COVID-19 has been a troublemaker since it came onto the scene. You know all about the shortness of breath, fever, dizziness, delirium, fatigue and sore throat. And you’ve heard about COVID toes, hair loss, and lingering fatigue.
Now, there’s the possibility the novel coronavirus may be linked to erectile dysfunction (ED), which is the inability to get and keep an erection firm enough for sexual activity.
Though first mentioned this summer, the idea resurged in January when Dena Grayson, MD, PhD, cited ED as a potential complication of COVID on an a Chicago NBC affiliate broadcast. There haven't been large-scale studies to date, but some research from Italy offers some preliminary evidence that ED is indeed a potential consequence of COVID. It also suggested that having ED might actually predispose some men to COVID as well.
What Causes Erectile Dysfunction?
First a little refresher on how erections work when things are going as you want them to. “The penis is made of three cylinders,” explains Howard Aubert, MD, a board certified urologist, and assistant clinical professor of surgery at the University of California – Riverside. “The two on top are filled with an expandable spongy tissue, and encased with a firm outer wrapping. The one on the bottom is responsible for carrying urine out from the bladder. During sexual arousal, a nervous system response initiates a series of events that stimulate your arteries to bring blood into the spongy tissue of the cylinders. They expand and engorge until the outer casing gets tight and blocks blood flow from leaving the penis.” That’s what you know as an erection.
“The nerves have to release a healthy amount of nitric oxide and the blood vessels have to be able to open wide enough so that the blood can flow in at a fast enough rate.” adds Jessica Yih, MD, a urologist who specializes in men’s sexual health at The Ohio State University Wexner Medical Center. All of this needs to happen in order to have a healthy erection. And in plenty of men, it does.
For the men who experience erectile dysfunction, there are numerous possible causes, and COVID may contribute to some of them. Reasons for ED typically fall into three camps, says Dr. Aubert: It could be an anatomical problem; could be due to problems with blood flow, nerve supply, or hormone sensitivity; or due to psychogenic factors (it’s partner related, performance related, or associated with major life stressors).
What Role Does COVID Play in ED?
Research is still pretty thin in this area. That said, there are things that we do know. One is that COVID has been associated with vascular—blood vessel—problems. When you have COVID, the lining of the blood vessels can become inflamed. And when that happens, the diameter of the vessel goes down, and less blood can get through. So that's a pretty straightforward blood flow and erection limiter.
Inflammation can narrow vessels in other ways, too: It causes reactions that can make the lining of the vessels “stickier,” explains Dr. Aubert. Blood cells stick to the vessel walls and each other, causing clots that further restrict blood flow. Certain antibodies that COVID-19 causes to circulate may also attack blood cells, causing more clots to form, according to a new study in the journal Science Translational Medicine.
The inflammatory response can apparently also cause priapism, which is an erection lasting beyond four hours, according to a The American Journal of Emergency Medicine study—at least it did for one 62-year-old man.
Side note: While unrelated to erections, but still related to your reproductive system, COVID may also affect the tissue in your testicles, leading to impaired sperm function, research from the University of Miami reveals.
If you already have ED, how might that affect your COVID risk?
Authors of the Italian study point out that ED is a marker of systemic health. So having ED could be an indicator of other health issues, like cardiovascular disease, that have been identified as risk factors for COVID.
You’re Experiencing Erectile Dysfunction, Now What?
The good news is that ED may not always be a finite situation.
If you think your concerns are linked to psychology, Dr. Aubert recommends seeing a therapist and trying to work through some of the root causes and triggers of stress and any depressive episodes you might be experiencing, especially since so many people are experiencing dips in mental health right now. “The expectation is that people are likely to experience more emotional distress with social distancing and isolation, and lack of congregation with friends and family,” Dr. Aubert says. “Sexual activity is closely associated with mental and psychological health. Sexual desire and frequency have declined for many people of all genders during the pandemic. In total, the psychological stressors of the pandemic are definitely a potential cause of erectile dysfunction.”
If you’re just too tired from COVID to have sex, that’s understandable. In fact, Dr. Aubert says wait until you’ve recovered completely from a physical standpoint to restart sexual activity. “We know that it takes an extended time to get your energy levels back to normal,” he says.
If your ED issue becomes consistent, consider talking with a doctor about it. There are many ways to treat ED, depending on what’s causing it. Dr. Yih says that lifestyle changes can have a significant impact on recovery. For example “quitting smoking and getting diabetes under control can sometimes restore a man’s erections to completely normal,” she says. Additionally, “losing weight, having a healthy balanced nutrition, and exercise—specifically weight bearing exercise and high intensity exercise—can help significantly. Your doc may also recommend one of these next-gen treatments for ED.
Having COVID doesn’t necessarily mean you’ll experience ED. But it can cause you problems. Knowing that may not only shore up your efforts to protect yourself from the virus, but also help you in knowing there are reasons you might have ED after COVID, and there are things you can do about it.
