COVID-19 and Erectile Dysfunction

Early research after the pandemic began reported higher rates of erectile dysfunction (ED) among men who had COVID-19 than among men who had not. In an Italian survey, 7 of 25 men with COVID-19 had ED, compared with 7 of 75 matched men without it (Sansone et al., Andrology, 2021). The association is still being studied; mechanisms below are proposed rather than settled.

Proposed mechanisms

Several pathways have been suggested for ED after COVID-19:

• Psychological — stress and depression related to illness can impair erectile function.
• Hormonal — low testosterone has been reported in men hospitalized with COVID-19 pneumonia (Rastrelli et al., Andrology, 2021).
• Neurologic — SARS-CoV-2 can affect neural tissue; nerve injury is a hypothesized contributor.
• Endothelial — damage to vascular endothelium, which is central to penile blood flow, is a plausible vascular route to ED.

Who may be at higher risk

Men across age groups have reported ED after COVID-19. Older men may be more susceptible because of lower baseline testosterone, stronger inflammatory responses, and higher rates of diabetes, hypertension, and cardiovascular disease — all independent ED risk factors. See ED and other health conditions.

Mild or asymptomatic infection, and duration

It is reasonable to expect more vascular or systemic complications after severe disease, but firm evidence that mild or asymptomatic COVID-19 causes less ED is still limited.

How long post-COVID ED lasts is not firmly established. Duration appears to vary with the underlying cause. In some men it may track other long-COVID symptoms and persist for months after recovery.

Other viral illnesses

Temporary ED during or shortly after many illnesses is common, from systemic stress or from medication side effects. Some viruses that infect the testes can cause longer-term hormonal, fertility, or erectile problems. COVID-19 vaccines have not been shown to cause ED or infertility (Diaz et al., Andrologia, 2022; Gonzalez et al., JAMA, 2021).

What to do

Men with new or worsening ED after COVID-19 should see a clinician, often a urologist. Standard ED evaluation and treatments apply — oral medication, devices, injections, and, when indicated, other options. For the range of treatments, see 8 treatment types for ED.

Vaccination reduces the risk of severe COVID-19. Whether that indirectly lowers post-COVID ED risk is plausible but not definitively proven.

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