"Mask up to keep it up": Preliminary evidence of the association between erectile dysfunction and COVID-19

Andrea Sansone, Daniele Mollaioli, Giacomo Ciocca, Elena Colonnello, Erika Limoncin, Giancarlo Balercia, Emmanuele A Jannini, Andrea Sansone, Daniele Mollaioli, Giacomo Ciocca, Elena Colonnello, Erika Limoncin, Giancarlo Balercia, Emmanuele A Jannini

Abstract

Background: Erectile dysfunction (ED), as the hallmark of endothelial dysfunction, could be a short- or long-term complication of COVID-19. Additionally, being ED a clinical marker and predictor of non-communicable chronic diseases, particularly cardiovascular, subjects with ED could potentially have a higher risk of contracting COVID-19.

Objectives: To investigate the prevalence of ED among subjects with a reported diagnosis of COVID-19 and to measure the association of COVID-19 and ED.

Materials and methods: We reviewed data from the Sex@COVID online survey (performed between April 7 and May 4, 2020, in Italy) to retrieve a sample of Italian male sexually active subjects with reported SARS-CoV-2 infection. A matching sample of COVID-19-negative male sexually active subjects was also retrieved using propensity score matching in a 3:1 ratio. The survey used different standardized psychometric tools to measure effects of lockdown and social distancing on the intrapsychic, relational, and sexual health of Italian subjects.

Results: One hundred subjects were included in the analysis (25 COVID-positive; 75 COVID-negative). The prevalence of ED, measured with the Sexual Health Inventory for Men, was significantly higher in the COVID+ group (28% vs. 9.33%; p = 0.027). Logistic regression models confirmed a significant effect of COVID-19 on the development of ED, independently of other variables affecting erectile function, such as psychological status, age, and BMI [OR 5.66, 95% CI: 1.50-24.01]. Likewise, subjects with ED were more likely to have COVID-19, once corrected for age and BMI [OR 5.27, 95% CI: 1.49-20.09].

Discussion and conclusion: On top of well-described pathophysiological mechanisms, there is preliminary evidence in a real-life population of ED as a risk factor of developing COVID-19 and possibly occurring as a consequence of COVID-19. Universal vaccination against the COVID-19 and the personal protective equipment could possibly have the added benefit of preventing sexual dysfunctions.

Keywords: COVID-19; SARS-CoV-2; coronavirus; endothelial dysfunction; erectile dysfunction; testosterone.

Conflict of interest statement

The authors declare no competing interests for the present study.

© 2021 American Society of Andrology and European Academy of Andrology.

Figures

FIGURE 1
FIGURE 1
Prevalence of erectile dysfunction in the COVID+ and COVID− groups

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