Analysis Of The Impact Of COVID-19 Infection On Erectile Function In Men And Related Risk Factors

Background and Objective:Since the end of 2019,the 2019 coronavirus disease(COVID-19)has had a significant impact on human health,primarily targeting the respiratory system.However,evidence suggests that the virus may also have deleterious effects on the urogenital system.Despite this,there is a lack of research on the immediate consequences of COVID-19 infection on male erectile function,which limits our comprehensive understanding of the disease’s impact.Therefore,this study aims to investigate the effects of COVID-19 on erectile function in males during the early stages of infection,identify risk factors for developing ED following COVID-19 infection,and evaluate the recovery of erectile function in COVID-19-infected individuals.Method:Data was collected between October 2022 and January 2023 from 107 patients who were diagnosed with COVID-19 for less than 30 days and received treatment at our hospital as inpatients or outpatients.These patients were used as the observation group.The control group,consisting of 107 individuals who were not infected,were admitted for inpatient or outpatient care during the same period.Clinical data,such as age,BMI,levels of vascular endothelial growth factor(VEGF)and sex hormones,semen quality results,scores on the Hospital Anxiety and Depression Scale(HADS),Generalized Anxiety Disorder-7 Scale(GAD-7),Patient Health Questionnaire-9 Scale(PHQ-9),International Index of Erectile Function-5(IIEF-5),Sexual Encounter Profile(SEP)results,Erection Hardness Scale(EHS)score,Audio-Visual Sexual Stimulation Test(AVSS)results,and Nocturnal Penile Tumescence and Rigidity Test(NPTR)results,were collected from the subjects.The impact of COVID-19 on erectile function and its associated risk factors were retrospectively analyzed using the IIEF-5 score as the evaluation indicator of erectile function.Patients who experienced a decline in erectile function after COVID-19 infection were categorized into treatment and control groups based on whether they received treatment with Type 5 phosphodiesterase(PEE5)inhibitors.The two groups were compared in terms of age,BMI,IIEF-5 score,AVSS results,and their respective IIEF-5 score and AVSS results after 3 months to evaluate the efficacy of the treatment.Results:1.General data analysis: no statistically significant differences(P>0.05)were observed between the two groups in terms of age,BMI,smoking history,and the incidence of hypertension,diabetes,and chronic kidney disease.2.Psychological status evaluation: compared to the control group,patients in the observation group had higher HADS-A,HADS-D,GAD-7,and PHQ-9 scores(P<0.001).3.Evaluation of sex hormone levels: compared to the control group,patients in the observation group had lower testosterone levels(P<0.001),but there were no statistically significant differences(P>0.05)between the two groups in terms of follicle-stimulating hormone,luteinizing hormone,prolactin,and estradiol levels.4.Semen quality analysis: compared to the control group,patients in the observation group had decreased sperm motility(P=0.013),but there were no statistically significant differences(P>0.05)between the two groups in terms of semen volume,sperm density,and the proportion of grade A sperm.5.Erectile function evaluation: compared to the control group,patients in the observation group had lower IIEF-5 scores and EHS scores(P<0.001);the proportion of "yes" responses in the SEP2 and SEP3 questionnaires was lower in the observation group(P<0.05);the levels of vascular endothelial growth factor were lower in the observation group(P=0.003);in the AVSS examination,the time for full erection and the time for full erection of the glans >60% were both reduced in the observation group compared to the control group(P<0.05);in the NPTR examination,the time for full erection and the hardness of the erection of the glans >60% were both reduced in the observation group compared to the control group(P<0.05).However,there were no statistically significant differences(P>0.05)between the two groups in terms of the increase in the coronal sulcus expansion value and the basal expansion value in the AVSS and NPTR examinations.6.Analysis of risk factors for erectile dysfunction: results from a single-factor logistic regression analysis indicated that COVID-19 infection,anxiety,and testosterone levels were correlated with erectile dysfunction(ED),with odds ratios(OR)of 3.51(95% CI = 1.98-6.19,P < 0.001),2.12(95% CI = 1.20-3.76,P = 0.009),and 1.67(95% CI = 1.17-2.38,P = 0.004),respectively.The results of the multiple-factor analysis showed that COVID-19 infection(OR = 2.63;95% CI = 1.32-5.23;P = 0.006)was an independent risk factor for ED.7.Evaluation of erectile function after 3 months of COVID-19 infection: a total of 76 patients with erectile dysfunction after infection were divided into a treatment group(n=30)and control group(n=46)based on whether they received PDE5 inhibitors on demand.There were no significant differences in age,BMI,IIEF-5 score,and AVSS examination results between the two groups(P > 0.05).Compared with the control group,the treatment group showed significant improvements in IIEF-5 scores(P < 0.001),increased duration of full erection during AVSS examination(P = 0.002),and increased duration of erection with >60%rigidity in the head of the penis(P < 0.05)at 3 months after treatment.However,there were no significant differences in the increases in the expansion value of the coronal sulcus and base between the two groups(P > 0.05).Conclusion:1.Patients with COVID-19 infection may experience erectile dysfunction and endothelial injury in the short term,along with anxiety,depression,decreased testosterone levels,and decreased sperm motility.Furthermore,COVID-19 infection is an independent risk factor for ED.2.Early use of PDE5 inhibitors in patients with COVID-19 infection can help protect their erectile function.