Erectile dysfunction, a topic that touches -and worries- many men around the world. Beyond what it can represent for self-esteem, for several years it has been studied from another side, focusing on those pathologies that can generate this problem in men.
A study published in Nature indicates that erectile dysfunction could be just the tip of the iceberg of many conditions after having suffered from a severe form of COVID-19. Men were more affected than women, with a higher average mortality and stronger affectations, according to the study abstract.
“Erectile dysfunction is defined as the inability to achieve or maintain an erection rigid enough to allow a satisfactory sexual encounter. It should not be considered just a symptom, but part of a systemic disease that can affect one in two men between the ages of 50 and 70, “explains to Infobae, Walter De Bonis, in charge of the Sexual Dysfunctions section of the Durand Hospital, urologist and consultant to the Argentine Society of Urology.
To understand the mechanisms involved in the genesis of erectile dysfunction, it is necessary to understand that erection is a complex myovascular neuroendocrine phenomenon. “For it to take place, it depends on the integration and synchronization of the functions of different systems and organs of the human body, ranging from the endocrine system to the neurological system, fundamentally passing through the cardiovascular system,” adds De Bonis.
Alejandro Sánchez Flores, from the Institute of Biotechnology, says that this dysfunction has not been seen to be presenting more in men 50 years of age and older who suffered from COVID-19, compared to those who have not suffered illnesses.
“What they do see is that it may be the tip of the iceberg, because it is known that the virus, being a pathogen that unbalances the regulation of renin-angiotensin, which has to do with blood pressure, damages, for example, tissues related to the epithelia, which are linked to the endothelium, tissues that are in the blood vessels, and in the end everything is part of the circulatory system, on which an erection depends”.
Within the effects that may occur after suffering from COVID, it is also possible to have psychological damage.
“It seems that there are some elements that can be related. We cannot specifically blame the virus, but there are two components: the psychological one that affects our behavior around sexual activities; the other is about the functioning of more specific things like nitric oxide synthase, a regulator that is basically necessary in an erection, since it is essential that the venous blood, the blood that does not have oxygen, remains trapped in the penis and does not circulate arterial blood” said Sánchez Flores.
There may also be infertility problems due to damage to the testicles, which is added to erectile dysfunction, although the frequency of cases has not been high. It is important to know that the dysfunction “can be an indicator of more severe damage to the heart or other organs -Sánchez Flores- many of the cases of cerebral infarcts originate from the rupture of blood vessels in the brain”.
De Bonis continues along the same lines: “There are some controversies regarding the effects of SARS-CoV-2 viruses on reproductive health and male genitalia and consequently there is concern about the potential effect on fertility as a sequel to infection. by COVID-19. The presence of virus fragments was observed in semen and in the seminiferous epithelium, which is the area where sperm are produced.
Which at least requires fertility control in those individuals who have suffered from coronavirus infection. On the other hand, it is known that the coronavirus family is capable of generating orchitis and orchitis are obviously risk factors linked to infertility. Alterations in testosterone levels were also observed. It is an androgenic hormone fundamentally involved in sperm production and is also involved in sexual response. Hence, what is another element to consider in the association effects on the genital and sexual apparatus of COVID-19 infections, “says De Bonis.
But what exactly is it that makes the erection not happen? You have to know that an adequate erection depends on “the blood vessels of the penis being intact, fundamentally the endothelium, which is the inner covering of the blood vessels of the body,” says De Bonis.
And he continues: “The endothelium fulfills very important functions, including the production of nitric oxide. Nitric oxide, which is a free oxygen radical involved in vasodilation phenomena. Its role is so important that the erection depends on the existence of an adequate production of nitric oxide, which is precisely diminished in all these comorbidities associated with erectile dysfunction, such as cardiovascular conditions, diabetes, hypertension, dyslipidemia, among others ” .
We must be attentive to symptoms that have been studied, such as excessive fatigue, which has been seen in young people who suffered from COVID and despite the fact that they do not have a disease as such, specifically, it has been discovered that they have microthrombi, very small and their platelet aggregation is greater than normal or is higher than normal. “Erectile dysfunction tells us that there is damage to the endothelium, because although the SARS-CoV-2 virus is no longer present, it leaves many things unregulated,” said Sánchez Flores.
According to another study, patients with COVID-19 have a six-fold increased risk of developing erectile dysfunction. Also, conversely, people who already have that sexual disorder are five times more likely to have the coronavirus infection. These data that serve as a warning about the risks of the coronavirus associated with erectile dysfunction were revealed by an Italian study published in the journal Andrology. It is one of the hundreds of works that have contributed to unraveling what happens when the coronavirus infection advances in the body and affects it to the point of producing erectile dysfunction.
For Dr. Emmanuele Jannini, professor of endocrinology and medical sexology at the Università degli Studi di Roma Tor Vergata, in Rome, Italy, the results of the study “are consistent with the pathophysiological mechanisms that relate erectile dysfunction, endothelial dysfunction and COVID-19 . Basically, endothelial dysfunction is common in both conditions (COVID-19 and erectile dysfunction).” If the risk to sexual health is considered, among the other impacts of the virus, people should adhere more to preventive care, such as the proper use of the mask, distancing, ventilation and vaccination.
“There are several at least preliminary studies that seem to show a strong association between erectile dysfunction and COVID-19. On the one hand, according to some authors, SARS-CoV-2 infections could increase the possibility of developing erectile dysfunction and, in turn, erectile dysfunction would be a marker of greater susceptibility to infection. In reality, this could be explained by certain pathological conditions that are common. in erectile dysfunction and which in turn are considered risk factors for more serious diseases resulting from SARS-CoV-2 infections. And the common factor in all these entities is precisely blood vessel disorders. These comorbidities also constitute elements of poor prognosis in patients infected with COVID-19, in fact the severity and prevalence of COVI-19 are greater among men who suffer from hypertension, obesity, and some cardiovascular disease, among others”, says De Bonis.
And he adds: “Although it seems hasty to consider that SARS-CoV-2 infections increase the incidence of erectile function, what is clear is that the same risk factors and comorbidities that give rise to more serious infections by COVID-19 , are also comorbidities and risk factors associated with sexual dysfunctions. In addition, changes in sexual behavior have been observed during the pandemic, which is reflected by several studies, some of which we have carried out at the Durand Hospital, in which we observed changes in terms of sexual frequency, type of interactions, self-stimulation practices and even greater consumption of pornography.”
Erectile dysfunction could well be the first sign of major complications in men’s health. Arie Parnham, a doctor at the Christie NHS Foundation Trust in Manchester, United States, revealed in a recent study on male aging that half of men between their fourth and seventh decade have multiple comorbidities, and the most frequent of them is the disease of the coronary artery.
His presentation took place at the Congress of the European Association of Urology 2020. The link between erectile dysfunction and coronary artery disease was made by Italian researchers in a study conducted on 300 men with acute chest pain and angiographically documented coronary artery disease. The prevalence of erectile dysfunction in the study cohort was 49%, and in 70% of these men, onset occurred within 40 months of their coronary heart disease diagnosis.
Then, a 44% increased risk of cardiovascular events, a 62% increased risk of myocardial infarction, and a 25% increased risk of all-cause mortality were observed in a 2013 systemic review of 14 studies: a group of 92,757 men with erectile dysfunction, with a mean follow-up of 6.1 years. “Younger people were at higher risk,” the systemic review showed, Parnham said, which “highlights the importance of screening in this group.”
