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Post-COVID Syndrome and Erectile Dysfunction in Malaysia: Understanding the Link

June 17, 2024

COVID-19, a global pandemic, has taken the world that we live in by storm. Whether or not we like it, the probability of contracting the virus at any region could be substantial, and should not be taken lightly because of the potential harm it can bring.

Although most individuals infected with COVID-19 get better within weeks, a small number of patients continue to experience symptoms that can last up to months after first being infected, or may develop new/recurring symptoms at a later time. Many have reported these symptoms despite recovery from COVID-19, even if the initial illness was mild.

This condition is known as “long COVID”, and has been one of the issues actively addressed by the WHO.

Examples of long COVID symptoms include extreme tiredness, difficulty breathing, palpitations, insomnia, changes to smell and taste, and finally, reports of development or worsening of erectile dysfunction.

What’s causing it?

As of now, multiple researches are ongoing to find out the link between the virus and erectile dysfunction (ED). ED, in simple words, is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

One of the first studies regarding this issue, led by Dr. Emmanuele A. Jannini, MD, professor of endocrinology, University of Rome Tor Vergata, Rome, Italy, was published around March 2021. In this study, it was shown that COVID-19 increases the risk of developing ED by nearly a staggering figure of six times[1]. Those numbers remained even after other factors considered.

Within the study, many possible explanations were being highlighted to explain the link between COVID-19 and ED.

Endothelial dysfunction – the link between COVID-19 and ED

The endothelium is the innermost layer within the blood vessels that helps maintain the tone of the blood vessels. The endothelium integrity is important for organ perfusion, as well as the balancing of blood clotting and the human immune system.

This layer of the blood vessel dilates and contracts in reaction to bodily physiological responses. In the case of endothelial dysfunction, it would mean that the blood vessel has an impaired ability to dilate and contract, causing it to be strict and stiff. It has been established that endothelial dysfunction can be caused by several co-morbids, such as diabetes, hypertension, smoking, and metabolic syndromes.

On a related note, ED has long been considered a hallmark of underlying endothelial dysfunction, since blood vessels that have endothelial dysfunction are unable to dilate to contribute to satisfactory erection. Because of the association of endothelial dysfunction with many other underlying co-morbids, ED is often considered a marker of impaired overall health status, including an indication early cardiovascular events (heart attack).

According to other recent researches and data[2], it has also shown that COVID-19 infection may also directly result in endothelial dysfunction (by inducing intracellular oxidative stress, as well as systemic inflammatory response). It stands to reason that, patients with pre-existing endothelial dysfunction would then be more susceptible to a more severe disease course of COVID-19, given the mentioned importance of endothelial integrity.

Mask it up to keep it up

After removing possible bias resulting from other ED risk factors age and BMI, psychological factors (eg. Anxiety, depression), Dr Jannini’s paper has managed to show that the prevalence of ED found is not only a consequence of the psychological burden of lockdown, but also prominently due to organic factors, among which endothelial dysfunction is the proposed most likely culprit. It has concluded that ED could be both a short term and long term complication of COVID-19.

In his study, it was highlighted in the discussions that the results of the study agree with the pathophysiological mechanisms linking ED, endothelial dysfunction, and COVID-19.

Therefore, other than the importance of treating ED itself, investigating the other possible causes of ED becomes of paramount importance in times like these: Identifying and treating potential comorbidities would have potentially beneficial effects on erectile function, while at the same time the precautions for contraction of COVID-19 or developing more severe forms of COVID-19 (such as wearing masks/ vaccination).

[1] Sansone, A., Mollaioli, D., Ciocca, G., Colonnello, E., Limoncin, E., Balercia, G. and Jannini, E., 2021. “Mask up to keep it up”: Preliminary evidence of the association between erectile dysfunction and COVID‐19. Andrology, 9(4), pp.1053-1059. https://onlinelibrary.wiley.com/doi/10.1111/andr.13003

[2] Nägele, M., Haubner, B., Tanner, F., Ruschitzka, F. and Flammer, A., 2021. Endothelial dysfunction in COVID-19: Current findings and therapeutic implications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554490/