Male Sexual Dysfunction and COVID-19

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Since the start of the COVID-19 pandemic, there have been indications that males are more vulnerable to initial COVID-19 infection and that they may experience greater symptoms. This has been related to both lifestyle issues (males may have more risk factors such as smoking or obesity, may work in more professions that pose a risk of exposure, have more comorbid health problems, and may engage in more behaviors that increase the risk of exposure or infection) and to biological factors.

Some research suggests that women’s immune systems may be more resistant to COVID-19, that some enzyme receptors (ACE-2) are more prevalent in male testes, and that these receptors are a primary route of COVID-19 infection. However, while there are studies indicating much higher mortality rates in males, some researchers have pointed out that these data may reflect a sampling bias, in that males are often much less likely to seek testing for COVID-19 infection compared to females. But troubling research now points to male sexual dysfunctions as a worrisome lingering after-effect of COVID-19.

Studies on male sexual dysfunction and COVID-19

In June 2020, Parisian emergency room physicians described a case of priapism (a long-lasting erection that becomes extremely painful and doesn’t resolve naturally) apparently caused by a COVID-19 infection. In this case, a 62-year-old man presented to the emergency room with COVID-19 symptoms of fever, respiratory problems, cough, etc. During treatment, it was discovered the man had priapism, and blood testing found that the blood in his penis had extremely low oxygen, high CO2, and blood clots. The patient’s condition responded to treatment, but this early 2020 finding seems to be a forewarning of things to come.

In July 2020, Italian physicians and endocrinologists published a literature review examining the potential indications that the COVID-19 epidemic could have an unprecedented impact on male sexual health and reproductive health. They described that due to the nature of hyperinflammatory “cytokine storm” caused by the COVID-19 infection, there is an increased risk of cardiac problems, micro-thromboses, and blood clotting, all of which could increase the risk for later erectile dysfunction and male sexual dysfunctions.

Further, because cells that produce testosterone are also highly impacted by COVID-19 infection, the physicians expressed concern that damage to these cells could result in later hypogonadism (extremely low levels of natural testosterone production), an issue that had already been identified in some medical research on male COVID-19 patients. In September of 2021, American physicians published similar findings, warning that erectile dysfunction is likely to be a long-term after-effect of COVID-19 infections. A recent follow-up to this early Italian research suggests that these findings are continuing to hold true, with additional evidence that not only is there impaired erectile function and low testosterone, but that male sperm count and motility appear to be at risk from COVID-19 infection.

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These same Italian physicians have published another clinical paper now suggesting the strong likelihood that not only is male sexual dysfunction a likely after-effect of COVID-19 infection, but that erectile dysfunction may be a specific biomarker indicator of those who suffer from “long-haul COVID-19.” Long haulers are individuals who experience lingering, persistent, and impairing symptoms long after recovering from COVID-19. These symptoms include “brain fog” and fatigue reported most often, along with impaired cardiovascular function. These physicians call for greater research on male sexual dysfunction related to lingering symptoms of COVID-19 and report concern that lack of attention to sexual health, combined with shame over erectile issues, may lead to this important health symptom going overlooked.

A recently published study that used health databases to compare the rates of erectile dysfunction in men with and without COVID-19 infections found that men with a prior COVID-19 infection were significantly more likely to later be diagnosed with erectile dysfunction. Further, the effects of the pandemic are more than just biological — one study of healthcare workers found a higher incidence of erectile dysfunction, which appeared related to higher symptoms of PTSD in healthcare workers who’ve been on the front lines for the past two years.

Anecdotal support

To show that it’s not just physicians raising this concern, there’s a recent Reddit post in a forum (not really a SFW forum, FYI) dedicated to discussion of the form of consensual nonmonogamy known as swinging. There, a 28-year-old swinging couple reports that since they recently resumed swinging, they’ve encountered extremely high rates of erectile dysfunction in male partners. They raise the concern, asking “Is there an erectile dysfunction epidemic going on, or are we just unlucky?” Although many commenters described how common erectile dysfunction is in the swinging community at large, mostly due to performance anxiety, many commenters also described encountering more sexual difficulties now compared to prior to the pandemic.

Preparing for the future

It has long been known in sexual health and medicine that male erectile difficulties are often an early and significant sign of cardiovascular problems and of difficulties with anxiety. Sex therapists in training are taught to carefully screen for these issues and to recommend a medical assessment to rule-out cardiac problems of which ED may be an early warning. Now, healthcare professionals need to prepare for a future increase in reporting of male sexual difficulties, which may also now be lingering effects of the global COVID-19 pandemic. Careful assessment and integrated medical treatment will be critical.

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As a group, men appear much less likely to obtain the COVID-19 vaccine. Men are often much less likely to practice preventive health care in general, and men are also overrepresented in modern politically driven anti-vaccine rhetoric, where Joe Rogan is saying, “If you’re young and healthy, I don’t think you need the vaccine.” Perhaps if more men knew the risk of impaired sexual functioning from COVID-19 infection, they'd be more willing to consider vaccination and other preventive health interventions.