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MENS HEALTH IN COVID TIMES

Men After COVID

Yes, COVID infection does seem to threaten men’s sexual life. There are preliminary studies that show that Erectile dysfunction (ED) is up to 5-6 times more in COVID recovered men.  For many men in 50’ and 60’s sexual life is an important aspect of living, I need not emphasize it in younger men. I find that in outpatient consultations people with erectile dysfunction are not leading a satisfactory life and that affects their family dynamics and economic productivity. It is interesting to note that ED is an important marker of the overall health of a person. Sexual activity requires a fair amount of vigor and stamina. Individuals with poor fitness, lack of physical activity, lung, liver, kidney, and heart diseases do suffer from ED. There are many studies that suggest that men engaged in regular sexual activity do live longer. Most of the erectile dysfunctions are because of vascular defects. The erection is achieved by vasodilatation causing gushing and pooling of blood in the penis. So, men with ED are associated with cardiovascular (heart) diseases. It can be understood that ED is a marker for overall health and especially cardiac well-being. As already mentioned ED is more common in men after COVID infection. Also, it is interesting to note that men with ED are more susceptible to COVID infections. It can be easily understood because ED is common in obese, diabetics, and people with heart diseases. It is in the same group of people who are also vulnerable to COVID infection. Studies have now established that the damage to the body tissues and cells is not directly because of the virus but because of “cytokine storm”. The body’s immune cells (white blood cells) release substances called cytokines which are normally needed to destroy the viruses and bacteria which invade the body. When the cytokines are released inappropriately in excess amounts then normal body tissues are damaged. Now, there are many ways in which COVID infection can affect erectile function:

Vascular cause:

Cytokines cause vascular endothelial lining damage which leads to thrombosis and clotting at the damaged site of the blood vessels. When clotting and thrombosis happen in the blood vessels of the penis the blood flow is blocked causing ED.

Reduced serum testosterone (Male hormone produced by testis):

Testosterone is a hormone essential for virility and fertility. It is observed that the testosterone levels in COVID patients were low. In postmortem studies carried out in Italy in COVID infected men, there was damage to seminiferous tubules, Sertoli, and Leydig cells. Damage to Leydig cells decreases the serum testosterone levels. Damages to Sertoli cells and seminiferous tubules can cause low sperm count and infertility. It is interesting to note that, though the COVID virus is so far not isolated in the semen – sperm banking and intrauterine insemination of semen in infertility management should be treaded cautiously.

Cardiac causes:

COVID-infected patients develop cardiovascular ailments that may directly affect the erectile functions of the cardiac drugs and beta-blockers prescribed for the ailments also can cause ED.

Lung causes:

Patients recovering from lung COVID pneumonitis develop fibrosis and loss of lung tissue. Lungs are the place of gas exchange. The oxygen is taken in and carbon dioxide is let out. Loss of lung tissue may affect tissue oxygenation. Tissue oxygen is needed for nitrous oxide synthesis in the cells lining the blood vessels. Nitrous oxide (NO) is essential for vasodilatation during erection. Reduced oxygen levels in the blood may impair NO synthesis and cause ED. Poor lung reserves as such cause breathlessness on sexual exertion and prevent intercourse.

Psychogenic causes:

 People with COVID infection are psychologically depressed and this may be an important cause of ED experienced. Men recovering from COVID go through post-traumatic stress disorder, a severe mental ailment in people who are recovering from life-threatening events. Other factors that can cause mental disturbance are economic loss incurred and the death of loved ones in the family. Fear of infection transmission during kissing and proximity may also be a reason. Reduced testosterone blood levels in COVID infection can also cause mood disturbance and play a role in ED.

Thus, there are many ways in which erectile function loss can happen in COVID infection. Further studies are still needed to confirm these causes. This can happen even in mild infections. Like loss of taste and smell, sudden loss of erection may be due to COVID infection. Since the pandemic is not over yet, please mask up, maintain social distance, do workouts, and get vaccinated to avoid COVID. Need not say that there is a lot at stake.

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Dr Kabilan Saminathan- MS(Gen Surg), M.Ch(Urology), Head & Consultant- Urology

 

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