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Frank Bures: Can COVID-19 cause erectile dysfunction?

From the COLLECTION: Recent Healthful Hints columns by Dr. Bures series
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Can COVID-19 infection cause erectile dysfunction (ED) in males? The topic was raised in earlier COVID times. Now there are two threads of indirect evidence that have come up from two different research papers. It cannot be said yet that the virus causes ED unequivocally. However, the virus has been found in penile tissue in one study in two males who had severe ED 7-9 months after their infections.

One paper appeared in the July 21, 2021, World Journal of Men’s Health from the University of Miami, Florida. Specimens were obtained of penile tissue from the two COVID-positive patients and also from two COVID-negative patients, all undergoing penile prostheses implants for severe ED. Using microscopic and electron microscopic techniques, viral particles with spike proteins were found in the two COVID-positive patients in and around the penile blood vessel tissue and internal lining, called endothelium (EN-do-THEE-lee-um). That label is used for the internal layer of all blood vessels. The two negative control patients had none.

An enzyme called endothelial nitric oxide synthetase is in those lining cells to help allow dilation during erection. It was diminished in the COVID chaps’ tissues, but not the other two.

These findings don’t show cause and effect of the virus inducing ED, but it is strongly suggestive of the relationship. The blood vessel damage is comparable to that seen in other organs like lungs, heart, bowel, kidneys, brain, etc. COVID is really a total body disease infecting and affecting small blood vessels in those tissues. The fact that the viral particles persisted for months after the documented infections may help understand “long COVID” problems (although long may not be the proper adjective for this complication?)

Disease severity is not apparently relevant. One of the guys had severe infection — two weeks in the hospital — and the other just a mild case. However, he had clogged arteries and high blood pressure before infection. Those problems, along with others are known predisposing conditions for ED. The virus may be another vessel insult.

The other current source of evidence that COVID can bring ED is a paper from a journal called Andrology, Mach 30, 2021, issue from Italy. Responses were extracted from an online survey between April 7 and May 4, 2020, of over 6,000 men. One hundred were selected as eligible. Of these, 25 had self-reported COVID infections and 75 had no known infection. The incidence of ED was 28% in the infection positive males and 9.33% in the negative group. Somehow, the number has been reported in many other references that ED was between 5 and 6 times higher in the positive patients.

The discussion of the results is complicated because the researchers tried to compare the groups for associated predisposing conditions such as high blood pressure, cardiovascular disease, diabetes, medicines that lessen erections, etc., which is difficult with self reported study data. The other confounding factors are whether an individual had ED before infection and it got worse after, or the ED was a sign of other endothelial inflammation problems, which provoked the ED. The question was raised whether ED predisposes the person to COVID infection or more severe disease, but no answer was evident.

Yet another documented facet is that the virus has been found in penis and testicle tissues, especially in the blood vessels in autopsies of COVID patient deaths. Other studies have revealed 10-11% of hospitalized COVID patients suffered from testicular pain. Yet, the virus has never been found in semen, nullifying the concept is can cause infertility.

The main author of the Italian study from Tor Vergata University of Rome said of the narrowed and inflamed vessels, “No oxygen, no sex.” In the discussion section of the paper it stated that based on the presented evidence, ED could be both a short-term or long-term complication of COVID-19. “The use of masks as devices for the prevention of sexual dysfunction is perhaps a bit stretched ... but this could be an additional strategy. … People have already posted on Twitter, using the hashtag #MaskUp To Keep It Up. … Subjects with ED should consider their erectile impairment as a sign of possible underlying conditions..”

The vaccine DOES NOT cause ED or impotence, a widely proven point. A well known pop rapper falsely claimed it did based a story about a cousin’s friend in Trinidad.

In a May 16, 2021, Forbes magazine article on the topic the author, Bruce Y. Lee, wrote, “ If avoiding hospitalization or death is not incentive enough to take precautions against COVID-19 such as getting vaccinated, maybe the possibility of the virus getting the shaft will.” This may be “impotent” news for some readers. … It sure presents another reason to get stuck up.

Dr. Bures, a semi-retired dermatologist, since 1978 has worked Winona, La Crosse, Viroqua, and Red Wing. He also plays clarinet in the Winona Municipal Band and a couple dixieland groups. And he does enjoy a good pun.


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