COVID affects everything—even your sex life

I had a nasty case of COVID-19 several months ago. It's taken a while, but I'm fully recovered—except for one thing: I've been having trouble getting and keeping an erection. I know that most men have erection troubles at some point, but I never have before and I'm wondering whether there could be any connection between COVID and sexual difficulties.

What a great question. In a word, the answer is yes. A recent study published in the Journal of Endocrinological Investigation explored that exact question. Professor Emmanuele A. Jannini, of the University of Rome Tor Vergata and his colleagues found a definite connection between erectile dysfunction (ED) and COVID-19. How does it work? According to Jannini, there are several likely culprits:

Overall health issues. Like it or not, ED is a good indicator of our overall health and is often a symptom of an underlying health problem. And since COVID-19 can aggravate (or cause) many health concerns, it's no wonder that there's a connection to ED.

Psychological issues. In addition to the damage COVID-19 can do to one's physical health, there are also numerous mental health issues, including depression and anxiety, both of which can cause ED. Men's Health Network (MHN, menshealthnetwork.org) and the Patient-Centered Outcomes Research Institute (PCORI, pcori.org) recently organized a conference entitled "Behavioral Health Aspects of Depression and Anxiety in the American Male," which discussed this topic in detail. MHN and PCORI have also put together a series of webinars on the effects of COVID-19 on the mental health of men and boys.

Cardio issues. Many people with COVID have developed cardiovascular problems, including dangerous levels of inflammation in the heart and circulatory system. And any problems with blood circulation may result in ED.

To dig deeper into the connection between COVID and ED, I spoke with Dr. Judson Brandeis, who's a urologist and an expert in men's sexual medicine. He's concerned that "the COVID-19 pandemic will result in widespread erectile dysfunction." How? Brandeis explains the big picture this way: "Erectile function is highly dependent on pressurized blood flow, which starts at the heart, pulses through the large arteries, and then flows through the small blood vessels. Conditions like diabetes, high cholesterol, and smoking cause damage to the inner lining of the blood vessels, which causes ED. So does COVID-19." That's fairly easy to understand. But there's also a more complicated—yet fascinating—explanation.

"The coronavirus hijacks our own cells to create new copies of itself, which then get released throughout our body," Brandeis says. "However, since our body has never seen this virus before, it hasn't developed the antibodies that would allow it to mount a targeted defense. As a result, it tries to stamp out the invader by launching a massive, non-specific immune response. The body's massive response ends up damaging itself—particularly the endothelium, which is the delicate layer of cells that lines our blood vessels." The bottom line: blood vessels are narrowed and blood flow is restricted, which increases ED.

Ask your doctor about ways to protect your endothelium. Several clinical trials are currently exploring the use of nitric oxide (a chemical produced naturally in our body that acts as a vasodilator, relaxing the lining of blood vessels and increasing blood flow). According to Brandeis, the results so far are optimistic. Also, get vaccinated at soon as possible. That will help your body produce the right antibodies and may reduce blood-vessel damage. In the meantime, keep wearing a mask and avoid groups of people.

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