Can COVID-19 Cause Erectile Dysfunction?

Scientists now know that a lot of people who’ve had a COVID-19 infection suffer from long-term effects in what is typically known as “long COVID.” These effects extend far beyond the respiratory system and can include persistent headaches, extreme fatigue, and difficulty concentrating. Now, a number of studies indicate that erectile dysfunction (ED) may also be a long-lasting consequence of COVID-19.

COVID-19 and Men’s Sexual Function

It’s not surprising that having COVID-19 may lead to sexual dysfunction in men over the long term. The virus that causes COVID-19, SARS-CoV-2, is known to be especially harmful to men’s health. Men have an increased risk of developing a severe form of COVID-19 and dying from the disease compared with women. 

Both high and low levels of testosterone may play a role in men’s increased risk of complications from COVID-19. Testosterone is important to both sexual function and libido. However, in younger men who have normal testosterone levels, this hormone may help the SARS-CoV-2 virus enter the host cells and lead to a reduced immune response against the virus. This can lead to less viral clearance and the disease spreading throughout the body. In older men the age-related decline of testosterone can contribute to inflammation throughout the body, cardiovascular concerns, and immune system problems, all of which can worsen a COVID-19 infection.

As if facing a more severe COVID-19 infection wasn’t enough to worry about, men’s reproductive health may also suffer after an infection with this coronavirus, with long-term impacts to both erectile function and testicular health. Scientists have released a number of studies investigating the connection between COVID-19 and erectile function. Let’s dive into what they found. 

COVID-19 and Men’s Sexual Health

There’s now a lot of research investigating whether there’s a connection between having had a COVID-19 infection and developing ED, the inability to have or keep an erection. Some of the studies looked at the physical effect of COVID-19 on men’s sexual health while other studies explored the mental health effects of the pandemic on erectile function.   

So is there a connection between COVID-19 and erectile dysfunction? To answer that question, a group of researchers that included scientists from the University of California, San Diego, reviewed the medical literature on the subject and concluded, “The evidence that COVID-19 infection causes or impacts ED is compelling. COVID-19 has a uniquely harmful impact on men's health and erectile function through biological, mental health, and healthcare access mechanisms.”

Why were the scientists so convinced of the link between COVID-19 and developing ED? Let’s take a look at the evidence pointing to the connection.

Men Who Had COVID-19 Nearly 6 Times More Likely to Have ED

One of the studies on erectile dysfunction and COVID-19 appeared in the March 20, 2021 edition of the journal Andrology. The study authors looked at ED prevalence among men with a diagnosis of COVID-19 and to find out if there’s a link between COVID-19 and developing ED.

The researchers examined data from the Sex@COVID online survey conducted between April 7 and May 4, 2020 in Italy to collect a sample of male patients who engaged in sexual activity and who had suffered from a SARS-CoV-2 infection. They compared this data to that from a matching sample of men who were having sexual intercourse and who were COVID-19-negative.

One hundred men were included in the study, 25 who had a history of COVID-19 and 75 who were COVID-negative. To determine the ED prevalence, researchers used the Sexual Health Inventory for Men, a shortened, five-item version of the International Index of Erectile Function. Significantly more men in the COVID group (7 out of 25 or 28%) had ED compared to men in the COVID-negative group (7 out of 75 or 9.33%). Men who had a history of COVID-19 had a 5.66 higher risk of developing ED.

COVID-19 affected the development of erectile dysfunction, independent of other risk factors for erectile function such as age, body mass index, or psychological status. The study suggested erectile dysfunction is both a short-term and long-term effect of COVID-19. This led to the popular social media hashtag #maskuptokeepitup.   

Men with ED More Likely To Get COVID-19

Not only did male patients in the study have a greater chance of developing ED, men with erectile dysfunction also were more likely to have developed COVID-19. This makes sense since the severity and prevalence of both erectile dysfunction and COVID-19 are higher in men with hypertension, obesity, diabetes mellitus, older age, and a history of cardiovascular disease. All of these conditions damage blood vessels and lead to sexual dysfunction and are also risk factors for COVID-19.

To account for the possibility that the stress and anxiety associated with lockdowns and other aspects of the pandemic could affect sexual function, the researchers removed any possible influence of psychological distress on the study results. This confirmed that the increased prevalence of ED in male patients with a history of a COVID-19 infection was not due to the stress and depressed mood resulting from the pandemic itself, but rather due to physical factors, with endothelial dysfunction being the most likely culprit. 

COVID-19 and Erectile Dysfunction: Other Evidence

In a study published online in the Journal of Endocrinological Investigation, researchers at the University of Florida found that male patients with COVID-19 are more than three times more likely to be diagnosed with ED compared to those who didn’t have the coronavirus infection. 

The study included 146 patients who received an ED diagnosis after having COVID-19. The researchers found that men with COVID-19 were 3.3 times more likely to develop ED compared with men who didn’t have the coronavirus. The connection remained strong even after the researchers adjusted for age, smoking status, respiratory disease, obesity, circulatory disorders, and diabetes.  

The researchers pointed out that the ACE2 receptor, which the coronavirus binds to in order to enter human host cells, is abundant on the penis just like it is on the testicles. In fact, the SARS-CoV-2 virus remains present in the penis long after the initial infection. This could offer one explanation for the connection between erectile dysfunction and COVID-19. 

The study authors also attribute their findings to blood vessel health, which is necessary for erectile function. Infection with the SARS-CoV-2 virus can cause vascular damage, which can affect the blood vessels of the penis. A COVID-19 infection can also exacerbate cardiovascular conditions. 

Factors Explaining the Link Between Erectile Dysfunction and COVID-19

Research studies investigating the association between ED and COVID-19 looked at whether the effects of COVID-19 on men’s health were due to either physical or mental causes. Here are some reasons explaining the possible link between erectile dysfunction and COVID-19.

The Cardiovascular Connection 

Erectile dysfunction is often considered a clinical marker for developing cardiovascular disease at an earlier age. This could suggest that patients with erectile dysfunction have underlying cardiovascular problems that get in the way of erectile function and also make them more vulnerable to developing COVID-19. The acute cardiac injury that occurs in some men after a COVID-19 infection can result in decreased blood supply to the penis.  

Both ED and COVID-19 share a common cardiovascular risk factor known as endothelial dysfunction. In this condition, the endothelial lining of the blood vessels becomes damaged, leading to poor blood flow. COVID-19 spike proteins can lead to endothelial dysfunction and ED has long been associated with blood vessel damage even before COVID-19 entered into the picture. 

Endothelial cells also line the tissues of the corpus cavernosum of the penis. The corpus cavernosum is the column of tissue that runs through the penis shaft. When blood vessels in the corpus cavernosum fill with blood, it triggers an erection. Any endothelial dysfunction caused by COVID-19 can affect the corpus cavernosum and is therefore likely to impact the ability to have and keep an erection.   

Other Cardiovascular Factors Leading to ED

Other cardiovascular consequences in COVID-19 patients, such as cardiomyopathy and myocarditis could explain the link between erectile dysfunction and COVID-19 infection, since these two conditions can last long after the acute phase of COVID-19 and lead to long-term effects on the cardiovascular system, erectile function, and overall health. 

Other factors could include the fact that COVID-19 patients are often prescribed medications linked to ED such as thiazide-type diuretics, aldosterone receptor blockers, β-adrenergic receptor blockers, or ACE inhibitors to control blood pressure. 

Pulmonary Reasons for the COVID-ED Link

Another potential factor that could have negative effects on sexual health in male patients who had COVID-19 is pulmonary fibrosis, which leads to lower oxygen levels throughout the body and deprives penile vascular tissue of oxygen. These impaired pulmonary hemodynamics (poor lung function) can deprive blood vessels in the penis of the blood supply needed for an erection.   

Neurologic Causes of ED in COVID Patients

Neurologic problems also happen a lot in men who have had COVID-19. These neurologic problems include central nervous system effects (dizziness, headaches, impaired consciousness, strokes, slurred speech, stumbling, falling, and seizures), peripheral nervous system effects  (loss of taste or smell, vision impairment, and nerve pain), and skeletal muscular injury manifestations. 

Most COVID-19 patients suffer from some neurologic effects, but the more severe effects usually occur in those with a more serious form of the disease. These neurologic problems can impact erectile function, but more research is needed to pin down the exact mechanism by which COVID-induced neurologic problems can lead to erectile dysfunction.

COVID-19 and Testicular Damage

COVID-19’s effects on men’s sexual health include damage to the testicles, indicating COVID-19 can impact the reproductive system and reproductive health. The SARS-CoV-2 virus enters host cells by using the angiotensin-converting enzyme 2 (ACE2). Leydig cells, which are located inside the testicles, express ACE2 in high numbers, which explains why testicles are susceptible to damage from COVID-19.   

COVID-19 infection may also damage the testicles and affect reproductive health by increasing blood clotting, which impairs testicular blood flow and oxygen delivery. 

Low Testosterone Levels After COVID Could Lead to ED

In addition, decreased testosterone production in the testicles that may occur after COVID-19 could lead to endothelial dysfunction. Higher testosterone levels are linked to lower levels of inflammatory proteins and higher levels of anti-inflammatory proteins. The reduced testosterone production that occurs after COVID-19 could lead to inflammation and clotting. This in turn could affect penile blood vessels, triggering endothelial dysfunction, reducing blood flow, and promoting more severe ED. 

Is Pandemic-Related Mental Health To Blame?

Because so many men were under a lot of stress during the pandemic and suffered from a depressed mood, a number of studies looked at whether pandemic-related mental health and psychiatric disorders could be to blame for the increased ED prevalence. A study published in Translational Andrology and Urology in December 2021 included 153 sexually active male patients who currently had COVID-19 and were hospitalized between May and July 2021 at a university hospital in Bangkok. The men had an erectile dysfunction diagnosis based on the International Index of Erectile Function 5. 

The researchers also evaluated the men for their mental health status, including whether the participants reported symptoms of depression, including loss of interest and energy, sleep and appetite problems, feelings of worthlessness, and trouble concentrating. In addition, they used the Generalized Anxiety Disorder Scale to evaluate symptoms of anxiety such as nervousness, uncontrolled and excessive worrying, trouble relaxing, restlessness, irritability, and fear that something awful might happen.

The Study Results Show a Connection Between Pandemic Stress and ED

Of the patients included in the study, 64.7% had ED, mostly a mild, moderate, or mild-to-moderate form of the condition. The study authors found a significant association between erectile dysfunction and mental health. They observed a significantly higher risk of erectile dysfunction in men with major depression and who had higher scores on the Generalized Anxiety Disorder Scale. 

Many Types of Reproductive Problems Common after COVID-19

Another study in the journal Sexual Medicine looked into whether there was an increase in sexual dysfunction in men reporting to 12 outpatient urology clinics in Turkey during the COVID-19 pandemic. The number of patients diagnosed with sexual dysfunction problems such as erectile dysfunction, premature ejaculation, Peyronie’s disease, priapism (a painful erection that lasts longer than 4 hours), varicocele (enlarged veins in the scrotum), infertility, primary/secondary hypogonadism (low testosterone), inability to ejaculate, spermatocele (an abnormal cyst on the tube of the testicle that collects and transports sperm), and undescended testicles was significantly higher during the pandemic period compared to pre-pandemic. 

The Sexual Medicine study authors theorized the more frequent occurrence of male sexual health problems in these patients may be caused by relationship stress during the lockdown periods, job losses, financial problems, and pandemic-related anxiety and depression that led to less sexual activity. 

Given that there are a number of other studies pointing to a physical cause for the link between COVID-19 infection and erectile dysfunction, the role of mental health in COVID-related ED needs more research. 

The Link Between Weight Gain, the Pandemic, and ED

It’s also possible that weight gain in some men during the pandemic lockdowns is one explanation for the link between erectile dysfunction and COVID-19, since weight gain leads to problems with overall health such as diabetes, hypertension, and cardiovascular disease, all of which are common risk factors for erectile dysfunction. It’s estimated that 39% of people gained weight during the pandemic, possibly due to stress eating. 

Frequently Asked Questions About COVID-19 and Men’s Sexual Health

If you’re worried about your erectile dysfunction, talk to your health care providers so they can pin down the root cause of the problem. Meanwhile, here are the answers to some questions you may have about a possible connection between ED and COVID-19.  

What Are Some of the Lingering Side Effects of COVID-19?

Some patients who have had COVID-19 develop what’s known as “long-COVID,” where their symptoms persist months or longer after the initial infection. Long-term effects of COVID-19 can include:

• Headaches

• Difficulty concentrating (brain fog)

• Extreme fatigue

• Problems with overall health

• Shortness of breath

It’s estimated that more than 13 million people in the United States have long-COVID.

Can COVID-19 Have Lasting Effects on Men’s Health?

More and more research indicates that male sexual dysfunction should be added to the list of long-term effects of COVID-19. Many studies have established a link between erectile dysfunction and having had a COVID-19 infection.  

Can COVID-19 Cause Erectile Dysfunction?

Research has found that having had COVID-19 is a risk factor for ED. Likewise, having ED is a risk factor for developing COVID, likely because the two conditions are linked to the same types of conditions such as cardiovascular disease and diabetes. In some cases the connection between erectile dysfunction and ED appears to have a physical origin while other factors are linked to the increase in stress and depression that occurred during pandemic lockdowns, leading to reduced sexual activity.  

Can COVID-19 Damage Testicles?

COVID-19 can damage the reproductive system and reproductive health in men. This includes damage to the testicles, which can lead to sexual dysfunction. The SARS-CoV-2 virus that causes COVID-19 enters host cells by using the angiotensin-converting enzyme 2 (ACE2). Leydig cells, which are located inside the testicles, express ACE2 in high numbers, which explains why testicles are susceptible to damage from COVID-19.