"Mask up to keep it up": preliminary evidence of the association between erectile dysfunction and COVID-19

Background: Erectile dysfunction (ED), as the hallmark of endothelial dysfunction, could be a short- or long-term complication of COVID-19. Additionally, being ED a clinical marker and predictor of Non-communicable Chronic Diseases, particularly cardiovascular, subjects with ED could potentially have a higher risk of contracting COVID-19. Objectives: To investigate the prevalence of ED among subjects with a reported diagnosis of COVID-19 and to measure the association of COVID-19 and ED. Materials and methods: We reviewed data from the Sex@COVID online survey (performed between April 7th and May 4th , 2020 in Italy) to retrieve a sample of Italian male sexually active subjects with reported SARS-CoV-2 infection. A matching sample of COVID-19 negative male sexually active subjects was also retrieved using propensity score matching in a 3:1 ratio. The survey used different standardized psychometric tools to measure effects of lockdown and social distancing on the intrapsychic, relational, and sexual health of Italian subjects. Results: 100 subjects were included in the analysis (25 COVID positive; 75 COVID negative). Prevalence of ED, measured with the Sexual Health Inventory for Men, was significantly higher in the COVID+ group (28% vs 9.33%; p = 0.027). Logistic regression models confirmed a significant effect of COVID-19 on the development of ED, independently of other variables affecting erectile function, such as psychological status, age and BMI [OR 5.66 ,95% CI: 1.50 - 24.01]. Likewise, subjects with ED were more likely to have COVID-19, once corrected for age and BMI [OR 5.27, 95% CI: 1.49 - 20.09]. Discussion and conclusion: On top of well-described pathophysiological mechanisms, there is preliminary evidence in a real-life population of ED as a risk factor of developing COVID-19 and possibly occurring as a consequence of COVID-19. Universal vaccination against the Covid-19 and the personal protective equipment could possibly have the added benefit of preventing sexual dysfunctions. Keywords: COVID-19; SARS-CoV-2; coronavirus; endothelial dysfunction; erectile dysfunction; testosterone.