"Mask up to keep it up": preliminary evidence of the association between erectile dysfunction and COVID-19.

Erectile dysfunction (ED), as the hallmark of endothelial dysfunction, could be a short- or long-term complication of COVID-19. Additionally, being ED a clinical marker and predictor of Non-communicable Chronic Diseases, particularly cardiovascular, subjects with ED could potentially have a higher risk of contracting COVID-19.

To investigate the prevalence of ED among subjects with a reported diagnosis of COVID-19 and to measure the association of COVID-19 and ED.

We reviewed data from the Sex@COVID online survey (performed between April 7th and May 4th , 2020 in Italy) to retrieve a sample of Italian male sexually active subjects with reported SARS-CoV-2 infection. A matching sample of COVID-19 negative male sexually active subjects was also retrieved using propensity score matching in a 3:1 ratio. The survey used different standardized psychometric tools to measure effects of lockdown and social distancing on the intrapsychic, relational, and sexual health of Italian subjects.

100 subjects were included in the analysis (25 COVID positive; 75 COVID negative). Prevalence of ED, measured with the Sexual Health Inventory for Men, was significantly higher in the COVID+ group (28% vs 9.33%; p = 0.027). Logistic regression models confirmed a significant effect of COVID-19 on the development of ED, independently of other variables affecting erectile function, such as psychological status, age and BMI [OR 5.66 ,95% CI: 1.50 - 24.01]. Likewise, subjects with ED were more likely to have COVID-19, once corrected for age and BMI [OR 5.27, 95% CI: 1.49 - 20.09].

On top of well-described pathophysiological mechanisms, there is preliminary evidence in a real-life population of ED as a risk factor of developing COVID-19 and possibly occurring as a consequence of COVID-19. Universal vaccination against the Covid-19 and the personal protective equipment could possibly have the added benefit of preventing sexual dysfunctions.

Andrology. 2021 Mar 20 [Epub ahead of print]

Andrea Sansone, Daniele Mollaioli, Giacomo Ciocca, Elena Colonnello, Erika Limoncin, Giancarlo Balercia, Emmanuele A Jannini

Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy., Department of Dynamic and Clinical Psychology, Health Studies "Sapienza" University of Rome, Rome, Italy., Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.