"But the authors offer a plausible mechanism by which COVID-19 may impact directly on erectile function," agrees Pacey. Adding, "There’s more work to be done.
"I'd also argue it's a good reason for men to wear a mask, practice social distancing, and take the vaccine when it's offered to them."
Urologist John Mulhall, MD, from Memorial Sloan Kettering Cancer Center, New York City, remarked, "It was a highly preliminary study, but the data are suggestive of a potential link between COVID-19 infection and ED.
"However, it raises enough questions such that further large, more long-term analyses are required to define causation. Future studies assessing testosterone levels and erectile hemodynamics will be needed to provide definite evidence of a causative link," he stressed.
Erectile Problems a "Hallmark" of Non-obstructive Coronary Artery Disease
Prior research has suggested that asymptomatic COVID-19 could be associated with undetected problems with small blood vessels with long-term on the cardiovascular system.
"Indeed, COVID-19 is by all means an endothelial disease in which systemic manifestations...can potentially be due to alterations in the endothelial thrombotic/fibrinolytic balance," emphasized Jannini. He added that these cells function similar to how SARS-CoV-2 does when attacking host cells.
"Erectile dysfunction has often been considered a hallmark of endothelial dysfunction, and as such, a potential association between ED and COVID-19 has also been postulated and underpinned the investigation in this study," he explained.
The study was based on the fact that ED is often considered a clinical marker of impaired overall health status, which often features cardiovascular events at an early age. It aimed to investigate the cross connection between COVID-19 and ED. It asked whether ED could be a risk factor for contracting COVID-19 and whether having COVID-19 predisposes to developing ED.
"This would possibly suggest that men with ED, due to the underlying conditions which impair erectile response, could also be more susceptible to contracting COVID-19," said Jannini.
Data were drawn from the Sex@COVID online survey, which was conducted from April 7 to May 4, 2020, in Italy. The survey included 6821 participants aged 18 years or older (4177 women; 2,644 men; mean age, 32.83 ± 11.24 years). They were divided on the basis of marital status and sexual activity during lockdown. From these participants, 985 sexually active men were identified, among whom 25 (2.54%) reported having tested positive for COVID-19. These persons were then matched with 75 COVID-19-negative men.