Erectile Dysfunction in Men Who Have Been Ill with COVID-19

##plugins.themes.bootstrap3.article.main##

Yevhen Luchytskiy
Vitaliy Luchytskiy
Halyna Zubkova
Viktoriya Rybal'chenko
Inna Skladanna

Abstract

The rapid spread of COVID-19 among the human population and the occurrence of complications of the disease, including sexual function, lead to the relevance of researches among the medical and scientific community.


The results of epidemiological studies indicate that COVID-19 more often affects men than women. Also, among the significant factors for the development of complications are the age and presence of comorbidities, among which diabetes, hypertension and obesity play an important role.


Erectile dysfunction (ED) in men today is considered as a marker of endothelial dysfunction and systemic inflammation caused by the background disease, and the presence of comorbidities.


Modern views on the pathogenesis of the development of ED in men who had COVID-19, and the features of development of sexual function in the presence of comorbidities are presented in the article.


According to modern positions, one of the main mechanisms of penetration of the SARS-CoV-2 virus is its interaction with angiotensin-converting enzyme 2 and transmembrane serine protease 2. Immunohistochemical studies have established a high expression of these enzymes in the endothelial cells of testicular tissue in men, which is currently considered by researchers as a direct damaging factor for the normal functioning of Leydig and Sertoli cells.


Subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics cause the potential development of ED. Also, in the pathogenesis of ED development in men who have been ill with COVID-19, important attention is paid to the role of systemic inflammation caused by the disbalance of proinflammatory and anti-inflammatory cytokines.


The relevant problem of today is the influence of coronavirus on the reproductive function of men. It is known that now male infertility has been diagnosed more often than before. In addition, there are enough reasonable factors to expect the effects of the negative effects of the COVID-19 not only on reproductive health but also on sexual and cardiovascular health of men, both in the short-term and in the long-term perspective.

##plugins.themes.bootstrap3.article.details##

How to Cite
Luchytskiy, Y., Luchytskiy, V., Zubkova, H., Rybal’chenko, V., & Skladanna, I. (2022). Erectile Dysfunction in Men Who Have Been Ill with COVID-19. Health of Man, (4), 47–53. https://doi.org/10.30841/2307-5090.4.2022.274443
Section
Sexology and andrology
Author Biographies

Yevhen Luchytskiy, State Institution «V. P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine»

Yevhen V. Luchytskiy,

MD, PhD, DSc, Professor, Head of the Department of Reproductive Endocrinology

Vitaliy Luchytskiy, State Institution «V. P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine»

Vitaliy Ye. Luchytskiy,

MD, PhD, DSc, Senior Researcher, Leading Researcher, Department of Reproductive Endocrinology

Halyna Zubkova, State Institution «V. P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine»

Halyna A. Zubkova,

PhD in Biology, Senior Researcher, Head Researcher, Department of Reproductive Endocrinology

Viktoriya Rybal'chenko, State Institution «V. P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine»

Viktoriya M. Rybal’chenko,

Senior Researcher, Department of Reproductive Endocrinology

Inna Skladanna, State Institution «V. P. Komisarenko Institute of Endocrinology and Metabolism of NAMS of Ukraine»

Inna I. Skladanna,

Junior Researcher, Department of Reproductive Endocrinology

References

Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809–15. doi: 10.1016/S0140-6736(20)30360-3.

Gallo MB, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: A literature review. Rev Med Virol. 2021;31(1):1–10. doi: 10.1002/rmv.2146.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5.

He Y, Wang J, Ren J, Zhao Y, Chen J, Chen X. Effect of COVID-19 on male reproductive system – a systematic review. Front Endocrinol (Lausanne). 2021;12:677701. doi: 10.3389/fendo.2021.677701.

Meng TT, Dong RJ, Li TG. Relationship between COVID-19 and the male reproductive system. Eur Rev Med Pharmacol Sci. 2021;25(2):1109–13. doi: 10.26355/eurrev_202101_24682

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–13. doi: 10.1016/S0140-6736(20)30211-7.

Fang D, Peng J, Liao S, Tang Y, Cui W, Yuan Y, et al. An online questionnaire survey on the sexual life and sexual function of Chinese adult men during the Coronavirus disease 2019 Epidemic. Sex Med. 2021;9(1):100293. doi: 10.1016/j.esxm.2020.100293.

Sansone A, Mollaioli D, Ciocca G, Colonnello E, Limoncin E, Balercia G, Jannini EA. “Mask up to keep it up”: Preliminary evidence of the association between erectile dysfunction and COVID-19. Androl. 2021;9(4):1053–9. doi: 10.1111/andr.13003.

Bakr AM, El-Sakka AI. Erectile dysfunction among patients and health care providers during COVID-19 pandemic: a systematic review. Int J Impotence Res. 2022;34(2):145–51. doi: 10.1038/s41443-021-00504-w.

Sansone A, Mollaioli D, Limoncin E, Ciocca G, Bắc NH, Cao TN, et al. The sexual long COVID (SLC): Erectile dysfunction as a biomarker of systemic complications for COVID-19 long haulers. Sex Med Rev. 2022;10(2):271–85. doi: 10.1016/j.sxmr.2021.11.001.

Hu B, Huang S, Yin L. The cytokine storm and COVID-19. J Med Virol. 2021;93(1):250–6. doi: 10.1002/jmv.26232.

Blick C, Ritchie RW, Sullivan ME. Is erectile dysfunction an example of abnormal endothelial function? Curr Vasc Pharmacol. 2016;14(2):163–7. doi: 10.2174/1570161114666151202205950.

Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2:16003. doi: 10.1038/nrdp.2016.3.

Imprialos KP, Stavropoulos K, Doumas M, Tziomalos K, Karagiannis A, Athyros VG. Sexual dysfunction, cardiovascular risk and effects of pharmacotherapy. Curr Vasc Pharmacol. 2018;16(2):130–42. doi: 10.2174/1570161115666170609101502.

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811–8. doi: 10.1001/jamacardio.2020.1017.

Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;20(6):363–74. doi: 10.1038/s41577-020-0311-8.

Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020;8(6):e46–7. doi: 10.1016/S2213-2600(20)30216-2.

Liu PP, Blet A, Smyth D, Li H. The Science Underlying COVID-19: Implications for the Cardiovascular System. Circulation. 2020;142(1):68–78. doi: 10.1161/CIRCULATIONAHA.120.047549.

Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathol. 2020;77(2):198–209. doi: 10.1111/his.14134.

Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417–8. doi: 10.1016/S0140-6736(20)30937-5.

Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9–14. doi: 10.1016/j.thromres.2020.04.024.

Sardu C, Gambardella J, Morelli MB, Wang X, Marfella R, Santulli G. Hypertension, thrombosis, kidney failure, and diabetes: Is COVID-19 an endothelial disease? A comprehensive evaluation of clinical and basic evidence. J Clin Med. 2020;9(5):1417. doi: 10.3390/jcm9051417.

Jung F, Krüger-Genge A, Franke RP, Hufert F, Küpper JH. COVID-19 and the endothelium. Clin Hemorheol Microcirc. 2020;75(1):7–11. doi: 10.3233/CH-209007.

Pons S, Fodil S, Azoulay E, Zafrani L. The vascular endothelium: the cornerstone of organ dysfunction in severe SARS-CoV-2 infection. Crit Care. 2020;24(1):353. doi: 10.1186/s13054-020-03062-7.

Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post-COVID-19 Symptom Burden: What is Long-COVID and How Should We Manage It? Lung. 2021;199(2):113–9. doi: 10.1007/s00408-021-00423-z.

Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS, et al. ‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalization for COVID-19. Thorax. 2021;76(4):396–8. doi: 10.1136/thoraxjnl-2020-215818.

Oran DP, Topol EJ. Prevalence of asymptomatic SARS-CoV-2 infection : A narrative review. Ann Intern Med. 2020;173(5):362–7. doi: 10.7326/M20-3012.

Long QX, Tang XJ, Shi QL, Li Q, Deng HJ, Yuan J, et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med. 2020;26(8):1200–4. doi: 10.1038/s41591-020-0965-6.

Suárez-Reyes A, Villegas-Valverde CA. Implications of low-grade inflammation in SARS-CoV-2 immunopathology. MEDICC Rev. 2021;23(2):42. doi: 10.37757/MR2021.V23.N2.4.

Kresch E, Achua J, Saltzman R, Khodamoradi K, Arora H, Ibrahim E, et al. COVID-19 endothelial dysfunction can cause erectile dysfunction: histopathological, immunohistochemical, and ultrastructural study of the human penis. World J Mens Health. 2021;39(3):466–9. doi: 10.5534/ wjmh.210055.

Gratzke C, Angulo J, Chitaley K, Dai YT, Kim NN, Paick JS, et al. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med. 2010;7(1 Pt 2):445–75. doi: 10.1111/j.1743-6109.2009.01624.x.

Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes. 2013;6(1):99–109. doi: 10.1161/CIRCOUTCOMES.112.966903.

Sansone A, Mollaioli D, Ciocca G, Limoncin E, Colonnello E, Vena W, Jannini EA. Addressing male sexual and reproductive health in the wake of COVID-19 outbreak. J Endocrinol Invest. 2021;44(2):223–31. doi: 10.1007/s40618-020-01350-1.

Abbas AM, Fathy SK, Khamees AA, Salem AS, Ahmed L. A focused review on the genital and sexual affection of COVID-19 patients. J Gynecol Obstet Hum Reprod. 2020;49(8):101848. doi: 10.1016/j.jogoh.2020.101848.

Haghpanah A, Masjedi F, Alborzi S, Hosseinpour A, Dehghani A, Malekmakan L, Roozbeh J. Potential mechanisms of SARS-CoV-2 action on male gonadal function and fertility: Current status and future prospects. Andrologia. 2021;53(1):e13883. doi: 10.1111/and.13883.

Schulster M, Bernie AM, Ramasamy R. The role of estradiol in male reproductive function. Asian J Androl. 2016;18(3):435–40. doi: 10.4103/1008-682X.173932.

Shen Q, Xiao X, Aierken A, Yue W, Wu X, Liao M, et al. The ACE2 expression in Sertoli cells and germ cells may cause male reproductive disorder after SARS-CoV-2 infection. J Cell Mol Med. 2020;24(16):9472–7. doi: 10.1111/jcmm.15541.

Nobre PJ. Psychological determinants of erectile dysfunction: testing a cognitive-emotional model. The Journal of Sexual Medicine. 2010;7(4 Pt1):1429–37. doi: 10.1111/j.1743-6109.2009.01656.x.

Katz J, Yue S, Xue W, Gao H. Increased odds ratio for erectile dysfunction in COVID-19 patients. J Endocrinol Invest. 2022;45(4):859–64. doi: 10.1007/s40618-021-01717-y.

Karagöz MA, Gül A, Borg C, Erihan İB, Uslu M, Ezer M, et al. Influence of COVID-19 pandemic on sexuality: a cross-sectional study among couples in Turkey. Int J Impot Res. 2020;33(8):815–23. doi: 10.1038/s41443-020-00378-4.

Harirugsakul K, Wainipitapong S, Phannajit J, Paitoonpong L, Tantiwongse K. Erectile dysfunction among Thai patients with COVID-19 infection. Transl Androl Urol. 2021;10(12):4376–83. doi: 10.21037/tau-21-807.

Chu KY, Nackeeran S, Horodyski L, Masterson TA, Ramasamy R. COVID-19 infection is associated with new onset erectile dysfunction: insights from a National registry. Sex Med. 2022;10(1):100478. doi: 10.1016/j.esxm.2021.100478.

Duran MB, Yildirim O, Kizilkan Y, Tosun C, Cirakoglu A, Gultekin MH, et al. Variations in the number of patients presenting with andrological problems during the coronavirus disease 2019 pandemic and the possible reasons for these variations: A multicenter study. Sex Med. 2021;9(1):100292. doi: 10.1016/j.esxm.2020.100292.

Hsieh TC, Edwards NC, Bhattacharyya SK, Nitschelm KD, Burnett AL. The epidemic of COVID-19-related erectile dysfunction: A scoping review and health care perspective. Sex Med Rev. 2022;10(2):286–310. doi: 10.1016/j.sxmr.2021.09.002.

Pennanen-Iire C, Prereira-Lourenço M, Padoa A, Ribeirinho A, Samico A, Gressler M, et al. Sexual health implications of COVID-19 pandemic. Sex Med Rev. 2021;9(1):3–14. doi: 10.1016/j.sxmr.2020.10.004.

Dunn KM, Croft PR, Hackett GI. Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey. J Epidemiol Community Health. 1999;53(3):144–8. doi: 10.1136/jech.53.3.144.

Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020;87:18–22. doi: 10.1016/j.bbi.2020.03.031.

Thomas C, Konstantinidis C. Neurogenic erectile dysfunction. Where do we stand? Medicines (Basel). 2021;8(1):3. doi: 10.3390/medicines8010003.

Fang D, Peng J, Liao S, Tang Y, Cui W, Yuan Y, et al. An online questionnaire survey on the sexual life and sexual function of Chinese adult men during the Coronavirus disease 2019 Epidemic. Sex Med. 2021;9(1):100293. doi: 10.1016/j.esxm.2020.100293.

Roychoudhury S, Das A, Jha NK, Kesari KK, Roychoudhury S, Jha SK, et al. Viral pathogenesis of SARS-CoV-2 infection and male reproductive health. Open Biol. 2021;11(1):200347. doi: 10.1098/rsob.200347.

Pedersen SF, Ho YC. SARSCoV-2: a storm is raging. J Clin Invest. 2020;130(5):2202–5. doi: 10.1172/JCI137647.

Rastrelli G, Di Stasi V, Inglese F, Beccaria M, Garuti M, Di Costanzo D, et al. Low testosterone levels predict clinical adverse outcomes in SARSCoV-2 pneumonia patients. Andrology. 2021;9(1):88–98. doi: 10.1111/andr.12821.

Dhindsa S, Zhang N, McPhaul MJ, Wu Z, Ghoshal AK, Erlich EC, et al. Association of circulating sex hormones with inflammation and disease severity in patients with COVID-19. JAMA Netw Open. 2021;4(5):e2111398. doi: 10.1001/jamanetworkopen.2021.11398.

Sathyanarayana Rao TS, Andrade C. Sexual behavior in the days of COVID-19. J Psychosex Health. 2020;2(2):111–2. doi: 10.1177/2631831820934987.

Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: A review. JAMA Cardiol. 2020;5(7):831–40. doi: 10.1001/jamacardio.2020.1286.

Moreno-Perez O, Merino E, Alfayate R, Torregrosa ME, Andres M, Leon-Ramirez JM, et al. COVID19-ALC Research group. Male pituitary-gonadal axis dysfunction in post-acute COVID-19 syndrome-prevalence and associated factors: A Mediterranean case series. Clin Endocrinol (Oxf). 2022;96(3):353–62. doi: 10.1111/cen.14537.

Corona G, Baldi E, Isidori AM, Paoli D, Pallotti F, De Santis L, et al. SARS-CoV-2 infection, male fertility and sperm cryopreservation: a position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) (Società Italiana di Andrologia e Medicina della Sessualità). J Endocrinol Invest. 2020;43(8):1153–7. doi: 10.1007/s40618-020-01290-w.

Peckham H, de Gruijter NM, Raine C, Radziszewska A, Ciurtin C, Wedderburn LR, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun. 2020;11(1):6317. doi: 10.1038/s41467-020-19741-6.

Wambier CG, Goren A, Vaño-Galván S, Ramos PM, Ossimetha A, Nau G, et al. Androgen sensitivity gateway to COVID-19 disease severity. Drug Dev Res. 2020;81(7):771–6. doi: 10.1002/ddr.21688.

Guay AT. ED2: erectile dysfunction = endothelial dysfunction. Endocrinol Metab Clin North Am. 2007;36(2):453–63. doi: 10.1016/j.ecl.2007.03.007.

Salonia A, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al. EAU Working Group on Male Sexual and Reproductive Health. European Association of Urology Guidelines on Sexual and Reproductive Health-2021 Update: Male Sexual Dysfunction. Eur Urol. 2021;80(3):333–57. doi: 10.1016/j.eururo.2021.06.007.

Kloner RA. Erectile dysfunction as a predictor of cardiovascular disease. Int J Impot Res. 2008;20(5):460–5. doi: 10.1038/ijir.2008.20.

Mazzotta F, Troccoli T. Acute acro-ischemia in the child at the time of COVID-19. Eur J Pediat Dermatol. 2020;30(2):71–4. doi: 10.26326/2281-9649.30.2.2102.