each cause of ED or other problems.
If you’re having trouble with sexual functioning after a SARS-CoV-2 infection, it’s best to speak with a healthcare professional about how to address it. There are options out there for people who are experiencing difficulties, and while the data are still young, we know quite a bit about the various underlying mechanisms.
So, what are the signs that you may have ED?
Here are four indicators that you should have a discussion with your doctor:
You experience difficulties getting or maintaining an erection during sexual activity.
You have a reduced ability to ejaculate (ejaculate less than usual).
Your erections are shorter and weaker than before.
Your partner has difficulty understanding why you can’t achieve an erection, even after trying different things.
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Three books I recommend checking out:
Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life
Sex at Dawn: How We Mate, Why We Stray, and What It Means for Modern Relationships
A Billion Wicked Thoughts: What the Internet Tells Us About Sexual Relationships
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