Why COVID-19 Might Lead to Erectile Dysfunction in Some People, According to Doctors

Jake Smith
·6 min read
Photo credit: laflor - Getty Images
Photo credit: laflor - Getty Images

From Prevention

At the onset of the COVID-19 pandemic, now-familiar symptoms like diarrhea and a loss of smell or taste hadn’t yet been confirmed; now, they’re hallmark signs of the illness. Although we know much more about the novel coronavirus now than we did months ago, doctors are still discovering new side effects of infection, including hair loss and lingering fatigue. The latest discovery? Research points to a surprising link between COVID-19 and erectile dysfunction (ED), the inability to obtain and/or maintain an erection for satisfactory sexual function.

A review of research published earlier this year was the first to note a correlation between survivors of COVID-19 and ED, plus evidence of other sexual and reproductive issues in recovered men, both short- and long-term.

“The virus causes your body to have a very strong [immune] response,” which can impact the cardiovascular system, circulation, and the heart, explains Anthony Harris, M.D., M.B.A., M.P.H., CIO and associate medical director for WorkCare.

Any major stressor can disrupt your normal hormone function, which can, in turn, “completely obliterate the libido,” says Amin Herati, M.D., director of male infertility and men’s health at the Brady Urological Institute and assistant professor of urology at Johns Hopkins University. Since COVID-19 infiltrates so many different parts of the body, from the skin to the brain, experts say it’s no surprise that ED could be a lingering effect, even post-recovery.

Erectile dysfunction has multiple origins.

The causes of ED vary widely. Psychologically, there must be arousal; physiologically, the brain and body need to release the proper compounds to initiate an erection; and physically, the penis must be able to become erect.

“It’s like a car,” Dr. Herati says. “There has to be a desire to get in the car,” plus a key in the ignition and gas in the tank. Long story short: Lots can go wrong along the way. And when the novel coronavirus starts to replicate in the body, the resulting illness can mess with every piece of this system, from blood vessels to testosterone levels, resulting in ED.

“Any major illness that affects the body can [cause ED], but COVID-19 has this strong systemic, inflammatory response that really drives the hormones down,” Dr. Herati notes. “When hormone levels drop, guys will notice reduced spontaneous nocturnal and morning erections. That loss of desire for intercourse, and also the diminished spontaneous erection, is something that some guys have noticed with COVID-19.”

Vascular issues brought on by COVID-19 could cause ED.

Remember that strong immune response? Dr. Harris says it also “affects your blood vessels, heart, and lungs, and that impact can affect your erection.” (In this case, the driver might want to get moving, but the car won’t start.)

COVID-19 attacks blood vessels, and symptoms caused by this complication of the virus have been well-documented over the past few months. Blood clots in the lungs, for example, can cause intense breathing issues, while clots closer to the skin’s surface can cause “COVID toes.” If blood flow is weakened or blocked by COVID-19, ED could be one of the ways that underlying issue presents itself—after all, a healthy erection requires healthy blood flow.

And in a more general sense, weaker overall health caused or aggravated by the virus could also play a role. “Men with poor health are at greater risk for developing ED and also for having a severe reaction to COVID-19,” per the Cleveland Clinic. For instance, ED could point to underlying issues with the heart or circulation, especially when combined with COVID-19. If you’re barely getting enough blood to other parts of your body because of clotting or a weakened heart, achieving an erection will be difficult.

COVID-19’s impact on mental health could also be a factor for some men.

Beyond the physical effects, the mental toll of recovering from the virus might play a role in suppressing libido. “There is a very strong association with [ED] and the psychological effects from COVID,” Dr. Harris says. “We have to be aware of that.”

For certain people, recovery is not so simple. So-called “long-haulers,” or people who have technically recovered from COVID-19, but still experience long-term symptoms or side effects, could be particularly at risk for ED caused by psychological distress. Depression, anxiety, and fatigue can all destroy the sex drive, leading to reproductive issues.

ED induced by COVID-19 could be a short- or long-term issue.

Photo credit: Hearst Owned
Photo credit: Hearst Owned

Until COVID-19 has been around long enough to study its long-term effects, experts can’t be sure which symptoms are most likely to linger—or who is most at risk for prolonged illness.

But there is some hope. Testosterone levels often rebound to their normal levels once a temporary illness has passed. “To my knowledge, there is no data that says that COVID-19 affects the [structures of the penis],” Dr. Herati says. With hormones replaced and blood vessels intact, ED could be a short-term issue.

Still, there is no guarantee. “I can give you a solid ‘I don’t know,’” Dr. Harris says. “We don’t know how long these effects will last prospectively, but we’ve seen them last for three months, six months, or even longer.” Like with neurological and cardiovascular symptoms, there simply isn’t enough research yet to determine how long patients can expect ED to last after COVID-19.

You should absolutely get the COVID-19 vaccine, even if you have ED.

Whether or not COVID-19 directly causes ED, the two conditions are at least correlated. (Other adverse effects like permanent lung damage, chronic fatigue, and even death, however, are confirmed side effects of the illness.)

But it is crucial to note that there’s no evidence that the COVID-19 vaccine causes ED. Its side effects are akin to those of the annual flu shot, which is also encouraged by medical experts. Avoiding ED could be reason enough to seek out the vaccine. “This is why men should go get vaccinated,” Dr. Harris says with a laugh. “It’s worth it.”

❗If you suspect you have ED, talk to your doctor.

COVID-19 is a serious illness, and your first step should be addressing serious symptoms and side effects, like shortness of breath or heart problems. Compared to these complications, ED should hit the bottom of the priority list. (Keep in mind that when you’re sick, you might not be in the right mental state to maintain an erection, either.)

But if you’ve recovered and you’re still experiencing ED, it’s a good idea to chat with your doctor. They will be able connect you with a urologist, who can help determine the cause of your ED and offer potential solutions.

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