When Steven Bell caught Covid-19 this spring, he was surprised that he didn’t have a fever. Rather, it felt like a bad sinus infection. Soon, he lost his sense of smell, and went on to develop insomnia. He felt like the virus was also affecting his circulation, and would swing his arms in circles to keep the blood flowing. Then, more bafflingly, when he and his wife were intimate, he couldn’t get an erection. “It was frustrating and infuriating for me, because I knew it wasn’t working the way it should,” said Bell, a 49-year-old from Phoenix, AZ. “My ego wouldn’t accept that I was performing like an 80-year-old in the bedroom.”
Some men who have survived Covid-19 say that the virus may have impacted their ability to get or maintain an erection. That tracks with the idea that Covid-19 is a vascular disease, which Elemental senior writer Dana Smith explained at length in May, as blood flow is important for getting or maintaining an erection. Erectile dysfunction can occur at any age — and becomes more common as men get older — and may affect up to a third of all men. In the context of Covid-19, men as young as 39 have been documented to experience erectile dysfunction as they recovered from the virus.
“In order to have really great sex, you have to be able to relax. The pandemic just makes that exceedingly difficult for many people.”
Currently, there are a handful of anecdotal reports, but no hard data nor large-scale study that documents the link, if any, between Covid-19 and erectile dysfunction. But for the men experiencing such issues, they’re convinced that the erectile dysfunction was caused by the novel coronavirus, because they never had issues with arousal or performance during sex prior to contracting the virus. Hunter Wessells, MD, a urologist at the University of Washington School of Medicine, urges other practitioners to collect this data on their patients. “It’s important to study it, because the total number of people involved may be in the millions and across all age ranges,” he says.
What’s actually causing the ED?
Figuring out the cause of erectile dysfunction would be challenging as there are so many potential causes.
No matter the cause, “[erectile dysfunction is] the final common pathway that no man wants to go to,” says William W. Li, MD, president and medical director of the Angiogenesis Foundation, a nonprofit that studies the health and disease of blood vessels.
For starters, the pandemic has introduced an immense amount of stress, says Alexandra Stockwell, a relationship and intimacy expert. “The desire for sex and intimacy is lower,” Stockwell says. “In order to have really great sex, you have to be able to relax. The pandemic just makes that exceedingly difficult for many people.”
That seemed true for Bruce (whose name has been changed to protect his privacy), a 66-year-old from Long Island, NY, who experienced erectile dysfunction after getting Covid-19 in late March. For him, the ED, which persisted for four to five weeks, was just the tip of his issues. “I just wanted to be alive,” he said. “The ED was no big deal.”
Based on what scientists know about SARS-CoV-2, the virus that causes Covid-19, it’s possible that the virus could have direct effects on erectile dysfunction. Successfully getting and maintaining an erection not only depends on mood, but also testosterone, blood flow, and nerves. In the penis, nerves are critically dependent on a fishnet of blood vessels to get an erection. SARS-CoV-2 exploits the ACE2 receptor, which is found in both nerve cells and endothelial cells lining blood vessels. ACE2 is also found in the cells of the testicles, the organ in men that makes testosterone, a hormone that fuels a man’s sex drive. Li and his colleagues have found that the virus infects testicular cells during the acute phase of Covid-19, which means the virus may be impacting testosterone production.
On top of the effects in the penis, Covid-19 affects the cardiovascular and pulmonary systems, which, in turn, are critical for sexual function, says Li.
Wessells notes that underlying health conditions, such as diabetes, obesity, hypertension, inactivity, and smoking, may predispose men to developing ED, and that at least a few of those are associated with a higher risk of contracting Covid-19 as well. Once someone contracts Covid-19, that may be the “straw that broke the camel’s back for the ED,” Wessells says.
Fortunately, for men who suffer from erectile dysfunction, many treatments, such as Viagra, should help even if Covid-19 has damaged the vasculature, says Wessells.
Some men who say Covid-19 caused their erectile dysfunction have found some reprieve.
Art (whose name has also been changed to protect his privacy), a 53-year-old from Elmira, New York, waited until marriage to have sex with his wife. Both of them got Covid-19 in the spring. During their honeymoon this summer, the sex just… didn’t happen, because he couldn’t get an erection. “We knew we wanted children, but I’m having all sorts of issues,” he said. “There’s definitely a degree of guilt. I’m convinced I’m the problem.” Doctors dismissed his concerns that the erectile dysfunction may have been caused by Covid-19. He eventually got over the stigma of talking about his sexual health and opened up to his parents, who suggested he start taking Geritol, vitamins that help with sexual dysfunction. So far, Art says, they’ve helped. “I need to make the best of it when I have it.”
Even so, the emotional toll for some men persists.
“When I’m in the mood and physically reporting for duty, my anxiety has increased,” says Bell. And he’s still sometimes frustrated about the impact that Covid-19 has had on his sex life: the erectile dysfunction “crushed” his confidence during sex.
For now, he hopes that his story offers a cautionary tale. “Stay away from Covid to keep that willy up.”