As the infection sweeps across the globe, we’re learning new information about coronavirus all the time, including how it spreads, and the short and long term effects of the disease. We’re all familiar with the respiratory symptoms coronavirus can cause. But what other, less expected effects can coronavirus have?  

This is what a new paper on coronavirus and sexual health seeks to explore, including whether COVID-19 can induce or exacerbate erectile dysfunction in men. 

What studies have been conducted on coronavirus and sexual health? 

To date, no cases have been reported or studies conducted that focus on sexual function and the coronavirus. However, some data does exist.

For example, NBC News conducted a survey of 9,000 people and asked questions about their sexual function. Of the respondents:

  • 24% said coronavirus had a positive impact on sex life;
  • 28% said coronavirus had a neutral impact on sex life;
  • 47% said coronavirus had a negative impact on sex life. 

A study was also conducted in China, which demonstrated sexual activity in both men and women had declined. 

A survey of people in Bangladesh, Nepal and India, which focused on the effects of isolation and lockdown on sexual function, showed that there had been a 3.3% increase from people having sexual intercourse one to five times a week, to more than five times per week. 

However, clinical data that is wholly comprehensive and conclusive in this area is still some way off. The priority for the wider medical community has been, and remains at this time, to respond to the virus first hand, and undertake vital research into both cures and vaccines. 

Is there a link between ED and coronavirus? 

The reason these limited datasets seem to give different conclusions may surround things like developmental and cultural factors, and how different governments have responded to the pandemic. 

For example, many countries announced strict lockdown procedures to limit the rate of transmission. This means great numbers of populations have been asked to remain at home and remain socially distant. In turn, this affects how physically active people have been. This impacts vascular function and blood flow, which can negatively impact the ability to get or maintain erections. 

‘We’re all spending more time in the house’, comments GP clinical lead at Treated.com Dr Daniel Atkinson, ‘and as cases of infection continue to fluctuate, we may find ourselves continuing to spend more time indoors until an effective cure or vaccine is found. 

This can affect our health in several ways, one very obvious one being less movement and physical activity. Some people may find they don’t leave their home for the entire day, which can be really damaging if repeated frequently and over a long period of time. My best advice would be to get out on breaks and after work for a walk or run. 

There are also lots of strength exercises that can be taken up in the home, many of which don’t require expensive equipment or kit. Things like push ups, press ups, dips and squats. 

Any physical activity is better than none, but as a rough guide we should aim for either 75 minutes of vigorous aerobic activity a week, or 150 minutes of moderate aerobic activity.  Aim to perform strength exercises at least twice a week that target each primary muscle group, repeating individual exercises between 12 and 15 times.’

There is also the psychological impact of isolation to consider, which can cause issues like anxiety, depression and can affect people’s moods. This may also negatively impact sexual function and libido. On the other hand, however, some people respond differently to stress. While certain people may lose some or all of their libido, others notice increases in their sexual desire. 

Feeling low or stressed can also negatively impact the natural production of important chemicals in the brain, some of which are vital for sexual libido and function. This could be even worse in older adults who already struggle with the physical causes of ED, like cardiovascular disease and diabetes. 

Medical professionals may consider prescribing antidepressant medication in response to these psychological changes in light of the virus, such as selective reuptake inhibitors (SSRIs). However, one side effect of many antidepressants includes a loss of libido. 

Isolation and mental health problems can also disrupt the ability to sleep properly. This was the subject of some focus in mainstream news publications. One UK study revealed that over half of the population had suffered with sleep problems at the height of the lockdown in its strictest form. Sleep problems, namely sleep deprivation, can negatively impact the mood and are known to affect sexual desire and ability. 

Adults are reminded to try their best to sleep for between six and eight hours each night. 

‘We’ve all been called upon to live and adopt new behaviours in a way we haven’t quite seen before. The global coronavirus pandemic and subsequent lockdowns, in the modern world as we know it, are completely unprecedented’, comments Dr. Daniel Atkinson, ‘so, of course, there will be psychological and behavioural knock-on effects for everybody. 

At the height of the strict UK lockdown, I’m sure the vast majority of us struggled to remain consistently happy and optimistic all the time, every day. Things like not being able to go and spend time outside, in nature, be with friends and family, travel and visit new places will all have a negative impact on mental health. 

It is likely that until we get a hold on the virus, which in my opinion only happens once we find an effective cure or vaccine, this new way of living is set to continue. It isn’t helpful to keep everything bottled up - talk with the people you live with if you’re struggling. If you live alone, reach out electronically to a neighbour, friend or family member. 

If you find that you continue to struggle, find the time to see your doctor. There are a broad range of things doctors can do to help with these kinds of things, it isn’t just a case of prescribing antidepressants and sending you on your way. They’ll want to work with you to find a comprehensive and helpful solution.

A lot of what I’m hearing from my patients is that they don’t want to impose themselves as a burden to an already struggling NHS - I would suggest that if you’re finding it hard to take care of your physical and mental health by exercising, ensuring you get enough sleep and sharing your worries and concerns with others, or if you’re doing those things and still struggling then seeking help and advice from your doctor would be very sensible rather than allowing things to get worse.’

Is COVID-19 an ‘STI’?

While COVID-19 is not thought to transmit sexually, sexual intercourse is often preceded by foreplay which can include kissing and the exchange of saliva. As we know, the virus can and does transmit in this way. 

These sexual and romantic pursuits also breach social distancing guidelines, unless you’re already living in the same household. This has caused many people to stop seeking new, healthy sexual relationships with people outside their homes. Clearly, this is correct and in line with the current UK advice. But on the other hand, not seeking healthy relationships could take a psychological toll. (Which, in turn, could affect libido). 

The coronavirus may also cause physical manifestations which could negatively affect a person’s libido. For example, in some cases of the virus, physical lesions have been reported which cover some or all of the body, including the genitals. The rash has not been studied enough, but vasculitis or Langerhans cell histiocytosis have been suggested as possible causes.

Furthermore, COVID-19 causes cytokine storms in some patients. This is, essentially, a dramatic overreaction from the immune system, where too many particular types of a protein - cytokine - are produced to combat the virus. It can have fatal consequences. 

Cytokine storms can cause itchy and ulcerating lesions in different organs. A symptom of this is petechial bleeding, which causes pinpoint, red and purple spots. This can manifest on the genitals, which could negatively impact sexual appetite. 

COVID-19 can disrupt crucial processes in the body like cardiovascular function, and can cause acute heart injury. These things can impact blood flow and, in turn, make erections difficult to obtain. Many of the medications used to treat CVD or heart conditions - like thiazide-type diuretics, the aldosterone receptor blockers, the β-adrenergic receptor blockers, or ACE inhibitors to control blood pressure -  carry the potential side effect risk of ED. 

COVID-19 can cause nervous system manifestations - such as acute cerebrovascular disease, ischemic stroke, or cerebral hemorrhage. Strokes have a negative impact on sexual function and desire including, for men, problems with erections and ejaculation. 

The authors of the study conclude by pointing to the lack of case studies on sexual function and the coronavirus: 

‘We are in a compelling need for studies on the current and future genital affection of COVID-19 patients. Support programs are needed now either for patients or the other healthy people to prevent any drawbacks from the pandemic.’

Dr Daniel Atkinson concludes by saying that whilst ‘it isn't the most pressing need at the moment, further studies are required to evaluate the impact of COVID-19 on sexual function, both as a direct effect of the virus itself on individuals and the wider impact of the social and cultural changes that have been imposed or adopted in response to the global pandemic."