Initially Ramasamy and his colleagues from the Urology Clinic of the Hospital of the University of Miami thought that the growing number of reports of erectile dysfunction was to be traced back to a psychological factor, as a consequence of pandemic stress.But many patients claimed not to feel in anxiety or depressed, and for some the problem lasted for six months and beyond.The team then began to suspect another possible cause: the Sars-Cov-2 virus, head of Covid-19.
In Italy, a study is being assessed in which to enlist men with a stable relationship in which erectile dysfunction appeared simultaneously with the diagnosis of Post Covid syndrome, according to when Nicola Mondaini, associate professor of Urology at the Magna Grecia University of Catanzaro announced.
Covid-19 can damage the lungs, but it is still a systemic disease that can also affect the heart, kidneys, brain and other organs, and these effects can also remain for a long time after healing.Many people live a limbo condition called Long Covid (or post-covid syndrome), which experts believe represents next health disaster.According to an article published in August in the magazine New England Journal of Medicine, from 10 to 30% of people who contracted the virus - at least 42 million in the United States and 229 million worldwide - manifests an extension of debilitating symptoms that can cause"Significant disabilities".
Considering the complaints complained, more and more data suggest that Covid-19 could sabotage male sexual health."We have noted that men who previously did not suffer from these problems developed rather serious forms of erectile dysfunction, after the infection from Covid-19" says Ramasamy.
The probability of developing short and long -term erectile dysfunction can increase by six times after contracting the virus, according to a research published in March.Other studies have documented a series of post-infection health problems that impact on sex, which can be presented individually or in a combined way: inability to achieve or maintain erection, testicle damage, pain or testicular swelling, inability to achieve the'orgasm, low testosterone levels and disorders concerning mental health.
The scientific world places itself in strong contrast with the disinformation that is spreading online against vaccines (including a sadly famous tweet of rapper Nicki Minaj) which claims that anti-Covid-19 vaccines would cause swelling to the testicles and impotence.To date, there are no studies that support these theses.
"It is important that a clear message passes: the vaccination against Covid does not cause erectile function problems," says Ramasamy."The virus can have significant long -term adverse effects, instead the vaccine is safe".
Trace the virus in the fabrics
The men most at risk of serious forms of Covid-19, or the elderly, hypertensive, obese, diabetic and heart disease, are also more at risk in terms of sexual dysfunction.These conditions affect, among others, on hormones, muscles and blood vessels.However, young men also reported disorders concerning sexual health.Compared to the identification of the late short -term and chronic effects of this new virus "we are still in an observation and monitoring phase" says Ryan Berglund, urologist at the Cleveland Clinic in Ohio, and this also includes the effects that concern sexual healthand male reproductive.
To find out if the virus actually also invades the male reproductive bodies, Ramasamy and its team performed bioptic exams on six men aged between 20 and 87 years of age due to Covid-19.Examining these samples of fabric under the lens of the electronic microscope have discovered viruse particles nestled in an individual's testicles.Half of the subjects also presented a poor quality of the sperm, aspect that supports the data of other short post -mortem studies that raise questions about the impact of the disease on fertility.
Since the virus was in the testicles, Ramasamy wondered if it could also be present in the penis.The team deepened the exams by studying two men who became powerless after having had the virus.One of them had had the disease in a mild form, the other had been hospitalized.Convinced that they would never have had a natural erection again, both had turned to the clinic to see if they could undergo intervention for the planting of a penis prosthesis.
The virus was in fact present in the penis fabric, which was a shocking detection, says Ramasamy, given the timing: eight months had passed since the first manifestation of the infection.The doctors also found damage to the coating of small blood vessels of the organ.
Blood and bones
A well -known consequence of the coronavirus, or the damage to the endothelial cells that cover the blood vessels, is the most probable culprit of poor sexual performance.While some mammals have a bone inside their penis, the man for erection can only rely on blood flow.The arteries must open up and the veins contract, almost as in a closed system.If compromised or restricted, the blood vessels do not allow the cavernous bodies to fill with blood or to retain that blood to maintain the erection.
If the blood is not enough, the cells are missing the necessary oxygen, the tissues inflame and the vessels lose elasticity, says Emmanuele a.Jannini, professor of endocrinology and medical sexology at the Tor Vergata University of Rome."If there is no oxygen, there is no sexual intercourse" he says.
Jannini adds that Covid-19 also seems to lower the levels of an enzyme, the nitric oxide of endothelial synthesis, which helps the dilation of the blood vessels and the illegal penis of the penis.For subjects who have long -term manifestations, the damage caused by lung and heart pathology can worsen the problem, altering blood circulation and oxygen levels in the blood and tissues.
In the early days of the pandemic, the Jannini team launched an online survey that collected information on sexually active Italian men who did not have the virus.This was the study that revealed the risk of erectile dysfunction of six times greater, after the infection from Covid-19.The duration of symptoms is still not known, says Jannini.
"Since the penis is one of the most vascularized organs of the body, it did not surprise us that erectile dysfunction was more common in men who present post-covid syndrome" says Ramasamy.
In addition, in July the Patient-Led Research collaborative, a self-managed group of researchers with Long Covid, published the most complete information set among those available to date.They documented 203 symptoms in 10 devices, collecting the data from an online survey by about 6.500 people around the world.The results include sexual problems.
About 18% of men suffered sexual dysfunction, about 13% had pain in the testicles, 8% detected other disorders related to the sexual organs and about 4% of men suffered a reduction in the size of the penis or godstesticles.
A viral hiding place
The testicles are a perfect hiding place for viruses.Just like the eyes and the central nervous system, they are also privileged sites from an immunological point of view.In these "places", viruses such as Ebola, Parotite and Zika can remain in the fabrics, eluding the immune system even after the invader has been driven out of other parts of the body.
A study hypothesized that the testicles could therefore act as a tank for the virus that causes Covid-19.This could explain why 11% of men with Covid-19 hospitalized suffered from testicular pain.The body's leydig cell infection, which produce testosterone, could also explain the low levels of this male sex hormone in patients with Long Covid.Even alone, this aspect can cause a drop in libido and desire.Jannini highlights another vicious circle: testosterone production decreases, when men do not have sex.
Berglund states that in intimacy also the state of mind plays an important role "which depends in part on our psychological state".The pandemic has had a heavy impact in general on the mental health of Long Covid affected.Many suffer from post-traumatic stress disorder, anxiety or depression.The psychological effects of Covid-19 on sexual health will be the most difficult to eliminate, Berglund continues.
The urologist adds that the mere fact of being sick can kill the desire."When you struggle to breathe or have a chronic disease, it is likely that you are less interested in sex," he says.To worsen things then maybe the fatigue intervenes, one of the most common symptoms, and the loss of the smell, which further hinders the excitement, often triggered by the smells.
Sex and vaccines
Further studies must be conducted to understand how virus actually affects male reproductive health.The researchers are at work to reveal the mechanisms of what is still a relatively new disease.Ramasamy's team is studying how this virus does to evade the immune system and deposited in the cells, including those of testicles and penalties.“Enter a dormant state?And if so, can it then reactivate? "Do you ask the scholar “Keep causing damage?Or is your attack unique? "
The Congress offered 1.15 billion dollars (almost 980 million euros) to the National Institutes of US Healthcare (National Institutes of Health) for their recovery program, which will study the set of Long Covid-19 symptoms in the next fouryears.Many hope that this program will provide answers that we now need much, as well as treatments for those who have not yet defeated the disease.
And despite the disinformation that spreads on social media, research continues to deny that vaccines have consequences on fertility.A study published in June, for example, reported that there are no connections between the mRNA vaccines and a reduced spermatic count.
"The possible relationship between Covid-19 and erectile dysfunction is one of the many reasons why those who have not yet vaccinated should decide to do so" concludes Jannini "if they want to continue having sex, it is better that they vaccinate".