Introduction
Several men worldwide have complained about erectile dysfunction (ED) after recovering from COVID-19. Researchers have been conducting studies to find the correlation between the virus and ED. Some studies do have some interesting outcomes, but the exact cause behind the onset of ED after covid recovery is not exactly conclusive.
Researchers have pointed out three crucial that could cause ED after Covid-19 recovery.
Vascular Issues
A healthy erectile function is often associated with a healthy heart. Since the vascular system of our body is connected with the reproductive system, any damage to the former may affect the latter. Since covid-19 is known for causing hyper inflammation in the body, it can affect the heart and surrounding muscles. As a result, the heart may not supply enough blood to the penis, causing erectile dysfunction.
Psychological impact
Both physical and mental fitness is equally crucial to experience satisfactory sexual activity. People undergoing covid-19 may develop a significant scale of stress, depression, and stress that can affect the sexual functions of the body too.
Health deterioration
ED could be a sign of some underlying health issues. Since covid-19 causes many health issues, people with pre-existing health issues can face ED and other complications.
Covid-19 and Impotence
Urologist Ryan Berglund, MD, considers erectile dysfunction a marker of overall health. People developing erectile dysfunction, particularly after covid-19, must get checked as it could be a sign of something more severe. Another important concerning factor after covid-19 recovery is the occurrence of impotence. There have been researches that suggest potential testicular damage occurring after covid-19. However, it is too early to say whether the damage is temporary, permanent, or can affect an individual’s fertility.
Study conducted by Dr. Ranjth Ramasamy and Team
Purpose of the study: To evaluate histopathological features of the penile tissue of symptomatic covid-19 recovered patients and subsequently developed Erectile Dysfunction (ED).
Methods:
Researchers collected penile tissues of patients undergoing penile prosthesis surgery for severe ED. Specimens were collected from four men, two of which were not affected by covid-19. The samples were imaged with TEM and H& E straining followed by RT-PCR from corpus cavernosal biopsies.
All collected tissues were inspected for finding eNOS (Nitric Oxide Synthase) and spike-protein expression of Covid-19. Blood samples were collected from both covid and non-covid patients for assessing endothelial progenitor cells.
Results
Under, Transmission electron microscopes (TEM), Patients with covid-19 history were found to have extracellular viral particles with peplomers near the penile vascular endothelial cells, while viral particles were absent in controls.
Under PCR, viral RNA was found in covid-19 specimens with a decreased level of eNOS expression in the corpus cavernosum compared to covid negative samples. The mean EPC levels of covid positive patients were also lower substantially from ED with no covid history.
Outcome
It is the first study that demonstrates the presence of the covid-19 virus in the penis after the initial infection. The result suggests the endothelial cell dysfunctions caused by the disease can lead to ED. For evaluating the mechanism at a molecular level, further studies are recommended.
Detail Analysis of the Research
Coronavirus is already known for damaging blood vessels, and it could affect the vessel supplying blood to the penis. Researchers took penile tissue samples of recovered covid-19 patients and put them under an electron microscope in the study. They found some coronavirus particles in those samples. Both the patients became impotent six and eight months after the infection.
When compared with two other men with ED with no history of covid-19 infection, it was found that the patients with covid-19 have suffered blood vessel damage in their penises.
Dr. Ranjith Ramasamy, Director of the reproductive urology program in the University of Miami’s Miller School of Medicine, further adds that the virus can potentially disrupt the blood vessels supplying blood to the penis, leading to erectile dysfunction. The penis gets affected the same way as any other organ damage in the lungs, kidneys, and brain.
The two patients who recovered from covid-19 underwent penile prosthesis surgery for their ED. According to a new report, both men had a successful erectile function before the infection. One of them was severely ill and was admitted to the hospital for two weeks. However, he didn’t have any sign of chronic health problems post-recovery. The other patient had mild covid-19 but had pre-existing high blood pressure and clogged arteries.
Covid-19 particles were found on the penile tissues of both men, which is evidence of endothelial dysfunction. It is a condition where the small blood vessels’ linings fail to function correctly, thereby blocking the blood supply to different body parts.
On the other hand, both Covid-free men undergoing ED surgery had no evidence of blood vessel damage in their penile tissues.
Covid-19 linked to erectile dysfunction- truth or myth?
Although it is too early to say it, researchers have discovered a link between covid-19 and erectile dysfunction. Some early studies show that around 20 percent of covid-19 patients experienced some health issues after their recovery, a condition known as Long-Covid. These long-term symptoms followed by a covid-19 recovery include fatigue, shortness of breath, joint pain, chest pain, cough, erectile dysfunctions, and more.
Dr. Jim Hotaling MD, MS, FECSM, published a paper in March 2020 regarding the correlation of covid-19 and ED. As mentioned in his report, he could not find any presence of the virus in the semen. Besides, several other studies across the country also end up with the same result. However, he also states that just because the virus does not affect the testes or sperm, we cannot discard the fact that some illnesses may impact the sperm count of an individual for a short term.
Generally, men recovering from covid-19 have shown normal hormone levels and sperm counts. We can’t ignore that any illness that causes fever can impact an individual sperm count for 60 to 70 days.
Various online articles link the virus with ED. Still, Hotaling says it is too early to conclude before concluding since most studies were conducted on very small sample sizes.
Treatment for Erectile Dysfunction
Medicines like Sildenafil (Generic Viagra) and Tadalafil (Cialis) are the most prescribed ED treatments in men worldwide. However, erectile dysfunction is not the only health condition that Sildenafil can treat. Actually, it was first developed to treat chest pain and angina. During clinical trials, scientists noticed patients experienced longer erections. Consequently, the manufacturers start marketing Sildenafil as an erectile dysfunction drug. Today, Sildenafil is one of the most popular ED drugs, besides Tadalafil (Cialis), often used to treat high blood pressure and pulmonary arterial hypertension.
How to Take Sildenafil (Viagra)?
Viagra or Sildenafil is prescribed to you as per your condition or severity of ED. Your doctor might suggest a 20 mg dose for treating high blood pressure and pulmonary arterial hypertension. Meanwhile, patients with ED are prescribed doses of 20 mg, 40 mg, 60 mg, 80 mg, or 100 mg.
The usual dose is 50 mg that you can take whenever you need it. However, restrict it to using only one tablet per day. Depending on your body’s response, your doctor can reduce the strength to 25 mg or increase it to 100 mg per day.
It will help if you take Sildenafil 4 hours before sexual activities.
Take it on an empty stomach as a full stomach may hinder its potency.
What is Cialis, and does it treat ED?
Cialis is the brand name for tadalafil, as Viagra is for Sildenafil. Both belong to a class of phosphodiesterase type5 (PDE5) inhibitor that treats ED by relaxing the blood vessels of the penis, allowing proper blood flow.
Cialis or generic tadalafil is available in 2.5 mg, 5 mg, 10 mg, and 20 mg. It comes with two dosing options, allowing more flexibility and choices.
Tadalafil is also known as the weekend drug because it offers a lasting effect up to 36 hours compared to Sildenafil which lasts only 4-6 hours. In some cases, tadalafil can last up to 72 hours.
Tadalafil must be taken atleast 30 minutes before sexual activity. If your doctor prescribed it daily, then make sure to use it daily at the same time.
What side effects can sildenafil and tadalafil cause?
Common side-effects of Sildenafil and tadalafil include:
- Headache
- Flushing or feeling warm around face or feet
- Numbness or tingling sensation
- Heartburn
- Changes in color vision
- Sensitivity to light
- Difficulty to falling asleep
Most men find their side effects go away within 1 hour. Within 12 hours, the full side effects will clear up. Call your doctor if the side effects get severe or persist even after 12 hours.
What not to take with ED medications?
High-fat foods
Avoid heavy or fatty meals with Viagra or Cialis as it will take longer for the medicine.
Nitrate and other drugs
Nitrates, antiseizure drugs, HIV medications, antifungal medications, high blood pressure medications can interact with ED medications.
Make sure to inform your doctor or pharmacist before taking Sildenafil or tadalafil.
Alcoholic beverages
Try to avoid alcohol altogether or use caution with drinking alcohol with Cialis or Viagra. Too much alcohol may impair its effect and cause low blood pressure, headache, dizziness, and fainting.
Grapefruit or citric juice
Citric fruits or grapefruit can increase the medication level in the blood, increasing the severity of side effects.
Remember, there is no homemade treatment for ED. Sometimes, erectile dysfunction can signify some underlying disease that needs to be addressed right away. Besides taking your usual medicine, a balanced diet, regular exercise, and smoking cessation can help.