There is insufficient evidence to suggest COVID-19 causes ED

THE Caribbean Urological Association (CURA) says there isn’t sufficient evidence and research to suggest that there is a clinical link between the novel coronavirus and erectile dysfunction (ED).

“COVID-19 is a new infection, so you’re not going to have any robust research or data to make much with it to begin with. After I heard about the local cases, I did review the literature and what I saw were isolated cases reports of persons reporting erectile dysfunction in association with COVID. But that is what we call case reports and it’s the lowest level of evidence. And because of how new the virus is, it’s probably not going to get higher than that right now,” Dr Belinda Morrison-Blidgen, president of CURA, told the Jamaica Observer.

She said, however, that there are men who have contracted the virus who are purporting that they have experienced ED. Morrison-Blidgen said the possibility exists, but as of now, it cannot be proven that the virus caused ED.

“It’s not to say you can’t get ED with COVID, but evidence for it is not very strong right now. We don’t have a lot of long-term data.”

ED is the inability to get or keep an erection firm enough for sex. Some risk factors include cardiovascular disease and diabetes. Further, medical officials have advised that that having erection trouble from time to time isn’t necessarily a cause for concern.

Morrison-Blidgen, past president of the Jamaica Urological Society and consultant urologist at the University Hospital of the West Indies (UHWI), told the Observer that ED is more common among elderly men.

“In general, ED is not a common condition in young men. ED is much more common in much older men, so between the ages of 40 and 70 years, there about a 50 per cent prevalence. So, therefore, when a young man does complain about something like that, one has to get concerned and try and figure out the mechanisms,” she said.

Craig Powe, 25, has come forward saying he has been a victim of ED. Powe said he realised this after his second encounter with COVID-19 last month.

“There are a lot of men who are like ‘what is this? Foolishness!’ But I am hoping that it’s still moving them to get vaccinated. This is a well-known thing that people don’t talk about,” said Powe.

Dr Kevin Goulbourne, director of mental health and substance abuse services at the Ministry of Health and Wellness, agreed that it is not an issue that people openly discuss. He said ED among younger people is a sensitive issue.

He added that it is something that could cause young men in Jamaica to be at an increased risk of mental stress.

“If they (young men) are having that issue, they should try and get help early because the more they try to perform and not perform, it causes increased anxiety. An increased anxiety in that situation also decreases performance; it becomes like a vicious cycle. So, if you are unable to perform and you get help early enough for it, you’re like to become more anxious each time, which will add to the problem you had before. So, they need to seek mental support,” Goulbourne told the Observer.

Meanwhile, Morrison-Blidgen added that COVID-19 could affect the function of the blood vessel, which is a leeway to ED.

“Every blood vessel has lining cells and those cells are called the endothelium. They are very important in terms of the function of the vessel and the release of substances. Because of the significant inflammation that occurs with COVID, if the endothelium is affected, then obviously, because erections are mediated by small blood vessels going to the penis, then perhaps that could be one mechanism.”

She has advised that generally, the causes of ED may be organic or psychogenic.

“By psychogenic, I mean anything causing any psychological stressor such as anxiety, stress, depression and fear. And it would be fair to say that a COVID-19 infection could create severe anxiety in a patient… dealing with whatever symptoms you’re having and even the fear of death.”

A study led by Dr Emmanuele A Jannini, professor of endocrinology and medical sexology, University of Rome Tor Vergata, Rome, Italy, said the coronavirus increases the risk of developing impotence by nearly six times in a real-life situation.

The study, published on March 20, 2021, also found that men with ED are over five times more likely to have COVID-19.

“This study only introduces an idea to be studied in further detail. Although the hashtag #maskuptokeepitup is both funny and is promoting the wearing of mask during the pandemic [which is good], it should not be taken literally that prevention of COVID will decrease the chance of ED. There is not enough evidence to suggest a direct causal link,” said urologist Dr Dean Wong.

“Before anyone runs away with the suggested conclusion from the article,” Wong added, “they will have to acknowledge the limitations of the study, as the authors did.”

“Some of the limitations include: retrospective nature, recall bias in questionnaire format, no swabs done to confirm COVID diagnosis, and that the list of overlapping comorbidities did not include some of the major ones like diabetes, hypertension, high cholesterol, low testosterone and smoking.”

The study focused on age, obesity and psychological health factors.

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