COVID-19 is known for causing respiratory issues, fatigue, headaches, loss of taste or smell, and even speech difficulties in some patients. A recent small-scale study suggests it may also lead to erectile dysfunction through vascular damage—but these findings come with important caveats.
Prior research shows SARS-CoV-2, the virus behind COVID-19, enters cells via angiotensin-converting enzyme 2 (ACE-2) receptors. Before binding, its spike proteins are activated by transmembrane protease serine 2 (TMPRSS-2). This duo—ACE-2 and TMPRSS-2—is co-expressed in various tissues, including endothelial cells. Electron microscopy has confirmed viral presence in endothelial cells of organs like the lungs, heart, and kidneys.
Given the penis's erectile tissue is rich in endothelial-lined blood vessels, researchers wondered if it too could suffer endothelial dysfunction from COVID-19. A pilot study from the University of Miami provides preliminary evidence suggesting yes.
Penile tissue samples were collected from four patients undergoing surgery for penile prosthesis implantation due to severe erectile dysfunction. Participants were aged 65 to 71 and all Hispanic. Two had COVID-19 infections 6 to 8 months prior; two did not.
Transmission electron microscopy (TEM) revealed extracellular viral particles with spike proteins near vascular endothelial cells in the COVID-positive samples. No such particles appeared in controls.
eNOS expression—a key marker of endothelial function—in the corpus cavernosum was lower in COVID-affected men compared to controls. Endothelial progenitor cell levels were also significantly lower in those with prior infection.
One patient had no other erectile dysfunction risk factors like hypertension, coronary disease, or diabetes. The other had coronary heart disease and hypertension but experienced only mild COVID-19 symptoms. Importantly, both reported normal erectile function before infection.
The authors report this as the first evidence of SARS-CoV-2 persistence in penile tissue months post-infection. They conclude: "Our results suggest widespread endothelial dysfunction from COVID-19 may contribute to erectile dysfunction."
However, limitations abound: the sample involved just two older Hispanic men, not representative of all males. As Dr. Ash Tewari, Chair of Urology at Mount Sinai's Icahn School of Medicine, notes: "One or two patients don't make a generality." He advises, "Men shouldn't panic until more research is done."
