By: Dr. Jaycie Loewen Last Updated: February 28, 2023
Medically Reviewed by Dr. Alina Fong
What to Do When Long COVID Causes Erectile Dysfunction
Education & Resources | Brain Safety & Care | COVID
Many patients have heard of the most common long-term effects of COVID-19: symptoms such as breathing issues, brain fog, and constant fatigue. But there is mounting evidence that COVID-19 may also affect sexual health negatively in both men and women. Men who hadn’t previously had problems of this nature have started developing erectile dysfunction (ED) after their COVID-19 infection.
In fact, studies show that men are six times more likely to develop problems achieving an erection after contracting the COVID-19 virus compared to men who didn’t get COVID. Other studies show a litany of symptoms caused by the coronavirus that can have an impact during sexual intercourse, including damage to the testis, testicular pain or swelling, difficulty achieving an orgasm, low libido, low testosterone levels, and even some urinary problems.
In this article, we’ll look at the main factors responsible for erectile dysfunction caused by COVID-19. We’ll also discuss how treatment at Cognitive FX helps patients recover from long COVID and may — although indirectly — represent a viable option to treat this symptom.
Our treatment is designed to help post-concussion patients recover from persistent symptoms. After just one week of treatment, 95% of our patients show statistically verified improvement in brain function. Thus far, we’ve seen similar results with long COVID patients who pass our current screening criteria. To discuss your specific symptoms of COVID-19 and determine whether you’re eligible for treatment at our clinic, schedule a consultation.
Note: Any data relating to brain function mentioned in this post is from our first generation fNCI scans. Gen 1 scans compared activation in various regions of the brain with a control database of healthy brains. Our clinic is now rolling out second-generation fNCI which looks both at the activation of individual brain regions and at the connections between brain regions. Results are interpreted and reported differently for Gen 2 than for Gen 1; reports will not look the same if you come into the clinic for treatment.
How Does COVID-19 Cause Erectile Dysfunction?
Male sexual arousal is a complex mechanism involving the brain, the nervous system, multiple muscles in the body, and blood vessels. Erectile dysfunction can occur due to problems with any of these components. For many men, erectile dysfunction has a strong physical component and is often associated with other health issues that increase the risk of ED, such as diabetes or cardiovascular disease. For others, there is no physical impediment to having an erection, but erectile dysfunction occurs due to psychological issues, such as stress and anxiety.
In fact, when the first reports about sexual dysfunction in COVID long haulers started appearing, most doctors assumed it was the result of stress caused by confinement and isolation. However, some patients weren’t feeling particularly anxious or stressed; nevertheless, the symptom persisted for months, which suggested a physical explanation.
It can be challenging to separate physical and psychological reasons for erectile dysfunction in COVID long haulers. At Cognitive FX, we find that concussion patients who have lived with similar symptoms for years have learned to recognize patterns in their symptoms. For example, if they experience erectile dysfunction during a bout of depression, it might have a psychological cause rather than a physical one (or could be a combination of both). In contrast, many long haulers have only lived with their symptoms for a few months, and it’s harder for them to “interpret” symptoms.
Briefly, there are four COVID-related factors that may lead to erectile dysfunction:
- Endothelial dysfunction
- Dysfunction in the autonomic nervous system (ANS), including cardiovascular and pulmonary issues
- Psychological issues aggravated by the pandemic
- Other causes (such as endocrine dysfunction)
We also briefly cover a few other factors that may cause sexual problems, but our list is not exhaustive. If you’re experiencing this issue—whether related to COVID-19 or not—we recommend you visit your family doctor or urologist as soon as possible.
Erectile Dysfunction as a Consequence of Endothelial Dysfunction
Every blood vessel in the body is lined with a single layer of cells called endothelial cells. Under normal circumstances, these cells play a vital role regulating the dilation and contraction of blood vessels to ensure enough blood flows where it’s needed.
In addition, the endothelium also protects internal organs from toxic substances, regulates the blood clotting mechanism, and controls inflammatory responses in the surrounding tissues. In short, a smooth running of the endothelium is critical for the normal functioning of the body’s tissues and organs.
However, this perfectly balanced system is disrupted in long COVID patients, as endothelial cells (which have ACE2receptors) are one of the most critical targets of SARS-CoV-2. There is enough evidence now to show that this virus causes endothelial dysfunction, leading to vascular leakage, thrombosis, blood clots, and an exaggerated inflammatory response.
This kind of vascular damage is the most likely explanation behind poor sexual performance and erectile dysfunction in long haulers. Erections rely solely on blood flow, so anything that interferes with the arteries’ ability to deliver blood to the penile tissue to create an erection could lead to erectile dysfunction. As the penis is one of the most vascular organs in the body, it’s not surprising that endothelial dysfunction caused by long COVID can lead to this kind of problem.
Disruption of the Autonomic Nervous System Also Causes Erectile Dysfunction
All the vascular events described above to ensure that an erection can occur are carefully orchestrated by the autonomic nervous system (ANS).
Recent studies show that the initiation, maintenance, and rigidity of penile erection are controlled by two sections of the ANS known as the parasympathetic nervous system (PNS) and sympathetic nervous system (SNS). To start, the PNS increases blood supply to the spongy tissues in the penis to allow an erection to occur. As sexual arousal increases, the SNS takes over until ejaculation.
Not surprisingly, any disruption in this balance between PNS and SNS causes erectile problems. In fact, a study reported approximately 14% of COVID long haulers experienced some sort of sexual impairment, along with a variety of other health problems also caused by ANS disruption, including pulmonary, urinary, and digestive conditions.
Erectile Dysfunction and the Stress Caused by the Pandemic
The psychological effects of the COVID-19 pandemic, including stress caused by job uncertainty and prolonged periods of staying at home, can also contribute to erectile dysfunction. Often, patients may wake up with an erection, but when it’s time to be intimate, they struggle. For these patients, the problem is either partially or wholly psychological.
While only a minority of people are affected by severe psychological trauma, it’s not unreasonable to suggest that most people have experienced some degree of distress and anxiety during the months of isolation. Since sexual activity is closely associated with mental health, sexual desire and frequency have declined during this pandemic, further aggravating the risk of erectile dysfunction.
Other Causes of Erectile Dysfunction after a COVID-19 Infection
There are several other factors related to COVID that can cause erectile dysfunction:
- Low oxygen levels: A COVID infection can lead to lung damage and low oxygen levels in the blood, which can, in turn, result in erectile dysfunction.
- Low testosterone: It’s common for long COVID patients to have reduced testosterone levels, typically accompanied by low production of sperm. This may cause low libido and erectile dysfunction.
- Fatigue and other long COVID symptoms: If you feel tired or are battling with constant headaches, you may find it difficult to engage in any sexual activity.
- Treatment for COVID: Patients staying in the ICU during a severe COVID case may receive many different medications, including thiazide-type diuretics, aldosterone receptor blockers, β-adrenergic receptor blockers, or ACE inhibitors to control blood pressure. Some of these are associated with a high risk of erectile dysfunction, but symptoms usually go away when you stop taking the medication.
Can Cognitive FX Treat Erectile Dysfunction?
We developed a treatment for COVID long haulers based on our approach to treating patients suffering from head trauma after we realized how similar the two conditions really are. (You can read more about this process here.)
We believe this treatment can address some cases of erectile dysfunction because it targets the autonomic nervous system (ANS).
After COVID, the SNS is often stuck in a state of overreacting (as discussed above). To stop this sympathetic dominance, we developed a series of cardio and breathing exercises to restore balance between the PNS and SNS. These exercises retrain the brain so that both the PNS and SNS behave according to the body’s needs rather than one overpowering the other. For some patients, restoring this balance in the brain can reinstate erectile function.
In summary, while we cannot treat erectile dysfunction directly, our treatment is able to resolve or significantly improve many common symptoms of long COVID, such as fatigue, brain fog, and other cognitive changes, vision problems, exercise intolerance, breathing difficulties, and more. For some COVID-19 patients, these improvements are enough to restore erectile function as well.
We recommend that patients with ED also consult with a healthcare professional who specializes in urology or andrology.
Assessment and Treatment at Cognitive FX
We perform a thorough assessment on long COVID patients so that our therapists can develop a customized treatment plan.
During this assessment, we’ll go over your medical history in detail, track the progression of your symptoms, and discuss what our treatment entails. At this stage, patients also undergo a special type of scan called functional Neurocognitive Imaging (fNCI) to detect what areas in the brain are affected by the virus.
Long COVID patient Madison Sharp had hyperactivity in the Inferior Frontal Gyrus, Anterior Insula, Fusiform/Interior Occipital Cortex, and Basal Ganglia (left). Her scores in those regions were three standard deviations from the norm. All of those values returned to normal (within the blue region on the graph) on her second scan after treatment (right). You can read about her, her mother, and her brother’s recovery from long COVID here.
If, during an interview, a patient tells us that they have erectile dysfunction, our approach may change slightly depending on whether this is a new symptom or the worsening of a problem they had previously.
We feel it’s important to set the right expectations before treatment starts: New symptoms are more likely to be caused solely by long COVID and are easier to treat. In contrast, symptoms that patients had before the original COVID infection may be trickier to address, especially if they have a strong psychological component.
After the assessment, patients begin a period of treatment we call Enhanced Performance in Cognition (EPIC) Treatment. Throughout the week, patients undergo a series of therapies, such as vision therapy, occupational therapy, cognitive therapy, neuromuscular therapy, sensorimotor therapy, and psychotherapy, in addition to supervised cardio sessions to promote recovery.
Patients also see a psychologist who can help with any psychological issues behind their erectile dysfunction. In addition to this, we recommend patients seek further therapy with a sex therapist or couples counselor when they return home. Psychological interventions such as cognitive-behavioral sex therapy, for example, have proven to be very effective in treating erectile dysfunction.
On the last day of treatment, patients go through a second scan to see how much they’ve improved. So far, our results with COVID long haulers have been positive. These patients have recovered at the same rate as our other patients.
If patients don’t see improvement in erectile function or are not progressing as expected, we refer them for further immune and hormonal testing to allow for more targeted treatment.
Given that there is a strong link between erectile dysfunction and hypertension and cardiovascular disease, we may also suggest an appointment with a cardiologist to determine if you are at risk of developing serious cardiovascular problems, such as a heart attack or stroke.
Lifestyle Changes to Improve Erectile Function
There are several lifestyle changes you can follow to improve erectile function:
Eat a balanced diet: Eating a balanced diet high in fruits and vegetables and low in red and processed meats can help maintain sexual activity and lower your risk of developing erectile dysfunction.
Exercise regularly: Adding aerobic exercise to your routine not only improves your overall health but may also reduce your sexual problems. Even just a brisk walk for 30 minutes, three to four times a week, may be enough to improve your cardiovascular health and have a positive impact on your erectile function.
Stop smoking: Smoking is a risk factor for erectile dysfunction because it causes changes to the endothelium of blood vessels, including in the penis. What’s more, many people smoke to reduce their anxiety, but smoking only exacerbates the problem. Quitting smoking may not reverse erectile dysfunction on its own, but it will improve men’s health and sexual function in general.
Practice breathing exercises: Stress and anxiety can cause erectile dysfunction. If you’re feeling anxious, your body will go into “fight-or-flight” mode and redirect blood flow away from the penis and into the vital organs essential for survival. To avoid this and to lower stress levels, take a deep breath in through your nose, ensuring that you are breathing with your diaphragm, then exhale, allowing the air to flow slowly and smoothly out of your mouth. Repeat until you feel relaxed.
Try progressive muscle relaxation: Progressive muscle relaxation is a way to reduce stress in different muscles of the body. The technique involves creating tension in a specific muscle and then releasing it to feel the difference between tense and relaxed muscles. There is only anecdotal evidence to support its use in cases of erectile dysfunction, but in theory, exercising pelvic floor muscles this way can improve blood flow to the genital area, which helps with arousal.
Follow a healthy sleep pattern: Not surprisingly, lack of sleep affects sexual desire and may cause erectile dysfunction. This is a common problem but is often missed during diagnosis. Make sure you have a good night’s sleep, as this can alleviate some symptoms associated with erectile dysfunction.
Misconceptions about COVID and Erectile Dysfunction
Misconception #1: Covid Vaccine Causes Erectile Dysfunction
Rapper and pop singer Nicki Minaj made headlines after tweeting about her cousin’s friend in Trinidad. Allegedly, he had to split up from his fiance just weeks before the wedding because the COVID-19 vaccine left him impotent and caused his testicles to swell.
To date, there are no studies supporting these claims. None of the manufacturers of vaccines currently being used, including Pfizer, Moderna, and Oxford, have listed any issues related to sexual health or erectile dysfunction in their clinical trials.
In addition, a small study measured sperm count before and after COVID-19 mRNA vaccination. The researchers concluded that there were no significant decreases in any sperm parameter after two doses of either Moderna or Pfizer vaccines.
Misconception #2: Men Don’t Have to Talk about Sexual Problems
You may think of erectile dysfunction as your own personal problem. However, any issue that impacts your sex life soon becomes a problem that affects your partner as well. Sex isn’t the only aspect that matters in a relationship, but physical intimacy plays a key role in maintaining emotional intimacy.
Talking about it openly is important. If you’re struggling, at least acknowledge that it is embarrassing and work your way from there. It may be easier to start with a general conversation about your relationship and then bring up your concerns about erectile dysfunction.
You should also consider seeking medical advice. In many cases, erectile dysfunction is treatable. Your doctor’s questions may feel very personal, but it's important to answer them honestly. This information is vital to finding the best treatment for you.
Talk to the Team at Cognitive FX
We offer consultations to anyone who passes our screening criteria. If we think we could help you, we’ll have a conversation about your symptoms and medical history, then discuss treatment options.
After just one week of treatment, 95% of our post-concussion syndrome patients show statistically verified improvement in brain function. Thus far, we’ve seen similar results with long COVID patients who pass our current screening criteria.
To discuss your specific symptoms of COVID-19 and determine whether you’re eligible for treatment at our clinic, schedule a consultation.
About Dr. Jaycie Loewen
Dr. Jaycie Loewen is a Clinical Neuroscientist who received her Doctorate of Neuroscience at the University of Utah. Her background includes the study of basic and clinical brain injury, including the publication of research regarding mechanisms of epilepsy pathophysiology. Her work has elucidated the role of glial and neuronal cell profiles in viral-induced brain injury and acute seizures. Dr. Loewen is further a Howard Hughes Medical Institute Scholar, with a Master's in Clinical Investigation awarded in 2018, as well as a recipient of the Higher Education Teaching Specialist Certificate. Through these degrees, she obtained experience with patient care and education as well as an understanding of the necessity of respecting patient experience and symptoms. Dr. Loewen’s focus is firstly patient care and education. She also provides literature analysis and aids in the publication of Cognitive FX’s research. Her goal is to improve Cognitive Fx’s ability to help patients through equal interaction and communication, as well as the furthering of concussion and mild traumatic brain injury treatment and science.