Of Course SARS-CoV2 Causes Erectile Dysfunction


Cinderella might take her broomstick back.
I have spent the last 25 years educating consumers, employees, therapists and health professionals about sexual health. Over that time, I’ve gradually narrowed down everything I know into three answers. In fact, I now tell people before I begin trainings, to answer all of the questions I might ask with these three answers, given in the following order:

  1. Blood flow
  2. Nitric Oxide
  3. Inflammation

(Keep referring to this list as you read thru this article.) Over time, I have come to accept that few people want to know about number 2. Nitric Oxide[i] is a ubiquitous, influential gas that has a role in modern medicine akin to Cinderella without a fairy god mother. Present but unloved.


Incidentally in 2003, as a physician epidemiologist, I noted appearance of a coronavirus that leapt across the zoonotic “barrier” called SARS-CoV1[ii]. It was concerning for the obvious reasons, but one detail held me enthralled. The method of entry into the human body was thru the ACE-2 receptor. This was important to me because ACE2 receptors change

(answer #1)

by manipulating

(answer #2).
Fortunately, SARS-CoV1 did not reach the United States which is exceptional for it’s vast underfunding of public health services[iii], and persistent ignorance of how infections are transferred between people[iv].


When SARS-CoV2 leapt across the zoonotic “barrier” in 2019 and landed in the US in December 2019, I made several predictions. Like SARS-CoV1, SARS-CoV2 infection would cause endothelitis[v], or inflammation (-itis) of the inner (endo-) lining (-thelium) of small blood vessels where the ACE2 receptors lie. Infectious disturbance of the ACE2 receptor (lock) by the SARS-CoV2 spike proteins (keys), would reduce
(answer #1)
because of
(answer #2)
dysmetabolism caused by
(answer #3).
The effects of SARS-CoV2 infection would be system-wide, because blood vessels are everywhere in the human body. COVID-19 is not a lung disease, because as an organ of gas exchange, blood vessels are the other half of lung function. Instead, it’s a lung, kidney, brain, etc. disease, because again, blood vessels are everywhere. Blood clots are a given, because when something roughs up the endothelium, the body responds with clotting[vi] and messed up platelet function[vii]. In fact, the inflammation (“cytokine storm”) is triggered by nitric oxide-induced dysfunction[viii]. Cinderella might do magical things when cared for, but has a load of cinders at her fingertips. Hypoxemia[ix] pisses off Cinderella and all sorts of cinders fly.


Erectile Function
Penile erections are a reasonable barometer of sexual function[x] if you have a penis to pay attention to. Important by not omnipotent, penile erections require adequate functioning of intact anatomy, functional
(answer #1)
and biologically functional
(answer #2)
in a healthy environment of controlled
(answer #3).
While sexual arousal is a much larger concept than the presence of an erect penis, the capacity for erection is as useful as a broom stick to Cinderella. Something, but not everything.
[Do Not, Do Not, Do Not go and buy yourself a bottle of “nitric oxide”. If you are interested in maintaining sexual health, you will realize that although functional nitric oxide is critical for sexual arousal, too much or too little are both recipes for sexual function disaster. Just as in another fairy tale, Goldilocks needs just the right amount.]


Erectile Dysfunction and SARS CoV-2
Now that you’ve memorized my three answers, I ask you: how could COVID-19 NOT cause erectile dysfunction[xi] [xii]? Notice that if you can use the same three answers for both erectile dysfunction and SARS-CoV2 there is already an undeniable relationship between the two. While erectile dysfunction is by no means the most important outcome of COVID-19 infection, it is important to many people.
I predict that scientific research will reveal this outcome in the near future. But for now, judging from the calls/messages we are already receiving from concerned sex therapists, cases of young people (22-29 yo) experiencing erectile dysfunction after COVID-19 infection are beginning to accumulate. If sexual dysfunction isn’t a more personally relevant reason to avoid a SARS-CoV2 infection (beyond death, or death of your grandmother), I don’t know what is.


[i] https://en.wikipedia.org/wiki/Nitric_oxide

[ii] https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus

[iii] https://www.norc.org/PDFs/PH%20Financing%20Report%20-%20Final.pdf

[iv] https://onlinedoctor.superdrug.com/std-us-eu/

[v] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30937-5/fulltext

[vi] Riddell DR, Owen JS. Nitric oxide and platelet aggregation. Vitam Horm. 1999;57:25-48. doi: 10.1016/s0083-6729(08)60639-1. PMID: 10232045.

[vii] https://ashpublications.org/blood/article/95/11/3451/253303/Nitric-oxide-induces-apoptosis-in-megakaryocytic

[viii] Stefano GB, Esch T, Kream RM. Potential Immunoregulatory and Antiviral/SARS-CoV-2 Activities of Nitric Oxide. Med Sci Monit. 2020 May 26;26:e925679. doi: 10.12659/MSM.925679. PMID: 32454510; PMCID: PMC7271680.

[ix] https://www.frontiersin.org/articles/10.3389/fphys.2018.00125/full

[x] https://abdominalkey.com/physiology-of-penile-erection-and-pathophysiology-of-erectile-dysfunction/

[xi] Sansone A, Mollaioli D, Ciocca G, et al. Addressing male sexual and reproductive health in the wake of COVID-19 outbreak [published online ahead of print, 2020 Jul 13]. J Endocrinol Invest. 2020;1-9. doi:10.1007/s40618-020-01350-1

[xii] https://www.emedicinehealth.com/erectile_dysfunction_during_covid-19/article_em.htm