COVID-19-cause-erectile-dysfunction

Here we go again.

Last week, an episode of Slate’s How to do it podcast explored the issue of ‘COVID dick’ sparking widespread reports that the virus will make your penis shorter. You’d be forgiven for thinking there was a great penis shrinkage pandemic accompanying the rapid spread of Omicron (as if being 30% more likely to require hospitalisation and 89% more likely to die than females, despite vaccination[1], is not enough of a burden for men).

Read more: Optimism bias, vaccine hesitancy and the ‘underlying condition’ nobody is talking about

An anonymous letter from “a heterosexual man in [his] 30s” claimed that before having COVID-19 he was “above average” but after suffering erectile dysfunction because of the disease, he had “lost an inch and a half and become decidedly less than average”. Urologist Charles Welliver, director of Men’s Health at Albany Medical College, tries to “connect the dots” between COVID-19 and penis shrinkage but he comes up… well… a bit short.

It makes sense that COVID-19 could cause erectile dysfunction. Blood vessel function is critical for erectile function, and it is impaired by COVID-19. That’s why the same drugs that are used to treat erectile dysfunction may be useful for treating COVID-19[2], because of their actions in blood vessels.

Despite the headlines you might have seen, there’s not overwhelming evidence to support the idea that COVID-19 causes erectile dysfunction. Most of the scientific literature on the topic is opinion, not fact[3]. The few studies that have assessed sexual function in men after COVID-19 suggest erectile dysfunction is more common than normal, but we need better quality evidence to be sure. It’s probably too early to call it an “epidemic of COVID-19-related erectile dysfunction”3.

Dr Welliver also mentions priapism (a prolonged erection) as a potential consequence of blood clotting disorders that accompany COVID-19. There are six case reports about priapism in COVID-19 patients[4], so it happens but we don’t know how common it is.

Dr Welliver and urologist Ashley Winter provide the same simplistic explanation for “COVID dick”. They suggest that a lack of stretching of the penis because of erectile dysfunction is probably responsible for it becoming shorter. They liken the situation to shortening of the penis that occurs after men have their prostate glands removed, and both suggest that a particular device for stretching the penis might provide some recovery of length. This device, though, has been proven effective only in men aged in their late 50s who have had their prostates removed, or in men with Peyronie’s disease[5].These are very different groups to a man in his 30s who has had COVID-19.

Read moreDoes COVID-19 affect male fertility?

It’s a bit like suggesting that “face masks can make you more attractive”[6], based on the subjective assessments of 41 female undergraduate psychology students (all but one aged 18-24) from Cardiff University, looking at digitally altered images of 40 men’s faces[7].

Simple explanations are attractive but they’re not always correct. The danger is that simplistic interpretations become dogma and discourage further enquiry. For example, the “artery size hypothesis” is used to explain the association between erectile dysfunction and subsequent cardiovascular events, based simply on the idea that the penile arteries are narrower than the coronaries and are therefore affected earlier in the course of atherosclerosis development[8]. There is no empirical evidence to support this hypothesis – just the opposite[9] – but the erroneous explanation persists in the literature[10].

If “COVID dick” is real, and it really does become an “epidemic”, we will need to understand its pathogenesis to provide optimal treatment. Simplistic explanations and unsupported hypotheses* are unlikely to be enough.

* My own goes like this: COVID-19 increases sympathetic activity[11]. The penis is maintained in a flaccid state by adrenergic activity of the sympathetic nervous system, acting to maintain tone of the arterial smooth muscle, thereby restricting blood flow in the corpus cavernosum[12]. I hypothesise that increased sympathetic activity due to COVID-19 increases adrenergic signaling to the arteries supplying the corpus cavernosum, further decreasing blood flow and shortening the penis. A similar cause of penile shortening after prostatectomy has been proposed[13].

A/Prof Tim Moss
A/Prof Tim Moss

Associate Professor Tim Moss has PhD in physiology and more than 20-years’ experience as a biomedical research scientist. Tim stepped away from his successful academic career at the end of 2019, to apply his skills in turning complicated scientific and medical knowledge into information that all people can use to improve their health and well being.

Tim has written for crikey.com and Scientific American’s Observations blog, which is far more interesting than his authorship of over 150 academic publications. He has studied science communication at the Alan Alda Centre for Communicating Science in New York, and at the Department of Biological Engineering Communication Lab at MIT in Boston.

References

[1] Hippisley-Cox et al., 2021. Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study. BMJ

[2] Isidori et al., 2021. Targeting the NO‐cGMP‐PDE5 pathway in COVID‐19 infection. The DEDALO project. Andrology

[3] Hsieh., 2021. The Epidemic of COVID-19-Related Erectile Dysfunction: A Scoping Review and Health Care Perspective. Sexual Medicine Reviews

[4] Silverman et al., 2021 Am J Emerg Med: Lamamri et al., 2021 Am J Emerg Med: Lam et al., 2020 Eur J Case Rep Intern Med: Giuliano et al., 2021 Case Rep Urol: Carreño et al., 2021 Urol Int: Addar et al.. 2021 J Surg Case Rep

[5] Toussi et al., 2021. Efficacy of a Novel Penile Traction Device in Improving Penile Length and Erectile Function Post Prostatectomy: Results from a Single-Center Randomized, Controlled Trial. J Urol

[7] Hies & Lewis, 2022. Beyond the beauty of occlusion: medical masks increase facial attractiveness more than other face coverings. Cognitive Research: Principles and Implications

[8] Montorsi et al, 2005. The Artery Size Hypothesis: A Macrovascular Link Between Erectile Dysfunction and Coronary Artery Disease. The American Journal of Cardiology

[9] Ponholzer., 2012. Is penile atherosclerosis the link between erectile dysfunction and cardiovascular risk? An autopsy study. International Journal of Impotence Research

[10] Yannas et al., 2021. Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men’s Health? Journal of Clinical Medicine

[11] Stute et al., 2021. COVID‐19 is getting on our nerves: sympathetic neural activity and haemodynamics in young adults recovering from SARS‐CoV‐2. The Journal of Physiology

[12] Traish et al., 2000. Role of alpha adrenergic receptors in erectile function. International Journal of Impotence Research

[13] Mulhall, 2005. Penile length changes after radical prostatectomy. BJU International

Subscribe to the monthly newsletter

Each month we release two email newsletters – one written for men, family and friends, and another for health professionals.

Gender
Which newsletter/s would you like to subscribe to?