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Study: Erectile Dysfunction Is 5 Times More Likely in Men Who've Had COVID-19

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Key Takeaways

  • Erectile dysfunction is five times higher in men who have had the SARS-CoV-2 (COVID-19) virus.
  • Some of the same risk factors exist for both erectile dysfunction and having a severe case of COVID-19.
  • Lifestyle improvements could reduce the risk of developing both conditions, as well as future heart disease.

Several months ago, a group of Italian researchers hypothesized that there could be a connection between COVID-19 and erectile dysfunction—trouble getting and maintaining an erection. The cause, they suspected, was damaged blood vessels.

A March study confirmed their suspicions, showing erectile dysfunction was five times more likely to occur in men who had tested positive for COVID-19.

The researchers at the University of Rome Tor Vergata studied the sexual health of men in Italy during 2020. They looked at whether men had tested positive or negative for COVID-19. But they also considered their age, body mass index, and psychological health during the pandemic lockdown, because trouble with erections can be affected by age and obesity, as well as anxiety or depression. Ultimately, having had COVID-19 was more strongly related to erectile dysfunction than were age, BMI, or mental health.

Survivors of COVID-19 are currently followed with lots of examinations, MRI, and tests attempting to evaluate possible sequelae [after effects] of the pneumonia associated with COVID-19,” Emmanuele Jannini, MD, professor of endocrinology and medical sexology at the University of Rome in Italy, tells Verywell. “All are more or less related to endothelial damage.”

The endothelium is the innermost lining of the blood vessels — arteries, veins, and capillaries. It controls blood flow by releasing compounds that constrict (narrow) or dilate (open up) the blood vessels. One of those compounds is nitric oxide, which dilates blood vessels. To achieve an erection, the endothelium of blood vessels inside the penis must produce enough nitric oxide to open up the blood vessels to allow blood to flow in and fill the penis. If the endothelium is damaged, the level of nitric oxide may be too low to help produce an erection.

“Endothelial cells express many of the cofactors used by the SARS-CoV-2 virus to invade host cells,” Jannini says. “The virus may cause damage.”

Whereas erectile dysfunction can be caused by the inability of blood vessels to open up, too much constriction of the blood vessels is problematic, too. When blood vessels are too constricted, blood pressure rises. The high pressure against the endothelial lining of the blood vessels causes damage over time, and eventually blood clots can form. Blood clotting is regarded as a serious complication of COVID-19.

“The penis is the first organ clinically affected by endothelial damage because of the size of the blood vessels carrying blood to it,” Jannini says. “In contrast, heart vessels are much bigger. The penis is affected by endothelial damage leading to erectile dysfunction 10 years before heart disease is detected.”

Take Control of Your Health

Erectile dysfunction and COVID-19 share risk factors, including high blood pressure, obesity, diabetes, and cardiovascular disease. Managing those conditions to reduce risk factors is more important than ever.

“Unfortunately COVID is teaching us a lot. We prefer not to have this lesson, but the lesson is coming,” Jannini says. “It’s a very good idea to think of this pandemic as the time to revise your lifestyle, which is clearly so critical. Some endothelial problems that could be fixed sooner rather than later could reduce the risk of severe COVID as well as future cardiovascular disease."

And, of course, you should take actions to reduce the chance of getting COVID-19: get vaccinated, wear a mask, and wash hands often. “Avoid complications,” Jannini says.

Making lifestyle changes to improve your vascular health pays off by improving your overall health, including your sexual health. But remember that erectile dysfunction has several causes. “If you currently have erectile trouble, go to the doctor to get checked,” Jannini says. Taking that first step may jumpstart your journey toward better health.

What This Means For You

If you currently have COVID-19 or have tested positive for it over the past year, pay close attention to your vascular health:

  • If you have type 2 diabetes, make sure you do everything possible to control your blood sugar levels and keep them in the normal range.
  • If you have high blood pressure, follow your doctor’s recommendations and treatment plan to meet your blood pressure target. Blood pressure that stays high damages the inner lining of blood vessels over time, contributing to complications such as erectile dysfunction or blood clots.
  • If you smoke, quit. For help, go to www.smokefree.gov.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Sansone A, Mollaioli D, Ciocca G, et al. “Mask up to keep it up”: Preliminary evidence of the association between erectile dysfunction and COVID-19. Andrology. 2021 Mar 20. Online ahead of print. doi:10.1111/andr.13003

  2. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of erectile dysfunction. Updated July 2017.

  3. Feletou M. The Endothelium. Part I: Multiple functions of the endothelial cells. 2011. Morgan & Claypool Life Sciences.