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Can Covid-19 really cause erectile dysfunction? We take stock

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Some Covid-19 patients may present with breathing problems, fatigue, headaches, loss of taste or smell … and even erectile dysfunction according to a small study recently published. The latter would be inherent in vascular disturbances. However, these conclusions should be qualified.

Covid-19: a possible erectile tissue dysfunction?

We know from previous work that the ability of Covid-19 to enter cells is highly dependent on the presence of the angiotensin-2 converting enzyme (ACE-2). We also know that before binding to ACE-2 receptors, viral tip proteins must be primed by cellular proteases, in particular the transmembrane protease serine 2 (TMPRSS-2).

This is why Covid-19 appears to affect cells and other tissues that co-express ACE-2 and TMPRSS-2, including endothelial cells. Electron microscopy has in fact highlighted the presence of SARS-CoV-2 viral elements in the endothelial cells of affected organs such as the lungs, heart or kidneys.

We could then ask ourselves if the erectile tissue of the penis, which is also rich in endothelial blood vessels, could also be prone to endothelial dysfunction induced by the coronavirus. A small pilot study signed by researchers at the University of Miami suggests that this is indeed possible.

Outline of the study

As part of this work, penile tissue was collected from patients undergoing penile prosthesis surgery due to severe erectile dysfunction. The ages of the patients ranged from 65 to 71 years and all were of Hispanic origin. A sample was taken from two men with a history of Covid-19 infection six to eight months earlier, and two men without a history.

Transmission electron microscopy (TEM) analyzes then highlighted the presence of extracellular viral particles with peplomers (spikes) near the vascular endothelial cells of the penis of Covid + patients. Conversely, these viral particles were absent in controls.

The expression of eNOS (a marker of endothelial function) in the corpora cavernosa of men affected by Covid was also decreased compared to controls. Finally, the mean levels of endothelial progenitor cells of affected patients with the disease were significantly lower to those of men with erectile dysfunction without a history of Covid.

Note that for the first patient, other risk factors for erectile dysfunction such as hypertension, coronary heart disease and diabetes mellitus were not present. In contrast, the second sample recovered was from a patient with a significant medical history of coronary heart disease and hypertension with a relatively mild case of Covid-19 (low symptoms). Finally, these two men had “normal erectile function” before their infection.

Credit: lukasz_gl / pixabay

There is a possible link, but more work will be required

For the authors, this study is the first to demonstrate the presence of Covid in the penis long after the initial infection. “Our results also suggest that generalized endothelial cell dysfunction due to Covid-19 infection may contribute to erectile dysfunction“, Can we read in conclusion.

However, these remarks should be qualified. Recall that these two people were between the ages of 65 and 71, and that they were both of Hispanic origin. So, the sample does not in any way reflect the entire male population.

As Dr. Ash Tewari, president of urology at the Icahn School of Medicine at Mount Sinai Hospital in New York, points out: “one or two patients do not make a generality“. Too, “men shouldn’t panic until more research is done“.


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