This should get men to start wearing a mask or getting the vaccine – there are some new data that COVID-19 increases the risk of erectile dysfunction. And not by just a little bit, by nearly 6X in young men.
In case you missed that, if you are young and male, you have a 6X increased risk of permanent erectile dysfunction after contracting COVID-19, even mild cases. If you need a reason to wear a damn mask, get vaccinated, and stay away from super spreader events, this should be it.
But, it gets worse. This data also indicated that erectile dysfunction is correlated to an increased risk of SARS-CoV-2 infection. Men with ED are more than five times more likely to have COVID-19.
Mask up to keep it up
This study, led by Emmanuele A. Jannini, MD, professor of endocrinology and medical sexology, University of Rome Tor Vergata, Rome, Italy, was published on 20 March 2021 in Andrology. Basically, the study showed that erectile dysfunction can be a short- and long-term complication of COVID-19.
Let’s dig into the details of the results of the study. The study included 100 subjects from one medical setting in Italy. Of these 100, 25 were COVID-19 positive, and 75 were negative.
- 28% of the COVID-19 positive group had ED vs 9.33 in the negative group.
- The COVID-19 positive group had a 5.66X greater risk of developing erectile dysfunction correcting for age, BMI, and psychological issues.
- On the other hand, subjects with pre-existing ED were 5.27X more likely to develop COVID-19, corrected for age and BMI.
I need to put some perspective into this study. It is very small, only including just 100 patients. Because it’s small, the errors around the mean are quite high, though the risks were all statistically significant.
And I’ve said before, correlation does not mean causation, so it is possible that those at the highest risk of COVID-19 are also at the highest risk for erectile dysfunction. However, these data indicate, irrespective of comorbidities that might lead to ED, that COVID-19 is a causal factor. Older age, diabetes, high body mass index (BMI), and smoking increase the risk of contracting COVID-19 and happen to increase the risk of ED itself.
This seems to be a well-conducted study. However, at the moment, the relationship is just a correlation, and it might be that some of the comorbidities that increased the men’s chances of getting a significant COVID-19 infection may have also independently increased their chances of erectile dysfunction.
“But the authors offer a plausible mechanism by which COVID-19 may impact directly on erectile function,” agrees Pacey. However, “There’s more work to be done,” he said. “I’d also argue it’s a good reason for men to wear a mask, practice social distancing, and take the vaccine when it’s offered to them.”
Why COVID-19 may cause erectile dysfunction
For those of you who follow my posts, you know I like two things before I’m convinced of some claim:
- There is some biological plausibility, that is, there is a logical and known mechanism that can reasonably and easily explain an effect.
- That you provide evidence that supports the claim. And that does not mean anecdotes, but it means studies published in important journals.
So, what might be a plausible mechanism whereby the SARS-CoV-2 virus can cause erectile dysfunction.
The pathophysiology of COVID-19 has shown that it causes endothelial dysfunction which can cause erectile dysfunction. And both dysfunctions are common in COVID-19 cases. Research published last year suggested that asymptomatic COVID-19 could be associated with subclinical microvascular involvement with long-term cardiovascular effects.
According to lead researcher Dr. Jannini:
Indeed, COVID-19 is, by all means, an endothelial disease, in which systemic manifestations…can potentially be due to alterations in the endothelial thrombotic/fibrinolytic balance. In addition, endothelial cells express many of the cofactors used by SARS-CoV-2 to invade host cells.
Erectile dysfunction has often been considered a hallmark of endothelial dysfunction, and as such, a potential association between ED and COVID-19 has also been postulated and underpinned the investigation in this study.
We would like to find some sort of biomarker of endothelial dysfunction post COVID because it seems that there are many sequelae that coexist for a long time after infection. Asking a patient if they have ED after COVID might provide a measure of systemic wellness.
This research is preliminary, and it will need a lot of large, case-control studies to confirm the results of the study.
But if you want to go with “abundance of caution,” I’d say that the long-term risks to young men who contract COVID-19 are quite significant. But I think if there’s one risk that young men who believe they are immortal will fear is erectile dysfunction.
- Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, Madhur MS, Tomaszewski M, Maffia P, D’Acquisto F, Nicklin SA, Marian AJ, Nosalski R, Murray EC, Guzik B, Berry C, Touyz RM, Kreutz R, Wang DW, Bhella D, Sagliocco O, Crea F, Thomson EC, McInnes IB. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. 2020 Aug 1;116(10):1666-1687. doi: 10.1093/cvr/cvaa106. PMID: 32352535; PMCID: PMC7197627.
- Sansone A, Mollaioli D, Ciocca G, Colonnello E, Limoncin E, Balercia G, Jannini EA. “Mask up to keep it up”: Preliminary evidence of the association between erectile dysfunction and COVID-19. Andrology. 2021 Mar 20. doi: 10.1111/andr.13003. Epub ahead of print. PMID: 33742540.
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