COVID-19's link to erectile dysfunction

As the world awaits a coronavirus vaccine, experts in Italy and the US are warning of another potential long-term consequence of COVID-19: erectile dysfunction. 

During a recent interview with the US broadcaster NBC, American physician Dena Grayson said there was growing concern that COVID-19 could cause long-term difficulty getting an erection. 

"We know that it causes issues in the vasculature," Grayson said. "So this is something that is of real concern — not just that this virus can kill, but can actually cause long-term, lifelong potential complications." 

Both a risk factor and a consequence

A study out of Italy in July found that erectile dysfunction was both a risk factor for COVID-19 pneumonia and also a "likely consequence" of the disease for survivors, making it a "worrying phenomenon" among elderly patients in particular.

"Erectile dysfunction is a perfect biomarker of general physical and psychological health," said the study's lead author, Emmanuele Jannini, professor of endocrinology and medical sexology at the Tor Vergata University of Rome. As COVID-19 affects both mental and physical well-being, he said, erectile dysfunction is not necessarily a surprising consequence of the disease. 

People infected with coronavirus who have previously suffered erectile dysfunction may also be more prone to developing COVID-19 pneumonia, according to Jannini.

That's because pneumonia entails the same comorbidities that are often associated with erectile dysfunction, he said, including respiratory difficulties, inflammation, hormonal issues, stress, anxiety, depression and endothelial dysfunction — or when the lining of the small arteries constricts.  

"Erectile dysfunction is a bona fide marker of risk for pneumonia from coronavirus. But it is not necessarily a risk factor for getting the infection, that remains to be seen," Jannini said. 

Damage to blood vessels a cause for concern 

Erectile dysfunction occurs when blood flow to the penis is limited — the causes of which can be complex and varied, both physiological and psychological. Many different factors affecting the cardiovascular system, nervous system and endocrine system can cause or contribute to issues with getting an erection. 

One risk factor that stands out for coronavirus patients is the damage done to the vascular and respiratory systems.  

The coronavirus has been found to attack the inner walls of blood vessels — called the endothelium — throughout the body, including those in the penis, which can cause vascular blockages.  

Although large blood clots can cause heart attacks and strokes, the heart damage caused by COVID-19 is believed to stem mostly from very small clots that block tiny blood vessels in the heart muscle. There are particularly small blood vessels in the penis which can quickly become blocked when the arterial blood flow is restricted.  

While this may explain some presentations of erectile dysfunction among coronavirus patients, experts stress that more research needs to be done to determine its link to COVID-19, and this is likely to differ among individuals. 

Preventing long-term COVID-19 effects 

Although the vast majority of people seem to recover from COVID19 — the disease caused by the coronavirus infection — multiple long-term effects have been observed.

According to the Centers for Disease Control and Prevention in the US, some of the reported long-term complications of COVID-19 include heart palpitations, brain fog, acute kidney injury and impaired lung function. Erectile dysfunction is not listed, but, as Grayson points out, experts are still learning about the disease as infection numbers grow and patients are monitored long-term. 

"As time goes on, and more and more people are infected, we're going to unfortunately see more and more of these long-term negative consequences of infection," she said. 

Experts say the best way to prevent the potential long-term consequences of COVID-19 is to avoid getting infected with coronavirus in the first place.  

The World Health Organization recommends wearing a mask in public place, keeping at least 2 meters (6 feet) away from other people, frequently washing hands and avoiding crowds and poorly ventilated spaces.