Long Covid Short

Long Covid

“Long Covid” refers to ongoing health consequences of a coronavirus infection that can last for weeks, months, or even years. Long Covid occurs more commonly in those who have had severe COVID-19 infections but can occur even in those with mild or asymptomatic cases. A C.D.C. study has suggested that more than 1 in 5 adult Covid survivors in the U.S. may develop long Covid. Its prevalence is highest in those who have been hospitalized for severe Covid infections.

Although it is not clear what causes the long-term consequences of Covid, it is theorized that an over-reactive immune response to the virus may lead to inflammation and damage throughout the body, resulting in long-term symptoms. Four factors seem to correlate with an increased risk of experiencing long Covid: the extent of the viral load; the presence of auto-antibodies that attack bodily tissues and cause an autoimmune response; reactivation of the Ebstein-Barr virus; and the underlying condition of diabetes. Studies suggest that the risk of developing long Covid peaks in middle age and women seem to be affected more than men.

Long Covid symptoms are highly variable, but often include ongoing fatigue, malaise — particularly experienced after exertion — and fever. Cardio-respiratory symptoms are prominent, including shortness of breath, cough, chest pain, and palpitations. Neurological symptoms may include brain fog, headache, insomnia, lightheadedness, pins-and-needles sensations, altered smell and taste, and anxiety or depression. Gastrointestinal symptoms may include diarrhea and stomach pain. Other symptoms include joint and/or muscle pain, rash, and menstrual cycle changes. The kidneys and endocrine systems may be adversely affected as well.

Long Covid Short

There have been many reports (both domestically and internationally) of men with prior Covid infections developing difficulty obtaining and maintaining a rigid erection. Anecdotally, I have seen numerous patients in our urology office complaining of post-Covid erectile dysfunction. A recent scientific paper from Italy reported a six-fold increase in the incidence of erectile dysfunction in those infected as opposed to those spared. Imaging and biopsies have demonstrated that the coronavirus can infect male genital tissue, where it may reside for prolonged periods of time after the initial infection. Some refer to post-Covid erectile dysfunction with the term “Covid dick.”

I refer to Covid-induced ED as “Long Covid short,” not having to do with penile dimensions (although they may be adversely affected), but in reference to erectile function potentially being “shortchanged” as an unexpected long-term consequence of Covid infection. Interestingly, erectile dysfunction is often linked to conditions — such as high blood pressure, smoking, diabetes, and obesity — that put men at increased risk for COVID-19 and its complications in the first place.

Is the erectile dysfunction a direct consequence of the viral infection or are other factors are at play? Just because an event follows another temporally does not prove that the first event caused the second event, the fallacy of “post hoc ergo proctor hoc,” one of the favorite catch phrases of one of my urology professors at Children’s Hospital of Philadelphia.

Certainly the fatigue and malaise that are characteristic of long Covid can play a role in impairing erections. Furthermore, high stress and anxiety levels — associated with the pandemic, other long Covid symptoms, and our fraught times — are independent risk factors for erectile dysfunction. The main stress hormone (adrenaline) that is produced in the adrenals and circulates in high levels in the blood under the circumstance of stress, hinders erections and, in fact, medications with an adrenaline-like mechanism are often used in the setting of prolonged erections (priapism) to induce penile flaccidity. Moreover, there is some suggestion that Covid-induced erectile dysfunction may be linked to the loss of the taste and smell faculties experienced by Covid patients, since these senses play an essential role in sexual arousal.

Penile rigidity occurs with blood used as a hydraulic medium, so erections are dependent upon properly functioning blood vessels. With stimulation, the penis is uniquely capable of increasing its blood flow by a factor of 40-50 times over baseline, this surge of blood flow happening within seconds and accomplished by relaxation of the smooth muscle within the penile arteries and erectile tissues. This results in erectile chamber tumescence (fullness) and ultimately rigidity as the pelvic floor muscles engage. Covid is notorious for damaging blood vessels and may result in abnormal clotting, pulmonary emboli, heart attacks, and strokes. It is postulated that the coronavirus may damage the inner (endothelial) lining of blood vessels. When this occurs in the penile arteries it can result in erections being compromised on a vascular basis.

One of the consequences of acute Covid-induced erectile dysfunction is the potential for chronic erectile dysfunction. When blood flow to the penis is compromised by constant flaccidity, poor oxygenation within the erectile tissues can cause erectile smooth muscle scarring, penile shortening, and further impairment of function with compromise of the mechanism that ensures blood trapping in the erectile chambers. This situation is referred to as disuse atrophy. The long and short of it is that future erections demand current erections, since the surge of blood flow associated with obtaining and maintaining an erection also serves to keep the penile smooth muscles and tissues richly oxygenated, elastic, and functioning well.

In conclusion, the jury is still out on whether Covid is the actual cause of erectile dysfunction, but it is clear that a distinct correlation does exist.

Bottom Line: Minimize your risk for being too soft in the bedroom by getting vaccinated and boosted and mask up to help keep it up! If you have developed erectile dysfunction as a possible long-term consequence of COVID-19 (or for other reasons), effective treatments are available. Consult your urologist for solutions.