Bengaluru: Fertility and impotence research increasingly indicate that Covid-19 affects male sexual health, sometimes resulting in erectile dysfunction (ED), also known as impotence.
In a new study, researchers from Turkey have found that dysfunction of the endothelium — or the membranes that line blood vessels — and direct testicular damage, caused by Covid, as well as the burdening mental health effects of the pandemic, have led to a rise in erectile dysfunction. The study — a narrative review based on current evidence — was published in the International Journal of Impotence Research last month.
Another study, not yet peer-reviewed, has found remnants of the SARS-CoV-2 virus in the lungs, prostrate, penis, and testicles of rhesus macaque monkeys, two weeks post infection. The team discovered that as lung infection started to clear out after 14 days, the infection in the monkeys’ testicles actually increased. Blood vessels in genitalia were also found to be damaged.
Previous studies have also confirmed diminished sexual health and libido owing to the pandemic, both through affected mental health, as well as physically damaged cells from infection.
A 2021 pilot study also found that in a limited sample size of just two infected men, and two healthy men for controls, there were observable viral particles and RNA in the blood vessels in the penis.
Experts are calling for increasing monitoring of and studies into the sexual and penile health of male patients who have recovered from Covid, as well as an integrated multidisciplinary approach to treat those exhibiting impotence.
Why erectile dysfunction?
It is currently established that although Covid impacts all groups of people, it is more likely to lead to a serious disease or mortality in men with comorbidities like diabetes, hypertension, and obesity. The risk of severe disease and death is lowered with vaccination.
Erectile dysfunction (ED) is the inability to get and sustain an erection, when sexually engaged. It can be caused by various physical conditions, diseases and hormonal imbalances, as well as psychological factors — usually a combination of more than one factor. The mechanism is complex, and involves neural, vascular, and hormonal signalling systems. Hampering of these, as well as psychological systems, can induce ED.
ED is often induced by auto-immune responses, such as from inflammatory bowel disease, kidney disease and psoriasis, among others. These produce inflammatory cytokines, the proteins that modulate immune response, such as TNF-α and IL-6, which are known to worsen sexual dysfunction.
These cytokines are also released during a bout of Covid infection.
Viral RNA has been consistently detected in the endothelial cell surfaces, as the virus binds to the ACE2 receptor, which is used for signalling between cells and systems. This causes disruption in signalling from the cells of the penis, leading to endothelial dysfunction. ACE2 signalling damage from Covid in the testes also lead to further damage.
Researchers say that sexually active people facing economic and psychological pressure, driven by Covid, experience decreased frequency of sexual activity and lowered satisfaction. Additionally, stresses from isolation, lockdowns, uncertainty, fear of death, etc., are also leading to a spike in sexual distress in both men and women, say experts.
ED’s cardiovascular complications
The presence or onset of ED or impotence indicates an increased risk of future, progressive cardiovascular events — incidents that damage heart muscles like blood clots, heart valve disease, enlarged heart, chest tightness. ED also especially raises the risk of death from cardiovascular disease.
In a 2013 review of well-conducted clinical studies on the subject, which included over 90,000 participants in total as a part of 14 major studies, over 5,600 men had cardiovascular and cerebrovascular events (damaging blood flow to the brain leading to aneurysms or strokes). Of these, over 1,000 died of heart disease or a heart attack.
Other studies have suggested that since ED and cardiovascular disease seem so closely tied, severe inability to get or sustain an erection could also be an indicator of heart disease.
Since a large part of ED is psychological, experts have called for multidisciplinary and integrated approaches to treating it, with a mix of biomedical and psychological interventions such as cognitive behavioral therapy and sex therapy.
(Edited by Poulomi Banerjee)