Abstract
Introduction: The short- and long-term effects of coronavirus disease 2019 (COVID-19) on erectile function and penile vasculature remains poorly understood and is of particular importance as the virus has been found to be present within the penile tissue.
Aim: We determined the association of COVID-19 infection and subsequent diagnoses of erectile dysfunction.
Methods: We assessed the risk of ED in men with COVID-19 in the United States (US) using the TriNetX Research Network, a federated electronic medical records network of over 42 healthcare organizations and 66 million patients from the US. We identified adult men (>= 18 years) with a recorded COVID-19 infection (ICD-10-CM B34.2, U07.1, U07.2, J12.81, J12.82, B97.29) since January 1, 2020, and compared them to an equivalent number of adult men who did not have COVID-19 over the same timeframe. Men with prior history or diagnosis of ED before January 1, 2020 were excluded. We accounted for confounding variables through propensity score matching for age, race, body mass index (BMI), and history of the following comorbid medical conditions: diabetes mellitus (El 1), hypertension (110), ischemic heart disease (120-25), or hyperlipidemia (E78).
Outcomes: We assessed the association between COVID-19 and ED (N52) as a primary outcome through regression analysis with statistical significance assessed at P< .05.
Results: Prior to propensity score matching, men with COVID-19 were found to be older than men without COVID-19 (47.1 +/- 21.4 vs 42.4 +/- 24.3 years). Additionally, men with COVID-19 were noted to have increased prevalence of diabetes mellitus (DM) and hypertension (HTN) when compared to men without COVID-19 (13% DM and 27% HTN vs 7% DM and 22% HTN). After propensity score matching, we compared 230,517 men with COVID-19 to 232,645 men without COVID-19 and found that COVID-19 diagnosis was significantly associated with ED (odds ratio 1.20, 95% confidence interval 1.004-1.248, P= .04).
Clinical Implications: Our findings indicate that clinicians should consider evaluating erectile dysfunction among men with recent COVID-19 diagnoses and counsel them regarding the risk of developing erectile dysfunction.
Strengths and Limitations: Strengths include large sample size and adjustment for confounding variables. Limitations include reliance on a global federated dataset, retrospective study design, and lack of data regarding ED (mild vs moderate vs severe), COVID-19 infection severity, or history of prostate cancer and radiation,
Conclusion: There is an increased chance of new onset erectile dysfunction post-COVID-19 infection. Published by Elsevier Inc on behalf of the International Society for Sexual Medicine
