These are in large part the physical and psychological challenges posed by COVID-19, but what’s not getting a lot of press is the potential relationship between COVID-19 and erectile dysfunction. Erectile dysfunction refers to the inability to form or sustain an erection strong enough to have sex. It’s an issue that plagues millions of men across the globe and could lead to serious degradation of their lives. The pandemic has focused almost exclusively on its respiratory impacts, though recent studies have hinted at a possible correlation between COVID-19 and ED. In this paper, I review evidence and speculations about such a link and its implications.
First, we need to know how ED works physiologically. It is an underlying condition that can be influenced by multiple physical, psychological and lifestyle factors. Heart disease, diabetes, hormonal imbalances and neurological disorders are the primary physical causes. Because COVID-19 damages the cardiovascular and respiratory system, it can directly affect erectile function. Viruses have been reported to damage the endothelium, the inner wall of blood vessels, causing inflammation and clots. This destruction of the blood vessels can interrupt the circulation that is required to achieve and sustain an erection.
Additionally, COVID-19 can directly alter the level of testosterone, the male sex hormone that leads to sexual attraction and function. Researchers have found that the virus damages testosterone-producing testes and causes a decrease in testosterone. A drop in testosterone can lead to ED, as it is a key erectile hormone.
Another possible correlate between COVID-19 and ED is the psychological effect of the pandemic. The stress, fear and anxiety of the pandemic can impact mental health, including sexual functioning. The research also suggests that stress and anxiety may lead to ED by changing how hormones and neurotransmitters contribute to the process of erectile function. The social isolation and social distancing strategies adopted in the aftermath of the pandemic have also decreased sex and intimacy, leading to ED.
Though there are very few case reports and studies indicating a connection between COVID-19 and ED, some support the possibility. A 2014 study in The Journal of Endocrinological Investigation found that 28% of male COVID-19 patients had low testosterone, which may contribute to ED. A similar article in The World Journal of Men’s Health reported that 15% of male COVID-19 patients reported ED and 25% said they lost sexual desire. These studies indicate that COVID-19 can directly impact sexual function.
But it’s also worth bearing in mind the reticence of these studies. The vast majority of these studies involve a small sample and no control. Moreover, we do not know how COVID-19 will impact sexual function over time, because the virus is still relatively novel and we do not have very much information about its long-term health effects.
But it’s important to emphasize that there are other risk factors for ED during the pandemic, including lifestyle changes, medications, and preexisting conditions. ED may be exacerbated by pandemic-related increases in alcohol intake and smoking. Even medications like antidepressants, blood pressure medications can trigger ED. It is therefore difficult to know precisely what role COVID-19 plays in the evolution of ED.
Lifestyle Changes:
COVID-19 has forced people to adapt their way of life completely. Lockdowns and social distancing has brought about more sedentary living, less physical activity, and changed diets. These can all lead to the onset of ED. One study, published in the Journal of Sexual Medicine, for instance, reported that sitting reduced the risk of ED, while physical exercise protected against it (Esposito et al., 2010). Additionally, a paper published in Andrology found that eating processed foods, red meat and refined grains increased ED risk (Kohn et al., 2016).
A third lifestyle shift during the pandemic has been the emergence of drinking and smoking. Both of these habits are associated with poor sexual health. An analysis from the Journal of Studies on Alcohol and Drugs found heavy drinking to increase risk for ED, but moderate drinking did not (Liu et al., 2019). In a similar way, smoking has been found to adversely affect erectile function. A 2005 paper in the Journal of Urology reported that smokers experienced more ED than non-smokers (Penson et al, 2004).
Medication Use:
The second source of ED during the pandemic is medication. Antidepressants, for instance, have been found to impair sexual function. According to a review in the Journal of Clinical Psychopharmacology, up to three-fourths of patients receiving antidepressants suffered from sexual dysfunction (ED or not) of some sort (Fujimura & Hamada, 2016). ED has also been associated with blood pressure medications, including beta-blockers and diuretics. As one article in the Journal of Hypertension revealed, beta-blocker-treated men were more likely to develop ED than those not on the drug (Lip et al., 2006).
Pre-existing Health Conditions:
In addition to ED in the pandemic, certain previous conditions such as diabetes, obesity, and heart disease were also thought to raise the risk of ED. A 2010 Journal of Sexual Medicine study, for example, reported that ED was more than three times more likely to occur in men with diabetes than in those without it (De Berardis et al, 2010). What’s more, obesity has been shown to impair sexual function — overweight men have higher rates of ED than healthy men (Saad et al, 2011).
Conclusion:
So far, there’s still minimal evidence for a COVID-19-ED link. The way the virus might affect the heart, testosterone and mental health imply that such an association is possible. More work will be needed to better understand the long-term impacts of COVID-19 on sexual function and the precise mechanisms. In the meantime, clinicians should be attuned to this possibility and explore ED in COVID-19 male patients. Ensure that they also live in healthy ways, manage stress, and access therapy when a change in their sexual function occurs.
