Dear Dr G,

I am a 35-year-old chap who contracted Covid-19 from the workplace in February and had quite a horrible two weeks during the infection.

I am somewhat surprised I contracted the virus, while most of my colleagues were spared.

Admittedly, I am a little obese and have some sugar and blood pressure problems. Thankfully, I have fully recovered from the infection and getting back to normal life.

I discovered something quite curious after the Covid-19 infection. I realised my erectile function is no longer as rigid as its former glory.

I did realise before the infection, I was getting less morning wood and the erection was indeed weaker on occasions.

Following the Covid-19 recovery, I don’t even get good enough erection for penetration.

The fact is, my wife and I are also trying for a baby. Worrying how the virus can affect my fertility is really making my life hell.

I would like to know how getting infected with Covid-19 can affect one’s sexual and reproductive health.

First, is it true that men with prior erectile dysfunction (ED) are more susceptible to Covid-19 infection?

On the other hand, is there any evidence men get sexual dysfunction after Covid-19?

Can the Covid-19 virus also affect sperm production?

Lastly, how long does the virus linger in the semen after the infection?

I am really stressed about the aftermath of Covid-19. Really hope you can help.

Yours truly,
Stressed Steven

The coronavirus disease (Covid-19) has affected our lives in an unprecedented manner. One and a half years after the onset of the pandemic, we have begun to understand more about the risks and complications it has on our health.

The symptoms of Covid-19 can vary widely. Some infected individuals may have absolutely no symptoms and while others become so ill that it may lead to fatality. Those with comorbidities such as diabetes, obesity, hypertension, smoking and dyslipidemia are at higher risk of getting infected with the virus.

Men who suffer from erectile dysfunction (ED) are also known to share the same comorbidity such as diabetes, hypertension, dyslipidemia, and obesity. Hence it has long been proposed that men who experience ED may also have higher risk of developing critical symptoms when infected with Covid-19.

Broadly speaking, ED can be considered a clinical marker of cardiovascular and overall health. This can potentially mean subjects with ED, with underlying medical issues which impair erectile response, are more susceptible to contracting Covid-19.

Although Covid-19 can cause severe acute respiratory syndrome, the long- and short-term impact of such “inflammatory storm” on sexual and reproductive health is not well understood.

Many scientists have proposed the “silent” asymptomatic form would result in subclinical microvascular involvement causing another form of ED, which is endothelial dysfunction. Therefore, the risk of sexual reproductive dysfunction is being investigated.

During the height of the pandemic, Italy was one of the most badly-hit nations. During the crisis, a team from the University of Rome conducted a survey on 6,821 Italian subjects aged 18 years or older, stratified according to marital status and sexual activities during lockdown.

One hundred men were recruited for the analysis with 25 Covid-19-positive and 75 negative.

The study revealed significantly higher prevalence of ED in infected patients at 28%, compared to 9.3% of non-infected men suffering from ED during the stress of lockdown. Statistical analysis confirmed a significant effect of Covid-19 on developing ED, independent of other variables such as psychological and physical health.

The study prompted the “Mask-up to keep it up” campaign to encourage men to wear masks to avoid contracting Covid-19 and the accompanying risk of ED.

More recent studies have also been conducted to study the impact of Covid-19 infection on male reproductive health.

One publication looked at the samples from six Covid-19 patients who died from the disease and 23 patients who were recovering from mild or moderate cases.

In the tissues of the men who died from Covid-19, high levels of inflammation causing functional impairment were noted. In men recovering from Covid-19, 39% of them had low sperm counts, despite previously having at least one biological child through natural impregnation.

The presence of dead viral fragments was also reported in some studies from testicular samples retrieved from previously infected men during fertility treatment.

The impact of viral fragments on the overall reproductive health and the health of the offspring is essentially unknown.

Wearing of facemasks, observing physical distancing and the universal acceptance of vaccination are really the key to get everyone out of this catastrophe.

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