Sex and the Pandemic: The Shocking Link between Covid-19, Sexual Dysfunction, and ED

Valentine’s Day arrived, and indoor mask mandates were lifted across the U.S., couples everywhere can look forward to an almost typical holiday. It was a much-needed reprieve for long-term lovers and hopeful singles everywhere. The pandemic has tested all kinds of relationships, from the bonds between children and parents to those among coworkers, yet few have suffered as much as romantic partnerships. While children go back to school and workplaces resume in-person activity, couples are left facing lingering effects from the virus that public health policies can’t fix.

Studying Covid-19’s Effect on Sexual Dysfunction

An examination of recent scientific literature published in Sexual Medicine Reviews found that Covid-19 had a profound effect on sexual health, which may seem obvious to anyone who browsed Tinder during the lockdown. Across every demographic, sexual desire and intimacy rates declined. Couples isolated from one another and the whole world turned to pornography, despite data that shows individuals masturbated less. Human sexuality, the fodder of poetry and art, seemed almost vanquished by the virus. However, the most worrisome of all the review’s findings was the very physical obstacle the virus presented to lovers, an obstacle that would remain after normal life resumed.

Less than a year into the pandemic, researchers across the globe, from Iran to Canada, began to notice a significant link between erectile dysfunction and coronavirus infection. A study at the University of Florida observed that nearly 5% of all men who had tested positive for COVID-19 were later diagnosed with erectile dysfunction or ED. This statistic may, at first, seem insignificant. By the age of seventy, approximately 15% of men will experience ED, while 5% of men around the age of 40 will be diagnosed with the condition. However, a study conducted in Italy found no correlation between age and the likelihood of erectile dysfunction after coronavirus infection. This means men, young and old, are both at substantial risk of sexual dysfunction after testing positive for COVID-19.

Research Findings on Sexual Benefits and the Future

Bemoaning the effect of a global pandemic on our sex lives may seem insensitive and gauche. Millions have died because of the coronavirus and its complications. Yet a healthy sex life may, for some, play a crucial role in mitigating the emotional toll of Covid-19.

It’s a topic of much interest in the scientific community. Sex has been linked to better sleep, improved self-esteem, lifted mood, and reduced stress and anxiety. For young people, who have already been disproportionately affected by the psychological ramifications of lockdown, returning to normal patterns of intimacy could be an important step in coping with the aftermath of the past two years.

What is Sexual Dysfunction?

A healthy sex life means different things for different people, but regardless of what form your relationship with sex may take, maintaining sexual health is inextricable from physical and psychological well-being. Contrary to popular belief, sexual dysfunction occurs in men and women; it’s a broad tree of which erectile dysfunction is only one branch. There are four broad categories of sexual dysfunction, all of which can occur during any phase of the sexual response cycle.

The Sexual Response Cycle

The Cleveland Clinic defines the sexual response cycle as “the sequence of physical and emotional changes that occur as a person becomes sexually aroused and participates in sexually stimulating activities, including intercourse and masturbation.” Though it is considered to have four distinct phases, the way a person responds to sex is as varied as sexuality itself. Understanding your own unique emotional and physical response to sexual stimulation is important for protecting your health and improving your relationship with your body.

The first stage, desire, can last from minutes to hours and includes the physical and emotional properties any casual erotica reader will be familiar with; the breath quickens, the heart beats faster, nipples harden, and blood begins flowing to the genitals. After desire comes arousal, though these two phases are often grouped together under the more general name, Excitement. Arousal is the stage in which all the symptoms of desire are intensified. Arousal lasts until the climactic third phase, orgasm, in which involuntary muscle contractions occur all over the body and sexual tension is released in a dopamine surge. The last phase, called the resolution, can be understood as the body’s recovery when functioning returns to normal.

Types of Sexual Dysfunction

Any of the complex bodily changes that occur during the sexual response cycle are subject to becoming a source of sexual dysfunction. Arousal and orgasm disorders are the most common and frequently discussed forms of sexual dysfunction. Individuals with an arousal disorder find it difficult or impossible to become physically aroused when engaging in sexual activity, while orgasm disorders describe the absence or delay of orgasm. Other categories of sexual dysfunction include pain disorders, which, like the name implies, makes sexual activity painful, and desire disorders. It is important to note that people with desire disorders, a lack of interest in sex, are distinct from those who identify as asexual. Sexual dysfunction is most often characterized as a deviation from an individual’s typical experience of the sexual response cycle rather than a deviation from the cycle as it is generally prescribed.

Sex as a Signal: Comorbidities

Most people experience some kind of sexual dysfunction during the course of their lives, whether they realize it or not. Mood, diet, and sleeping habits are just some of the many factors that can disrupt sexual functioning. These disturbances are part and parcel of being a human being with complex physiology and an intricate interior life. Continued sexual dysfunction, however, can often be a sign of underlying health issues, ranging from depression to cardiovascular disease. Though it may be uncomfortable, sharing your concerns with a healthcare provider is an important step in protecting your health.

Covid-19 and Sexual Health: The Wealth of Information

Because sexual dysfunction is such a strong indicator of general well-being, it’s no wonder scientists took an interest in the connection between Covid-19 and sexual health. The studies focused primarily on arousal disorders in men and desire disorders, shed light on both the virus’s biological interactions and its psychological effects. A whopping 693 studies were analyzed in the scoping review. As might be expected, the mental health impact of months in lockdown was tremendous and disastrous for sex in its own right. It was the studies investigating male arousal, however, that proved most shocking. Though not without historical precedent, few could have predicted the findings that incontestably connected coronavirus infection with the development of erectile dysfunction.

What is Erectile Dysfunction (ED)?

Erectile dysfunction (ED), sometimes called erectile disorder, comes in many forms. Almost 70% of men will experience some form of the disorder in their lives, whether from performance anxiety or drinking too heavily before doing the deed or any other combination of factors. Simply put, ED is the inability to form and/or maintain an erection. To be officially diagnosed, symptoms must have a duration of at least six months, according to the Diagnostic and Statistical Manual of Mental Disorders. Increasingly, anorgasmia, which the Mayo Clinic describes as “difficulty reaching orgasm after ample sexual stimulation,” has begun to be accounted for in conversations about sexual dysfunction. There are many highly individual reasons a person might develop ED or experience sexual dysfunction. Some known causes are cardiovascular, while others are neurological, psychological, or hormonal.

What Does Covid-19 Have to Do with Erectile Dysfunction?

Scientists and medical professionals have, for a long time, found that age is the most significant correlation among people living with erectile dysfunction. Other factors that increase the likelihood of developing ED are mental health conditions, namely anxiety and depression, and obesity. In an analysis of 100 patients, however, researchers found COVID-19 dramatically increased the likelihood of ED development, independent of age, BMI, or psychological status. This is a striking discovery when contrasted with previous ED research. Young, physically active men were considered extremely low risk, yet these findings show that, after infection with the coronavirus, this is no longer the case. Two other studies, one conducted in Iran and the other in the United States, observed occurrences of ED and anorgasmia in young men after having had Covid. Researchers hypothesize that asymptomatic individuals are also at risk, though no studies have been done, as few subjects with “silent” Covid know they’re infected.

How is Covid-19 Infection Causing Erectile Dysfunction?

The mechanism by which Covid is causing this sexual dysfunction remains unclear. Some scientists point to blood vessel damage as a possible explanation, causing a form of endothelial dysfunction and reducing blood flow to the penis. Though endothelial dysfunction, which results in the narrowing of blood vessels, is most commonly seen in women, authors of the study “Mask up to keep it up”: Preliminary evidence of the association between erectile dysfunction and COVID‐19 call it “the most likely culprit.” Still other scientists believe the interaction between testosterone and Covid-19 is to blame, citing the virus’ apparent ability to decrease testosterone levels. In a treasonous and self-destructive twist, studies have also found the male sex hormone acts as a facilitator to Covid’s entry into cells, leading to harmful inflammation in tissues throughout the body.

Tied to both theories is the possibility that the virus simply worsens existing health issues associated with ED. “We know there are a number of different ways that the virus could cause erectile dysfunction,” says urologist Ryan Berglund, M.D. “But much more research is needed before we know for sure.” The only definite conclusions researchers and medical professionals can draw is the very real and “uniquely harmful” risks coronavirus poses to men of all ages.

Long-term Erectile Dysfunction and the Need for More Research

Although the duration of the pandemic has exceeded all early estimates (and felt even longer than that), not enough time has passed to evaluate the long-term effects of Covid-19. It’s unclear whether virus-related erectile dysfunction is a temporary consequence of infection. As researchers continue to investigate this question, the current focus should be on coping with the emotional aftermath of ED. Worse than the possibility of long-term erectile dysfunction is the mental health consequences that often follow the development of the disorder.

The Mental Health Consequences of Erectile Dysfunction

Covid-related erectile dysfunction complicates the post-pandemic healing process by intensifying the already severe psychological impact of life in the shadow of the virus. ED has been shown to lower self-esteem and body image, as well as increase rates of anxiety and depression. These feelings, more pronounced in younger men, often exacerbate the disorder, creating a vicious cycle wherein the physical and emotional symptoms are amplified.

Isolation, anxiety, and despair may be causal factors in the erectile dysfunction scientists observed across age groups. Poor mental health was a common cause of concern throughout the studies reviewed in Sex Med. Researchers have yet to completely dismiss the possibility that the psychological impact of the pandemic is as potent as the biological damage brought about by the virus.

Does Covid-19 Cause Sexual Dysfunction in Women?

Sexual dysfunction is rarely discussed in terms of female biology, though it arises in women for many of the same reasons it occurs in men. Women themselves often have little understanding of the issue, if they know it exists at all. Symptoms of female sexual dysfunction, like anorgasmia, are written off as inconquerable issues innate to the female body and go largely uninvestigated. The scientific community responded in much the same way when faced with the effect of the coronavirus on male sexual dysfunction. In a lengthy review of the ED-Covid literature published in Sexual Medicine, no mention was made of the broader, gender-spanning implications the data presents.

How Science, Sex and Covid-19 Research Fail Women

Research on Covid-19 and female sexual health has fallen through the cracks of scientific attention, glossed over by fertility concerns and sociological assessments of sexual activity, which are important in their own right but only pieces of a larger picture. During the pandemic, sexual desire decreased across all demographics, but saw an especially significant drop among healthcare workers and women. On every measure, women with children and long-term partners suffered the most pronounced change in the quality of their sex lives. Overall, sexual contact, especially among partners sharing a residence, decreased significantly, while pornography consumption increased. These findings offer myriad insights into the ever-lopsided dynamics of sex and sexual satisfaction, but do little by way of exploring the potential physical impact of the coronavirus on non-male bodies. Because the physical markers are less dramatic then they are in men, some may make the argument that arousal disorders are more difficult to study in women. Many of the studies discussed in the Sex Med literature review, however, were analyses of thousands of self-assessments. By bringing the issue of female sexual dysfunction into a broader dialogue, women would be better equipped to make self-assessments. Given the emotional toll erectile dysfunction has on men, it should be equally important to explore the mechanisms causing so much distress in the lives of women.

Preventing Sexual Dysfunction

Maintaining a healthy lifestyle, managing stress, and treating mental health issues is key to ED prevention. Though psychological status and BMI did not spare men infected with Covid-19 from the risk of developing erectile dysfunction, these factors can reduce the severity of symptoms if they do arise. The role of mood and emotional well-being cannot be overestimated. Many are hesitant to treat illnesses like depression, due to the effect many medications have on sexual function, but these potential side-effects are eclipsed by the much more dramatic impact mood and stress has on the sexual response cycle.

Treatment and Protection: the Role of Covid-19 Vaccines and Masks

To prevent further incidents of Covid-related erectile dysfunction, we must seek to reduce the spread of the virus. Wearing a mask is the first step, but receiving a vaccination is the most effective means of protecting yourself and others. Although further studies assessing the preventative role vaccines may play in preventing erectile dysfunction have yet to be published, it is well established that vaccination has broad protective powers against the coronavirus. Vaccinated people who contract Covid-19 experience less severe symptoms and will likely have a much greater chance of avoiding sexual complications as a result of the virus.

Erectile Dysfunction Medications and Medical Intervention

For men currently grappling with erectile dysfunction, remedies exist. The same is not true for women, though lube and ample foreplay may help. There are a number of medications, Viagra being the most famous, to treat ED in the short term. Elective and non-emergency medical care has become increasingly available since its disruption in the beginning of the pandemic, allowing patients the opportunity to receive a diagnosis and discuss viable treatment options with their doctor. Socioeconomic disparities, however, will continue to prevent many, especially those in marginalized communities, from accessing medical treatment for sexual dysfunction.

Faith in Facts

Going forward, it is important to remember that knowledge is power. Public and personal health can be protected by understanding the coronavirus and its risks. By failing to explore all avenues of research, that information is denied to those whose health depends on it. Information, no matter how alarming it may seem, is more dangerous to be without than it is to have.

Armed with facts, we can manage risk and live proactively. This Valentine’s Day, couples will go to dimly lit restaurants, flowers will be bought, and children will spend a whole school day cutting hearts from pink paper. Life will resume in spite of the virus, demanding to be celebrated in whatever form it may take.