By Bill Levesque

If the threat of death or severe disability isn’t enough to convince someone to get a COVID-19 vaccination, men can add this possible consequence of coronavirus infection — erectile dysfunction.

A new University of Florida Health study found that men with COVID-19 are more than three times more likely to be diagnosed with erectile dysfunction, or ED, than those who are not sickened by the coronavirus. The paper adds to emerging evidence that COVID-19 might impact sexual function, researchers said.

The study, published online Nov. 30 in the Journal of Endocrinological Investigation, is led by Joseph Katz, D.M.D., a professor in the UF College of Dentistry’s department of oral and maxillofacial diagnostic sciences. Katz has long investigated the systemic impact of poor oral health on the body and how it can influence cardiovascular disease, stroke, diabetes and other conditions.

One topic that has interested him is the known association between periodontal disease and erectile dysfunction, which Katz said led him to begin looking at a similar connection between ED and COVID-19 once the pandemic hit.

In combing through data from UF Health patients, the study found 146 patients who were diagnosed with ED after a bout of COVID-19, or 4.7% of all the men who were diagnosed with COVID-19.

The association remains high when adjusted for a number of other factors. For example, the association with ED was 1.6 times higher for men with respiratory disease, 1.8 times higher for those with obesity, 1.9 times higher in those with circulatory or cardiovascular disease, 2.3 times higher in those with diabetes and 3.5 times higher among smokers.

“The receptor that the coronavirus binds to is abundant on the penis and testes,” Katz said. “The virus can bind to those areas. And research has shown that COVID can reduce the amount of testosterone produced. The loss of testosterone has been shown to put someone at risk of having a more severe outcome from COVID-19.”

And that loss of testosterone increases the chance of ED, he said. Other mechanisms also might be at play.

Researchers at the University of Miami earlier this year said they discovered parts of the coronavirus in the penis of several people who had recovered from COVID-19 and then become impotent. Scientists said COVID-19 is known to damage blood vessels, and the virus appeared to have damaged the vessels in the penises of these patients and impeded blood flow there, impacting sexual function.

Katz’s study comes with some important caveats. While researchers were able to sort through a database of UF Health patients whose identities are not revealed to investigators, codes identified diagnoses and not complete medical histories. Among the limitations this leads to is the inability to assess the severity of each patient’s COVID-19 and potentially other factors that might have led to ED.

Additionally, researchers could only adjust for one condition at a time. So while, for example, they could adjust for diabetes, they could not do so for diabetes and obesity.

Researchers agree more research is needed. Scientists, however, are increasingly viewing the possibility that ED is another in a slew of long COVID symptoms.

In fact, a review published in Sexual Medicine Reviews in September looked at the available evidence of an association between sexual dysfunction and COVID-19.

“The evidence that COVID-19 infection causes or impacts ED is compelling,” according to a paper whose co-authors included researchers at Johns Hopkins University and the University of California, San Diego.

Kevin J. Campbell, M.D., an assistant professor in the UF College of Medicine’s department of urology specializing in men’s health, including ED, said an association between ED and COVID-19 would not be surprising and he thinks the study raises important questions.

Campbell, who did not participate in the study and is not a co-author, noted that viral illnesses, such as influenza, have been linked to reduced testosterone production and sexual dysfunction.

“You’ve got chronic inflammation throughout the body going on during viral infection, and getting back to your homeostasis and your normal body rhythms can take time,” he said.

Katz said he believes the possible association between ED and COVID-19 might even be stronger than the numbers in his study suggest because the stigma of ED makes men less apt to report it to physicians.

Katz said a COVID-19 vaccination is something everyone should get. He believes his study offers one more reason.

“Sex is such an important part of life, that will hopefully make them think, “OK, maybe I should be vaccinated,’” he said.

The study was completed with the assistance of researchers in the UF College of Public Health and Health Professions’ department of biostatistics.