ED and COVID-19

01 September, 2021  |  Holy Winter - Healthcare Writer

The COVID-19 pandemic has been a global issue for more than a year and a half now. Despite all this time, we are still learning new details about the health-related problems among people suffering from Long COVID. Long COVID-19 is the term used to describe the symptoms that last for longer than four weeks after getting infected for COVID-19.

From the beginning of this pandemic, doctors have suspected that COVID-19 can cause erectile dysfunction during the infection and the Long COVID-19 period. The exact mechanisms behind this are still being studied, but the link between COVID-19 and ED is undeniable.

The links between COVID-19 and Erectile Dysfunction

Although researchers are currently trying to determine the exact relation between ED and COVID-19, we do, however, have some idea of how COVID-19 can lead to Erectile Dysfunction, both while infected and during the long COVID-19 period.

The impact of COVID-19 on overall health

Erectile dysfunction can be an indication of further underlying health issues. Men with poor health are more likely to develop ED and experience any adverse reaction to COVID-19.  Among young and healthy men, a sudden onset of ED after contracting COVID-19 is especially worrying.

Due to the wide range of possible health complications of COVID-19, men should not suffer silently for months and hope that the ED will go away on its own. It is critical to seek medical attention in the early stages of Erectile Dysfunction, especially after COVID-19. Early intervention can better address the problem and keep it from worsening.

The Cardiovascular Impact of COVID-19

It is well known that the vascular system and the reproductive system are closely linked together. COVID-19 has been shown to produce hyper inflammation throughout the body, particularly in the heart and adjacent muscles. The degraded performance of the cardiovascular system can cause the flow of blood to the penis to become obstructed, which can lead to Erectile Dysfunction.

The impact of COVID-19 on blood flow

Inflammation can occur during or after a COVID-19 infection. It is one of the main factors that may cause Erectile Dysfunction during long COVID.  As the immune system attempts to fight off the virus, many people tend to also experience hyper inflammation.

Hyperinflammation can lead to the development of small blood clots and inflammation of the endothelium(lining the blood vessels). This disrupts the normal flow of blood, leading to Erectile Dysfunction.

The blood flow concern has risen to prominence among health practitioners, who now undertake further exams on patients to check for any abnormality. Raman Tanwar, MBBS, MS, FMAS, MCh, Department of Urology and Andrology, Jyoti Hospital, Gurugram, noted that "COVID-19 infection leads to widespread endothelial dysfunction which means that the linings of blood vessels do not function properly once infected. For erection, the optimal function of blood vessel lining is needed, and many studies across the world are finding an increased incidence of erectile dysfunction in positive patients. Studies have also pointed out that those who have ED are more likely to have COVID-19 infection".

Sexual function and the psychological impact of COVID-19

Sexual health is closely related to mental health and well-being. Pandemic-related worries and anxieties can, therefore, cause erectile dysfunction.  Moreover, isolation and financial struggles have also been magnified during the pandemic, leading to more loneliness and depression, diminished sexual function, and subsequently more erectile dysfunction.

Covid-19 induced Pneumonia 

If the Covid-19 infection spreads to the lungs, it is possible that it may cause pneumonia. Mild cases of pneumonia are readily observed among COVID-19 patients. However, sometimes COVID-19 can lead to serious symptoms as well, and one can experience severe bouts of pneumonia. Symptoms of severe pneumonia may include trouble breathing and low oxygen levels. In critical cases, pneumonia can progress to ARDS (Acute respiratory distress syndrome).

People with weakened immune systems, people with existing health conditions, and older people have an increased risk of serious illness as a result of COVID-19.

The symptoms of COVID-19 induced pneumonia tend to be similar to the symptoms of other forms of viral pneumonia. It is thus advisable to get tested for COVID-19 and other respiratory infections to determine the cause of your symptoms.

According to Pramod Krishnappa, Consultant Andrologist at NU Hospitals in Bangalore, "The COVID-19 pandemic has wreaked havoc on humans causing both physical and mental illness. Although the lung is the most prominent organ affected, the latest research paper from Miami has revealed the presence of COVID-19 viral particles in the most sensitive organ, the penis. The authors have additionally hypothesised that this widespread endothelial dysfunction could result in erectile dysfunction".

How does COVID-19 cause pneumonia?

The oxygen one breathes passes into the bloodstream via the alveoli (tiny air sacs in the lungs). A COVID-19 infection can damage the alveoli and their adjacent tissues, thus reducing their ability to transport oxygen into the bloodstream.

In addition, as the immune system fights COVID-19, pneumonia-related inflammation can cause fluid and dead cells to build up in the lungs. This is the primary cause of symptoms such as coughing and shortness of breath.

Damage to penile blood vessels

Recent research into penile tissue samples from people who have had COVID-19 showed that coronavirus particles were present in the penis even almost a year after getting the infection. Further research into these particles led doctors to determine that the blood vessels to the penis are damaged due to COVID-19. This is a primary cause for a sudden onset of ED after a COVID-19 infection. Due to the harmful effects of COVID-19 on the vascular system, blood vessels are unable to adequately supply the penis with enough blood needed for an erection.

This damage to penile blood vessels is similar to the damage suffered by other organs in patients with COVID-19. Research is still ongoing, but it is suspected that this damage to the blood vessels could potentially be long-lasting or permanent.

Erectile dysfunction has been found to be widespread among those who had previously had COVID-19, according to a survey led by Emmanuele A. Jannini, MD, professor of endocrinology and medical sexology, University of Rome Tor Vergata, Rome, Italy. He stressed vaccination as a way of avoiding ED, arguing that "when offered, men should have the COVID vaccination. It also gives a whole new meaning to wearing the mask ― masks up to keep it up". He went on to say, "It could have the added benefit of preventing sexual dysfunction".

Additionally, clinical Director of Diyos Men's Health Centre Vineet Malhotra has said that "The recent study conducted at the Miller School of medicine, Miami, USA notes the presence of COVID-19 in the penis even seven months post-infection. The increased risk of endothelial dysfunction can lead to a risk of erectile dysfunction in affected men".

COVID-19 and impaired testosterone production

COVID-19 may infect cells in the testicles, including Leydig cells. Leydig cells are essential for the production of testosterone — the primary male sex hormone that influences libido and sexual desire.

According to a survey of scientific literature on the likely causes of erectile dysfunction among COVID-19 survivors, it has been observed that Leydig cells also contain a protein called ACE2. COVID-19 uses ACE2 to infect human cells at the start of the infection. Autopsies performed on men who died of COVID-19 show that the number of their Leydig cells were dramatically reduced. To definitively determine the causation, further studies are still underway.

More research is needed

There are a number of potential reasons to explain the possible links between COVID-19 and erectile dysfunction. However, more research is needed to explain how COVID-19 causes ED.

If you have ED, it is not necessary that it is linked with COVID-19. Erectile dysfunction is a fairly common disorder among men, and there could be a number of reasons behind it. If you or your spouse is suffering from ED, the first step to address it is to see a doctor.