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Can COVID-19 cause lasting erectile dysfunction?

This is now the topic of some discussion among doctors and health experts as they try to better understand the effects of the coronavirus. The problem has been observed in some patients, but experts agree more study is needed to form any conclusions.

Some men are coming into doctors’ offices saying erectile dysfunction has occurred following a COVID-19 infection, said Dr. Ryan Berglund, a urologist at the Cleveland Clinic. At the moment, there’s primarily anecdotal evidence, and “we don’t know the scale of the problem at this point.”

Erectile dysfunction could be a symptom of “long COVID,” he said, an array of symptoms that can last months after the initial coronavirus infection.

Jannini said he suspected the risk was higher in patients who suffered from pneumonia accompanying COVID-19, which triggers inflammation of the blood vessels — specifically, endothelial cells that line the body’s blood vessels.

When those blood vessels and the rest of the cardiovascular system are harmed, it can trigger erectile dysfunction, Jannini said. He suspects that when a coronavirus infection leads to erectile dysfunction, it can last long after the initial bout with COVID-19 has passed.

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Physicians across the globe have said that the virus is known to cause inflammation in the endothelium, which is the inner lining of blood vessels through the body. Because the arteries supplying the genitals are small and narrow, the inflammation is likely to disrupt blood flow and impede a man’s sexual response. Urologist, Dr. Judson Brandeis explains how this damage occurs.

“Our immune system has never seen this virus before, so we don’t have antibodies that would make our immune response selective and targeted. As a result, our body responds with a massive, nonspecific, immune response that cause our white blood cells to furiously assault the virus, gobbling up particles and pouring out chemicals in a feverish attempt to eliminate it, causing massive collateral damage to our own body. Particularly the delicate microscopic cells that line our smallest blood vessels. That endothelium is especially vulnerable to this type of destruction,” shares Dr. Brandeis.

“In addition, this creates a risk to the protective lining of the endothelium called the glycocalyx, which shields the endothelial cells from damage and prevents blood clots from forming. The immune system vigorously attacks this protective coating, resulting in the loss of protection to the endothelial cell,” Brandeis continues.

Studies and clinical trials suggest that Shockwave Therapy, better known as GAINSWave® have been shown to reduce inflammation and promote vascularity by generating angiogenesis (revascularization) and improving endothelial function. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a form of energy transfer that is of lower intensity (<0.2mJ/mm2) relative to traditional Extracorporeal Shock Wave Lithotripsy (ESWL) used for the management of urinary stones. At this intensity and at appropriate dosing energy transfer is thought to induce beneficial effects in human tissues. The proposed therapeutic mechanisms of action for Li-ESWT include neovascularization, tissue regeneration, and reduction of inflammation. These effects are thought to be mediated by enhanced expression of vascular endothelial growth factor, endothelial nitric oxide synthase, and proliferating cell nuclear antigen.