"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, bumpy
“Covid tongue.”
Now scientists are examining a
possible link to an altogether 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 in Egypt, Turkey, Iran and Thailand.
Estimates of the magnitude of the
problem vary wildly. A paper by Dr. Ranjith Ramasamy, director of reproductive
urology at the University of Miami’s Desai Sethi Urology Institute, and his
colleagues found that the risk of erectile dysfunction increased by 20 percent
after a bout with Covid. Other investigators have reported substantially higher
increases in that risk.
When patients first 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
physicians began to see a pattern, he said. “Six months after the initial
infection, patients had gotten better overall, but they continued to complain
of these problems,’’ including both erectile dysfunction and low sperm counts,
Dr. Ramasamy, who has written several papers on the topic, said.
At the outset of the pandemic, Dr.
Emmanuele Jannini, a 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 ill with Covid with those
who had not, he found that those who had been infected were nearly six times as likely to report impotence
as those who had avoided the coronavirus.
“Communicating that the disease can
affect your sexual 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 imaging scans and biopsies indicates that the
coronavirus can infect tissue within the male genital tract, where it may
linger long after the initial infection.
Scientists say it is too early to be
certain that the link to erectile dysfunction is causal, since so many factors
— psychological as well as physiological — play a role in producing and
maintaining an erection. The pandemic has led to social isolation and a surge
in anxiety and depression, all of which may play a role.
“Men’s erections are more complicated
than people think,” Dr. Justin Dubin, who co-wrote a paper about the adverse
impact of Covid on men’s health, said.
“You need good blood flow, you need
the nerves to be firing, and you need good hormone levels, specifically
testosterone,” he said. “But you also need to be in a good state of mind, and
you also need to be aroused. If any of these things go wrong, you may have an
issue getting an erection.”
In that sense, the pandemic is the
perfect confluence of converging factors for causing erectile dysfunction, Dr.
Joseph Katz, a professor at Florida College of Dentistry, said. Dr. Katz
stumbled on the issue of erectile dysfunction while investigating Covid’s
effects on oral health.
Some researchers speculate that
erectile dysfunction may be linked to the well-documented loss of the ability
to 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 ignited,” three Italian urologists wrote last year in a letter responding
to Dr. Jannini’s paper.
At the very least, men need healthy
blood vessels and good blood flow in order to develop and sustain erections.
The coronavirus may damage blood vessels and the lining of the vessels, called
the endothelium, as it binds to the molecular receptors that are plentiful on
endothelial cells.
The vessels may not constrict and stretch as needed to allow
for blood flow to the penis. Injury to the blood vessels may also contribute to
more serious complications of Covid, like heart attacks, strokes and abnormal
clotting.
“Our entire vascular system is
connected — it’s not an isolated penis problem,” Dr. T. Mike Hsieh, director of
the men’s health center at University of California, San Diego, said.
But vascular problems can manifest
in the sexual organs first, 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, having metabolic diseases
like diabetes, smoking and older age — which also increase the odds 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 problem or a vascular problem, it will show up there
first, even before you see it in a larger artery,” Dr. Hsieh said.
Erectile dysfunction can precede a
heart attack by about five years, he said, and can be an early signal that
there are other underlying risk factors.
“When I see a guy for erectile dysfunction, they don’t just
get a Viagra or Cialis prescription,” Dr. Hsieh said. “They get a referral to a
primary care colleague or a cardiologist to make sure their cholesterol is in
check, their diabetes is under control, to discuss weight management, lifestyle
or dietary changes.”
Erectile dysfunction may point the
way to better diagnosis of long Covid, Dr. Jannini said, or even deteriorating
mental health.
“If you have a patient who survived Covid, and you want to
know if he has long Covid or not, just ask him how it’s going in bed,” Dr.
Jannini said. “If he’s having a normal sex life, the possibility of him having
serious long Covid is very, very low.”
Left untreated, erectile dysfunction
can lead to further complications. Cases of Peyronie’s disease, a condition that causes
curved, painful erections as a result of fibrous scar tissue built up in the
penis, and orchitis, the inflammation
of one or both of the testicles, have developed in men who have had Covid,
according to published research.
Men who don’t have normal erections
for several months at a time may develop scar tissue and fibrosis, which makes
erectile dysfunction harder to treat and may even lead to shortening of the
penis.
Erectile dysfunction can resolve on
its own, but Dr. Hsieh encouraged men with symptoms to see their physicians,
and sooner rather than later.
“If you’re having these problems, do
not wait,” he said. “For the most part, we can get the guys’ sex lives back.””
Half of Western men had Covid, so many have low sperm count and erectile
dysfunction. Very small percentage of Chinese did have Covid. Western women
need healthy sexually active men having the ability to conceive babies. Chinese
men preserved those abilities since the Chinese society decided not to allow coronavirus
to spread freely. Internet and international travel makes possible for these
active men and women to meet and fulfill their dreams.
