Erectile Dysfunction Can Affect Many Post COVID Males

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A study team from Faculty of Medicine, Chulalongkorn University -Thailand, King Chulalongkorn Memorial Hospital – Thailand and the Thai Red Cross Society – Thailand decided to investigate the erectile function at three months after COVID-19 recovery along with its predicting factors.
 
The study team enrolled all COVID-19 male patients, who were hospitalized from May to July 2021, and declared to be sexually active within the previous two weeks. Demographic data, mental health status, and erectile function were collected at baseline and prospectively recollected three months after hospital discharge.

To determine changes between baseline and the follow-up, a generalized linear mixed effect model (GLMM) was used. Also, logistic regression analysis was used to identify the associating factors of erectile dysfunction (ED) at three months.

The study findings showed that a high ED prevalence during the third month of recovery from COVID-19.

The predicting factors of persistent ED were age over 40 years and diagnosis of major depression during acute infection.
 
The study findings were published in the peer reviewed journal: PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0276429

A past study showed that ED remained prevalent six to nine months after COVID-19 recovery.
https://www.jsm.jsexmed.org/article/S1743-6095(21)00656-1/fulltext 

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As COVID-19 continues to spread globally, it is predicted that it will infect more than half of the world population [17]. Clinicians should prepare to overcome complications after COVID-19 infection or long COVID, which is considered common (37.7–54.0%) in recovered patients [20, 21].

Despite several etiologies or pathogenesis of long COVID, multiple studies hypothesized that long COVID might be due to several factors. The factors include incomplete viral eradication, prolonged inflammatory response resulting from poor immune system and residual viral remnant, or direct viral infiltration into organ system and cytokine network dysregulation [29–31]

Additionally, ED, as a consequence of long COVID, is also complicated by both aforementioned biological and notorious psychological factors including socioeconomic problems, social isolation, or traumatic events.

Notably, impaired erectile function was reported to be a part of sexual long COVID (SLC) [5]. We found that the prevalence of ED at the third month compared with during COVID-19 infection, was significantly lower (50.3% vs. 64.7%, P = 0.002), which implied the erectile function improvement.

However, the number was still higher than ED in the general Thai population (37.5–42.2%) [32, 33]. Association between lower prevalence and a longer period after recovery was also reported in one study from China with ED prevalence of 44.8% and 30%, at six and nine months after recovery of COVID-19, respectively [23].

We speculate that improvement of ED could be explained by gradual recuperation of physical competency. Apart from ED, other symptoms during COVID-19 infection, including mental health, anosmia and ageusia, were also significantly improved after three months of infection [34–36].

Moreover, mentality during infection might be accountable for the higher prevalence of ED. Physical stress that became intact after recovery and psychosocial difficulties that tended to be relieved at three months also led to better mental status and resulted in better erectile function.

Bidirectionally, improvement in sexual function could enrich sexual health and, consequently, promote psychological well-being [9]. This confirms the complexity between ED and mental health which requires further bio-psycho-social investigations. In addition, studies on SLC are still limited and its risk factors are questionable. Thus, future SLC research would be immensely beneficial [37].

Adjusted for BMI, medical comorbidities, anxiety severity, and normal morning erection, multivariable logistic regression identified age over 40 years old (adjusted OR 2.65, 95% CI 1.17–6.01, P = 0.02) and having major depression during infection (adjusted OR 8.93, 95% CI 2.28–34.9, P = 0.002) as predicting factors of ED at three months. Both older age and depression are established risk factors for ED [38, 39] and our result emphasized the role of a bio-psychological issue in the pathogenesis of ED.

Interestingly, only mental conditions without aging were found to be associated with ED during infection [40], but patients over 40 years of age were also at risk for ED at three months. Elderly COVID-19 patients should be screened for SLC, and long-term follow-up is still necessary.

ED course found in our participants was both persistent and self-remitted. This was similar to the prognosis of other long COVID complications, which were wax and wane or uncertain [41]. Improvement of COVID-19 symptoms, especially anosmia and ageusia, which contributed to ED etiologies could explain a recovery in patients whose ED was transitory [42].

To our knowledge, our study was the first ED cohort study on COVID-19 patients for three months after recovery. Our sample size was considerable, and all participants were confirmed COVID-19 diagnosis by a gold standard method. Both biological and psychosocial aspects were measured, and our dropout rate was low.

However, this study is not without limitations. Firstly, because of a lack of comparison group and pre-existed erectile function status, the assumption of whether COVID-19 was the cause of ED could not be concluded and the confounding bias from social situations such as health policy during pandemic and change in sexual habit might affect the erectile function.

Nevertheless, the improvement of ED three months after COVID-19 recovery could be assumed from our study except in older and major depression patients who needed further monitoring. Secondly, limited generalizability should be declared, considering all participants were hospitalized and those with severe symptoms were excluded.

The questionnaire used in our study was self-rated and affected by a recall bias. Treatment of persistent ED should be further studied to help clinicians and patients globally, as the number of COVID-19 patients, both recovered and infected, is still increasing.

Conclusion

Although long COVID has been widely studied, only a few studies have focused on erectile function as its complication. Our study showed that, even though the erectile function was significantly improved after three months of COVID-19 infection, the prevalence of ED was still high.

In addition, male patients older than 40 years or having major depression during COVID-19 were at risk to be screened positive for ED at three months. Future studies focusing on ED treatment, especially in persistent ED, would be helpful for both clinicians and patients in the time after pandemic cessation.

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