Two and a half years into the pandemic, we are still calculating the damage caused by SARS-CoV-2 and its disturbing descendant, Long COVID. The Center for Disease Control says nearly 20% of American adults who have been infected with the virus — or one in 13 adults in our country — still have long-lasting COVID symptoms.

Doctors and researchers have comprehensively classified these symptoms, which range from the mundane (cough, fever, headache) to slightly mysterious (brain fog, loss of taste or smell, tingling sensation). But it’s a newer body of evidence that has them searching for answers — and it may cause many vaccine-hesitant men to reconsider.

“I have no doubt in my mind that there is an association,” says Dr. Ranjith Ramasamy, director of male reproductive medicine and surgery for the University of Miami Health System. “Like anything else in science, association does not imply causation.”

The statistics are significant. Ramasamy and his team conducted the largest study to date on this topic, in which they compared national registry data from more than 230,000 men with a history of COVID-19 infection to an equivalent number of men. who have not had the virus. Result: “We found that the risk of being diagnosed with erectile dysfunction was approximately 20% higher in men with COVID than in those without after balancing several of the comorbidities,” Ramasamy says.

Survey studies in China and Italy, among others, support the notion of a link between erectile dysfunction and the virus. While the majority of these studies have small sample sizes, a study of nearly half a million adults published in Nature identified difficulty ejaculating and reduced libido as long-lasting COVID symptoms. at men’s.

A comprehensive review of 60 studies concluded that “erectile dysfunction may be a concerning consequence for a large segment of the male population given the high transmissibility of COVID-19, signaling the need for long-term studies to clarify the issue. extent of the problem.

“We know that COVID infection, especially with high fever, can significantly reduce sperm count and motility (the number of sperm moving),” says Raevti Bole, a Cleveland Clinic researcher in male fertility and andrology. “Many studies have been done on a small number of patients suggesting that men can recover their sperm quality after three to six months, but we really need to follow more patients for longer (namely with certainty).”

Although the prevalence of these problems varies, some epidemiological studies suggest potentially dramatic figures, with tens of millions of men affected. In a small study conducted at the start of the pandemic, Dr. Emmanuele Jannini, professor of endocrinology and medical sexology at the University of Rome Tor Vergata, found that those who had been infected were nearly six times more likely to report impotence than men who ‘d dodged the virus, after the results corrected for other potential factors. A University of Florida health study found that these reports were three times more likely after an infection.

“Men are typically reluctant ‘to report sexual dysfunction,’ suggesting the problem may be more serious than we know,” says Jannini.

What is happening here?

First and perhaps foremost, biology is at work. Emerging data shows that COVID-19 can negatively affect endothelial cell function, which is an important clue. These cells release substances that modulate vascular relaxation and contraction, so damage to them is likely to impair a wide range of functions, including the body’s ability to obtain adequate blood flow to the penis by most urgent need.

For this reason, a case of erectile dysfunction post-COVID can be an indicator of a more general health problem, putting a person at increased risk of other serious diseases such as cardiovascular disease, heart attack or stroke. ..

Ramasamy and his researchers found evidence that the virus remains in penile tissue endothelial cells for up to seven months after infection, suggesting that direct damage to the cavernous endothelium may affect erectile function. A non-peer-reviewed preprint study in COVID-infected monkeys by Northwestern Medicine researchers found that multiple sites of the male genital tract, including the prostate, penis, and testicles, were infected with SARS. -CoV-2.

Ramasamy described it as “probably the best evidence we have that the virus can stay in those organs and replicate.”

“Endothelial dysfunction could make erectile dysfunction worse, says Dr. Amarnath Rambhatla, director of men’s health at Henry Ford Hospital. However, Rambhatla added, “We don’t understand the whole mechanism of why (increased ED) happened.

This is partly because men’s sexual health has always been dependent on multiple variables, each of which can exert considerable influence in its time, including hormone levels, blood flow, or other factors. physiological, a deficiency of one of them being able to inhibit sexuality. health.

ThisIt is important to emphasize the role that mental health – and certain medications used to treat psychological or emotional disorders – can play. Simply put, a good mindset is closely linked to good sexual performance for men. Meanwhile, the World Health Organization reported a 25% increase in the prevalence of anxiety and depression worldwide in the first year of the pandemic, as COVID forced people to isolate themselves and increased emotional and physical stress.

Even loss of taste or smell, two common symptoms of Long COVID, could be factored in, as researchers say these senses may contribute to a person’s ability to wake up.

In other words, there can be a lot of things working together, including the simple fact that COVID is throwing you into an unhealthy, albeit (hopefully) temporary, state. “I think if you get COVID it can affect your health, and it’s directly related to adversity in terms of your penile erection mechanism,” says Dr. Arthur Burnett, professor of urology at The Johns. Hopkins Medical Institutions.

According to a 2021 report by Nassau et al.

How long does it last?

“Men’s sexual health is definitely affected,” says Bole of the Cleveland Clinic. “We just don’t know how much and for how long.”

A Chinese study of recovered COVID-19 patients showed erection problems could last for at least six months, while a prospective cohort study found significant deterioration in sperm morphology, sperm concentration , semen volume and sperm count in COVID-19 patients up to 60 days after infection.

An Italian study showed that seven months after COVID infection, more than 50% of men still had low testosterone (which can affect erectile function.) “We don’t think it’s a permanent thing” , says Ramasamy, but follow-up data is needed.

Needless to say, you want to avoid all of this, and every doctor and researcher interviewed about it for this article said the same thing: get vaccinated.

“People thought the COVID vaccine and the COVID virus were quite similar and might have the same impacts… But we showed there was almost no association,” said Ramasamy of the University of Miami. He co-authored a study that found no decrease in semen parameters after two doses of the Pfizer or Moderna vaccines, and several other studies. came to the same conclusion.

Despite all the alarmist talk about the potentially harmful effects of COVID vaccines on male sexual health, no evidence has been found. The danger lies in contracting the virus, not in taking steps to prevent it.

At the same time, it’s not clear that getting vaccinated is a shield against COVID-based erectile dysfunction. “That’s the million dollar question,” says Dr. Rambhatla of Henry Ford Hospital. As he said, since vaccines protect against many of the most severe symptoms of COVID, “logically, it makes sense” that sexual function might also be protected. “We don’t have definitive data yet.”

It’s a common theme when it comes to this topic. “It is important to emphasize that all of the available studies have major limitations, and we cannot draw strong conclusions at this time,” says Matthew Ziegelmann, a urologist specializing in male sexual dysfunction and infertility at the Mayo Clinic in Rochester.

It is not at all certain that a COVID infection will lead to erectile dysfunction. You could suffer many effects of the virus without sexual dysfunction being one of them.

“If you already have a condition that affects the blood vessels in your penis (like diabetes or heart disease), and then you get COVID, which could cause more injury, you’re more vulnerable than someone else. one that had healthy blood vessels to begin with,” Bole said. Baseline erectile status, severity of COVID-19, and smoking were also found to be significant predictors of erectile dysfunction in healthy individuals post-COVID.

Treatments for those affected are certainly available, as anyone who watches sports on television will tell you. Domestic sales of erectile dysfunction drugs have increased dramatically during the pandemic. However, the best option is not to suffer from COVID and its complications in the first place – and that goes for younger men as well. Researchers say they have seen cases of COVID-related sexual dysfunction in men ranging in age from their 20s to their 60s.

The bottom line: Don’t guess at this virus, not with your sexual health – among other things – potentially at stake.

“I think we always have to be careful before we try and try not to catch the virus,” Ramasamy says. “I think the whole concept of ‘Let me get COVID so I’m safe for the future or I don’t get it anymore’ — it’s just bad assumptions and theories. It’s still a bad virus, and I think we still don’t know its full ramifications.

Carolyn Barber, MD, has been an emergency physician for 25 years. Author of the book Runaway Medicine: What You Don’t Know Can Kill Youshe has written extensively on COVID-19 for national publications, including Fortune. Barber is a co-founder of the California-based Wheels of Change homeless work program.

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