For respiratory illnesses, Covid-19 causes some strange symptoms. It can reduce the sense of smell and taste, leaving patients with deformed “Covid fingers” or even causing a swollen and bumpy “Covid tongue”.
Scientists are now studying a possible link to a completely unexpected outcome of Covid-19: erectile dysfunction. A relationship has been reported in hundreds of papers 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 paper by Dr. Ranjith Ramasamy, MD, director of urogenital surgery 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-19. Other investigators have reported much higher increases in this risk.
When patients first started coming to Ramasami’s clinic complaining of erectile dysfunction, “we refused it, thinking it was all psychological or stress-related,” he said.
But, he said, over time, he and other doctors began to see a pattern. “Six months after the initial infection, patients generally improved, but they continued to complain of these problems,” said Ramasamy, who has written several papers on the topic, including erectile dysfunction and low sperm count.
At the start of the epidemic, Dr. Emmanuel Giannini, professor of endocrinology and medical sexology at the University of Rome Tor Vergata, reported a strong link between erectile dysfunction and the Covid-19 virus. When he compared the men who had contracted Covid-19 to those who did not, he found that those who were infected were about six times more likely to report ED as those who avoided the coronavirus.
“Being informed that the disease can affect your sex life is a very powerful message,” Janini said, especially for men who are still resistant to vaccination. “The evidence is very strong.”
Research from imaging scans and biopsies suggests that the coronavirus can infect tissues within the male reproductive system, where it may persist long after the initial infection. Scientists say it’s too early to confirm that the link to erectile dysfunction is causal, because 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.
Some researchers speculate that erectile dysfunction may be related to the well-documented loss of the ability to taste and smell experienced by Covid-19 patients, as these senses play an important role in sexual arousal. “Through smells the mechanism of excitation in the brain is ignited,” three Italian urologists wrote last year in a letter responding to Giannini’s paper.
At the very least, men need healthy blood vessels and good blood flow in order to develop and maintain an erection. Corona virus may damage blood vessels and the lining of the vessels, called the endothelium, because it binds to molecular receptors abundantly available in endothelial cells.
The blood vessels may not contract and dilate as needed to allow blood to flow into the penis. Injury to the blood vessels may also contribute to more serious complications of Covid-19, such as heart attacks, strokes, and abnormal clotting.
“The entire vascular system is connected; it is not an isolated phallic problem,” said Dr. T. Mike Hsieh, MD, director of the Men’s Health Center at the University of California, San Diego.
But problems with blood vessels in the genitals can appear first, because the vessels there are very small. (Gannini calls erectile dysfunction the “coal mine canary” for cardiovascular disease.) ED and cardiovascular disease share risk factors — such as extreme weight gain, metabolic diseases such as diabetes, smoking and old age — that also increase the odds. Severe COVID-19 infection.
“The penis artery is about a tenth the size of a coronary artery, and when you have a narrower vessel, whether it’s a plumbing issue or a vascular issue, it’s going to show up there first, before you even see it further,” Hsieh said.
He said erectile dysfunction can precede a heart attack by about five years, and could be an early sign of other underlying risk factors.
“When I see a man with erectile dysfunction, they just don’t get a prescription for Viagra or Cialis,” Hsieh said. “They get a referral to 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.”
Janini said erectile dysfunction may point the way to a better prognosis for prolonged Covid-19, or even worse mental health.
“If you have a patient who has survived Covid, and you want to know if they have had Covid for a long time or not, just ask them how things are going in bed,” Janini said. “If he’s living a normal sex life, the likelihood of him having Covid for a very long time is very low.”
If erectile dysfunction is left untreated, it can lead to further complications. Cases of Peyronie’s disease, a condition that causes curved, painful erections as a result of a buildup of fibrous tissue in the penis, and orchitis, inflammation of one or both testicles, have developed in men who have contracted Covid-19, according to published research.
Men who do not have normal erections for several months at a time may develop scar tissue and fibrosis, which makes erectile dysfunction more difficult to treat and may shorten the penis.
Erectile dysfunction can be treated on its own, but Hsieh encouraged men with symptoms to see their doctors, sooner rather than later.
“If you’re having these problems, don’t wait,” he said. “For the most part, we can restore men’s sex lives.”