Can anxiety and depression serve as primary factors associated with erectile dysfunction after coronavirus disease?

OBJECTIVE: We investigated the association between anxiety and depression and erectile dysfunction (ED) in patients who developed ED after coronavirus disease 2019 (COVID-19). PATIENTS AND METHODS: This study included 228 men who were hospitalized in pandemic wards between July 2021 and January 2022 with positive reverse transcription-polymerase chain reaction test results for the severe acute respiratory syndrome coronavirus 2 RNA. All patients responded to a Turkish version of the International Index of Erectile Function (IIEF) questionnaire to determine erectile status. Patients were administered the Turkish version of the Beck Depression Inventory (BDI) and Generalized Anxiety Disorder 7-item scale (GAD-7) questionnaires the day after hospitalization and also during the 1st month after diagnosis of COVID-19 to compare the COVID-19 situation with the previous situation. RESULTS: Patients' mean age was 49.66 ± 13.3 years. The mean pre-COVID-19 erectile function score of 28.65 ± 1.33 decreased to a mean post-COVID-19 score of 26.58 ± 4.23, which indicates a statistically significant difference (p=0.03). Post-COVID-19 ED occurred in 46 (20.1%) patients; 10 (4.3%) patients had mild, 23 (10.0%) had mild-to-moderate, 5 (2.1%) had moderate, and 8 (3.5%) patients had severe ED. The mean pre-COVID-19 BDI score (which indicates depression) of 1.79 ± 2.45 increased to a mean post-COVID-19 score of 2.42 ± 2.89 (p<0.01). Additionally, the mean pre-COVID-19 GAD-7 score of 4.79 ± 1.83 increased to a mean post-COVID-19 score of 6.79 ± 2.52, which indicates a statistically significant difference (p<0.01). We observed a negative correlation between the increase in BDI and GAD-7 scores and the decrease in IIEF scores (r=0.426, p<.001, r=0.568, p<.001, respectively). CONCLUSIONS: Our study highlights that COVID-19 can cause ED and that disease-induced anxiety and depression serve as primary contributors to ED.

The prevalence and severity of mental health problems and sexual dysfunction in hemodialysis patients before and during the COVID-19 pandemic.

INTRODUCTION: This study aimed to investigate the prevalence and severity of mental health problems and sexual dysfunction in hemodialysis patients before and during the COVID-19 pandemic. METHODS: A total of 84 hemodialysis patients were evaluated in terms of Pittsburgh Sleep Quality Index, Beck Depression Inventory, International Index of Erectile Function (IIEF-5), and Female Sexual Function Index (FSFI). RESULTS: Poor sleep quality (79.8%) and poor mental health status (62.7%) and higher likelihood of having depression (31.0 vs. 61.9%, p < 0.001) were noted. The IIEF-5 (10.5 [5-25] vs. 7.5 [5-23], p < 0.001) and FSFI (12 [4-78] vs. 6 [4-66], p < 0.001) scores were significantly decreased during the pandemic with an increase in the likelihood of having erectile dysfunction (p < 0.001). CONCLUSION: Our findings indicate high prevalence of mental health issues, an impaired quality of life and an increase in prevalence and severity of suspected depression during pandemic in hemodialysis patients along with deterioration in erectile dysfunction among males.

COVID-19 vaccination does not affect male sexual functions.

BACKGROUND: COVID-19 infection has been linked with erectile dysfunction, which has also raised apprehensions about the impact of COVID-19 vaccination on male sexual functions. The purpose of this study was to investigate the impact of COVID-19 vaccination on male sexual functions, such as erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. METHODS: We used International Index of Erectile Function (IIEF) questionnaire for data collection. Mixed methods were adopted for this study, which consisted of Google online form distribution and the distribution of hard copies of the form to those who were not internet friendly. All data were entered in a spreadsheet and scores were assigned to each response according to the standard scores given in the IIEF questionnaire. Fifteen questions, one corresponding to each question in the IIEF questionnaire, were included to assess the impact of COVID-19 vaccination on each sexual function. RESULTS: In the first part of analysis, we calculated sexual function scores and men reporting low sexual function scores (~ 15%) were excluded, providing us with 465 individuals for further analysis. Regarding the impact of COVID-19 vaccination on male sexual functions, 71% individuals reported no impact, 3% reported a decline, 2.7% reported an improvement, and 23.3% could not assess the impact. We also performed analysis on the basis of age-groups of the participants and the duration after vaccination, finding that there was no impact irrespective of the age of subjects or the length of period after vaccination. CONCLUSIONS: COVID-19 vaccination does not affect male sexual functions, including erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall sexual satisfaction.

Relationship between COVID-19 and Male Sexual Dysfunction; A Prospective, Multicentric Study.

BACKGROUND: Sexual function is an excellent marker of psychological, systemic, and specifically vascular performance. Endothelial dysfunction is the main determinant of coronavirus disease 2019 (COVID-19) symptoms. Considering the adverse effects of the COVID-19 pandemic on psychological and sexual functions, we hypothesized potential differences and underlying factors if there is any erectile function and premature ejaculation status of male patients with COVID-19 by comparing both with the control group. METHODS: Hospitalized male patients diagnosed with COVID-19 pneumonia were evaluated. Male patients who applied to the Urology outpatient clinic were the control group. All participants completed the International Index of Erectile Function Form-15 (IIEF-15) and gave information regarding their premature ejaculation (PE) status if present. COVID-19 patients were called by phone to fill in the IIEF-15. Their PE status was questioned on the 45th and 90th days after discharge. The following parameters were in the data records: Age, comorbidity, length of hospital stay, treatment, oxygen saturation, pulmonary involvement, white blood cell (WBC), C-reactive protein (CRP), ferritin, fibrinogen, D-dimer, and sedimentation values. RESULTS: The study had 253 participants, including 168 COVID-19 patients and 85 volunteers as the control group. The number of PE cases was less, whereas erectile dysfunction (ED) cases were more in the COVID-19 patient group in comparison to the control group in the pre-pandemic period (p = 0.00) (p = 0.00). In the post-pandemic period, PE developed in 13 more COVID-19 patients on the 45th and 90th days (p = 0.00). The IIEF-15 scores of COVID-19 patients decreased by 4-point in the short term and by 3-point in the long term (p = 0.002). Age and sedimentation were responsible for the difference in PE status. On the other hand, comorbidity, length of hospital stay, treatment type, WBC, D-dimer, ferritin, CRP levels, and pulmonary infiltration were responsible for the difference in ED. CONCLUSIONS: Based on our findings, we can say that we have enough evidence to suspect COVID-19 sequelae can affect male sexual health. After the pandemic, male patients with andrological problems should have enough time to feel more comfortable and their organic and psychogenic conditions should be optimized.

Erectile dysfunction after COVID-19 recovery: A follow-up study.

OBJECTIVES: Several studies confirm multiple complications after COVID-19 infection, including men's sexual health, which is caused by both physical and psychological factors. However, studies focusing on long-term effects among recovered patients are still lacking. Therefore, we aimed to investigate the erectile function at three months after COVID-19 recovery along with its predicting factors. METHODS: We enrolled all COVID-19 male patients, who were hospitalized from May to July 2021, and declared to be sexually active within the previous two weeks. Demographic data, mental health status, and erectile function were collected at baseline and prospectively recollected three months after hospital discharge. To determine changes between baseline and the follow-up, a generalized linear mixed effect model (GLMM) was used. Also, logistic regression analysis was used to identify the associating factors of erectile dysfunction (ED) at three months. RESULTS: One hundred fifty-three men with COVID-19 participated. Using GLMM, ED prevalence at three months after recovery was 50.3%, which was significantly lower compared with ED prevalence at baseline (64.7%, P = 0.002). Declination of prevalence of major depression and anxiety disorder was found, but only major depression reached statistical significance (major depression 13.7% vs. 1.4%, P < 0.001, anxiety disorder 5.2% vs. 2.8% P = 0.22). Logistic regression, adjusted for BMI, medical comorbidities, and self-reported normal morning erection, showed a significant association between ED at three months and age above 40 years and diagnosis of major depression with adjusted OR of 2.65, 95% CI 1.17-6.01, P = 0.02 and 8.93, 95% CI 2.28-34.9, P = 0.002, respectively. CONCLUSION: Our study showed a high ED prevalence during the third month of recovery from COVID-19. The predicting factors of persistent ED were age over 40 years and diagnosis of major depression during acute infection.

Sexual dysfunction among men with diabetes; a cross-sectional study at a specialised diabetes clinic in Sri Lanka.

BACKGROUND: Male sexual dysfunction in diabetes is often an unrevealed clinical issue. Though many publications report the prevalence, there is limited data on its associations, impact, and health-seeking behaviour. The objectives were to assess the prevalence of male sexual dysfunction, its associations, impact and treatment-seeking among men with diabetes in a selected tertiary care Diabetes Clinic. METHODS: A cross-sectional study was conducted at the Diabetes Clinic, National Hospital of Sri Lanka, from January to September 2020. Men with diabetes aged 18 to 70 years undergoing annual assessment were recruited consecutively. Socio-demographic and clinical information were collected using an interviewer-administered questionnaire. Erectile dysfunction (ED), premature ejaculation, mental health and quality of life were assessed using validated self-administered questionnaires. Cardiovascular autonomic reflex tests and total testosterone levels were performed. Penile colour Doppler ultrasonography was performed on consenting participants with erectile dysfunction. Associations were assessed using the chi-square test or Fisher's exact for dichotomous variables and independent sample t-test for continuous variables. RESULTS: Two hundred and twelve participants were recruited with a mean age of 54.1 (SD = 10.1) years. Erectile dysfunction was present in 168 (79.2%), (mild: 45, mild-moderate: 56, moderate: 26, severe: 41). Premature ejaculation was present in 26 (18.7%). Libido was low among 16%. Sexual dysfunction was not revealed to a health provider by 85.6% despite 60.5% experiencing psychological and/or relationship effects. Out of 18 who sought treatment, only 4 achieved a good response. Mean age (55.4 ± 9.5 vs 48.7 ± 10.6 years, p < 0.001) and duration of diabetes (10.9 ± 7.6 vs 5.8 ± 4.6 years, p < 0.001) were higher while eGFR was lower (73.9 ± 27.7 vs 100.51 ± 28.08 years, p < 0.008) among those with ED compared to those without. Diabetic retinopathy (4% vs 42%, p < 0.001), peripheral neuropathy (17.9% vs 38.4%, p = 0.041) and lower limb arterial disease (0% vs 12.2%, p = 0.04) were associated with ED. Arterial insufficiency was seen among 50% of the participants who underwent penile colour Doppler ultrasonography. CONCLUSIONS: Male sexual dysfunction is a pervasive yet underappreciated problem in diabetes care despite its effect on the individual. Patient and disease characteristics would guide the identification of high-risk individuals for targeted screening in clinical practice.

Impact of COVID 19 on erectile function.

Purpose: COVID-19, a novel infection, presented with several complications, including socioeconomical and reproductive health challenges such as erectile dysfunction (ED). The present review summarizes the available shreds of evidence on the impact of COVID-19 on ED.Materials and methods: All published peer-reviewed articles from the onset of the COVID-19 outbreak to date, relating to ED, were reviewed. Results: Available pieces of evidence that ED is a consequence of COVID-19 are convincing. COVID-19 and ED share common risk factors such as disruption of vascular integrity, cardiovascular disease (CVD), cytokine storm, diabetes, obesity, and chronic kidney disease (CKD). COVID-19 also induces impaired pulmonary haemodynamics, increased ang II, testicular damage and low serum testosterone, and reduced arginine-dependent NO bioavailability that promotes reactive oxygen species (ROS) generation and endothelial dysfunction, resulting in ED. In addition, COVID-19 triggers psychological/mental stress and suppresses testosterone-dependent dopamine concentration, which contributes to incident ED.Conclusions: In conclusion, COVID-19 exerts a detrimental effect on male reproductive function, including erectile function. This involves a cascade of events from multiple pathways. As the pandemic dwindles, identifying the long-term effects of COVID-19-induced ED, and proffering adequate and effective measures in militating against COVID-19-induced ED remains pertinent.

Genetic susceptibility to COVID-19 may increase the risk of erectile dysfunction: A two-sample Mendelian randomization study.

Coronavirus disease 19 (COVID-19) and erectile dysfunction (ED) have been linked in some observational research, but the causality of this association in the European population is uncertain. Therefore, the research intended to investigate the causality of susceptibility to COVID-19 on ED. We used Mendelian randomization (MR) analysis for this research. The subjects were from two genome-wide association studies (GWAS) of the European population, including COVID-19 (14,134 cases and 1,284,876 controls) and ED (6175 cases and 217,630 controls). We utilized the inverse variance-weighted (IVW) to evaluate the causality of COVID-19 genetic susceptibility on ED. Heterogeneity and pleiotropy were determined using the Cochran's Q test and MR-Egger regression. The robustness of the findings was verified using the Leave-one-out method. We obtained six single nucleotide polymorphisms (SNPs) as COVID-19 genetic instrumental variables (IVs), and there was no significant pleiotropy, heterogeneity or bias in these IVs. MR analysis revealed the causality of genetic susceptibility to COVID-19 on elevated risk of ED (ORIVW  = 1.235, 95% CI: 1.044-1.462, p < 0.05). The present study suggested the causality of genetic susceptibility to COVID-19 on elevated ED risk among the European population. Therefore, in order to decrease the ED risk, the European population ought to positively prevent COVID-19.

A factor not to be ignored in post-COVID-19 erectile dysfunction; psychological effect, a prospective study.

It was aimed to show the effect of anxiety and depression on erectile dysfunction seen after coronavirus disease-2019 (COVID-19). Between March and July 2021, the participants completed the International Index of Erectile Function, Beck Depression Inventory and Generalised Anxiety Disorder 7 forms at the beginning and after the 1st month of the disease. We investigated the psychological impact of COVID-19 on the development of erectile dysfunction. The mean age of 156 male patients in the study was 54.74 ± 8.01 years. It was determined that the mean International Index of Erectile Function scores of the patients before COVID-19 were 73.42 ± 3.43 and decreased to 68.28 ± 12.86 after COVID-19 (p < .01). The patients' erectile function scores were significantly lower after COVID-19 (29.45 ± 1.23, 27.69 ± 4.33, p < .01, respectively). Their Beck Depression Inventory scores were statistically significantly higher after COVID-19 (1.69 ± 2.56, 2.22 ± 2.79, p < .01, respectively). Their Generalised Anxiety Disorder 7 scores were also statistically significantly higher after COVID-19 (4.69 ± 1.63 6.56 ± 2.40, p < .01, respectively). A negative correlation was found between the increase in the Beck Depression Inventory score during the pandemic process and the decrease in the International Index of Erectile Function score (r = -0.356, p = <.001). A negative correlation was also found between the increase in the Generalised Anxiety Disorder 7 score and the decrease in the International Index of Erectile Function score (r = -0.200, p = .012). One of the main factors post-COVID-19 erectile dysfunction is anxiety and depression due to the disease.

Interaction between the impact of the Coronavirus disease 2019 pandemic and demographic characteristics on sexual/erectile dysfunction in Latin America: cross-sectional study.

AIM: Our objective was to investigate whether there is an interaction between the COVID-19 pandemic, demographic characteristics and erectile/sexual (E/S) function in individuals from Latin America. MATERIALS AND METHODS: Cross-sectional study which included Latin American individuals over 18 years old, recruited through social media and interviewed between July and August 2020 by online surveys (Google Forms) in Portuguese and Spanish languages. The E/S function was evaluated through the following questionnaires: Simplified International Index of Erectile Function (IIEF-5) and Female Sexual Function Index (FSFI); while post-traumatic stress disorder (PTSD) triggered by the COVID-19 pandemic was assessed through the Impact of Event Scale Revised (IES-R). The data was analyzed by T Student, bivariate and multivariate logistic regression, with significance determined by the Wald test (p<0.05), using the R software v4.0. RESULTS: Out of the 2016 individuals that responded to the survey, 1986 were included and 743 of them presented E/S dysfunction. PTSD occurrence was greater among people with E/S dysfunction when compared to those without E/S dysfunction, in the total score (males: IES-R=26.54[±19.17] and females: IES-R=35.92[±19.25]) and also in the three domains. It was found that those who do not live with a partner were 74% more likely to have E/S dysfunction, but living with a partner during the pandemic had a greater impact on E/S function. CONCLUSION: A negative interaction between the impact of the COVID-19 pandemic and erectile/sexual function of the Latin American population was observed, with greater implications among the individuals who live with their partners.

Tip of the iceberg: erectile dysfunction and COVID-19.

The novel severe acute respiratory syndrome coronavirus 2 caused the coronavirus 2019 (COVID-19) pandemic that resulted in more than 150 million infections and 3.5 million deaths globally. COVID-19 affected men more than women, emerging with more severe disease and higher mortality rates. Androgens may be responsible for the underlying reason of more severe disease, as androgen receptors have been implicated to mediate viral cell entry and infection. Besides, male reproductive organs have been reported to be affected by the especially severe disease, resulting in erectile dysfunction (ED). In this narrative review, we aimed to gather possible mechanisms of the development of ED led by COVID-19. Current evidence illuminates endothelial dysfunction, direct testicular damage, and the psychological burden of COVID-19 that are of the pathways of ED. Although the proposed underlying mechanisms partly fail to answer the questions by which COVID-19 leads to ED, it is important to monitor men who recovered from COVID-19 regarding the sexual dysfunction sequelae of infection and address the long-term consequences.

Erectile dysfunction among patients and health care providers during COVID-19 pandemic: A systematic review.

COVID-19 pandemic is associated with devastating effects on social, psychological, and economical aspects of survivors. We assume that erectile function (EF) is affected as well. We performed a systematic review of the published articles about the change in EF among patients and health care providers during the COVID-19 pandemic. We searched PubMed and Cochrane databases for English literature using a combination of medical subject headings (MeSH) terms and keywords. We extracted data of erectile dysfunction (ED) rate, international index of erectile function (IIEF), changes related to exposure to the pandemic (Primary objectives), and factors affecting these differences (Secondary objectives). Twenty articles were included in the screening phase. Only 3 articles were eligible for primary objectives, and 2 articles were included for the secondary objective. Three articles revealed an increase in ED cases and a reduction in IIEF-5 scores during the pandemic. Rates of ED have ranged from 32% to 87% of the study populations. Anxiety, depression, and post-traumatic stress disorder (PTSD) were associated with increased ED rates. We conclude that the COVID-19 pandemic is associated with increased rates of ED. Anxiety and depression augment this increase. Health care providers are at higher risk for PTSD, which increases the risk of ED.

Erectile dysfunction and testosterone levels prior to COVID-19 disease: What is the relationship?

OBJECTIVE: We aimed to investigate the relationship between COVID-19 and Erectile Dysfunction (ED) and the effect of serum testosterone level on the disease prognosis. METHODS: Between April-December 2020, 70 patients who were admitted with a complaint of ED after having COVID-19 and whose serum testosterone level was checked for varicocele, premature ejaculation, and infertility reasons before COVID-19. The patients filled the International Index of Erectile Function (IIEF-5) and their testosterone level was checked. The questionnaire was arranged to assess the first month before COVID-19 and after COVID-19. Testosterone levels of the patients before and after COVID-19 were compared. The relationship between testosterone levels and hospitalization in the intensive care was evaluated. RESULTS: It was revealed that testosterone levels and IIEF-5 scores after COVID-19 in all patients were statisticaly and significantly different compared to the period before COVID-19 (p < 0.05). Testosterone levels of patients in need of intensive care were significantly higher than those without any need of intensive care (p < 0.05). CONCLUSIONS: Our study has presented that COVID-19 may cause ED and high testosterone levels increase the rate of hospitalization in the intensive care by intensifying the disease.

The Association Between Sleep Disturbances and Erectile Dysfunction During the COVID-19 Pandemic.

INTRODUCTION: There is increasing concern about the impact of the SARS-CoV-2 pandemic on mental and physical health. Among the many possible outcomes of COVID-19, reports of sleep disturbances, and erectile dysfunction are becoming prevalent worldwide. OBJECTIVES: We sought to evaluate the recent literature on this subject to produce a narrative review of the topic. METHODS: We performed an extensive literature search to identify recent scientific findings on this subject. RESULTS: To date, the precise mechanisms that trigger pandemic related sexual dysfunction are not completely understood, although it has been suggested that psychogenic effects play an important role, in addition to the direct effects of the disease itself on those infected. There is evidence that the stress induced by the pandemic has had a significant impact on sleep, and sleep disturbances are known to induce erectile dysfunction. Other mechanisms which trigger this phenomenon, such as hormonal changes and previous health conditions, have been suggested to be associated with SARS-CoV-2 infection, and these factors may have a potential link to sleep disturbance. CONCLUSION: The combined effect of COVID-19 and the psychogenic disorders triggered by isolation, grief, and anxiety might be associated with the increased prevalence of erectile dysfunction. This feature might be worsened by the onset of pre-existing or pandemic-induced sleep disorders. However, few studies explored this subject. Understanding this phenomenon is important for the strategic planning of treatments that could improve the quality of life of the population. Andersen ML and Tufik S. The Association Between Sleep Disturbances and Erectile Dysfunction During the COVID-19 Pandemic. Sex Med Rev 2022;10:263-270.

Erectile dysfunction treatment with Phosphodiesterase-5 Inhibitors: Google trends analysis of last 10 years and COVID-19 pandemic.

OBJECTIVES: We aimed to analyze the trend change of the most popular Phosphodiesterase-5 Inhibitors (PDE5i) over time and geography by using Google Trends (GT) data in 10 years period and COVID-19 pandemic. MATERIALS AND METHODS: GT is able to generate a "line-graph", showing how interest has increased or decreased over a period within specific territories. The search values for specific terms are indexed as relative search volume (RSV), which is presented on a scale from 0-100. Avarage annual percentage change (AAPC) and RSV were analyzed to evaluate gain or loss of interest in trends. Search terms were generated for Food and Drug Administration (FDA)-approved PDE5i; tadalafil, sildenafil, vardenafil, avanafil, and their most-used brand names. The data was within "worldwide" from 1 January 2010, to 31 December 2020, using the ''global'' query category. RESULTS: The overall interest in PDE5i has doubled. Sildenafil has become the most trend PDE5i of today with a regular increase (AAPC: 0.016, p < 0.01). Although the search trend of tadalafil remained almost constant until 2014, the rate of increase in the last 6 years raised and tadalafil has become the 2nd most popular PDE5i recently (AAPC: 0.007, p < 0.01). For vardenafil there has been a decreased interest (AAPC: -0.009, p < 0.01). There is no significant change in avanafil trend (AAPC: 0.000, p: 0.5). All PDE5i interest on GT decreased notably from February to June 2020. But after June, search trends reached the level before the COVID-19 period in a month. CONCLUSIONS: These findings show us, with its increasing prevalence, erectile dysfunction (ED) has become a major public health problem. People from different geographies search the internet for ED treatment options. Patients should be informed that ED may be the first sign of many comorbid diseases, and patients with ED should be referred to a health institution for diagnosis and treatment.

Increased odds ratio for erectile dysfunction in COVID-19 patients.

PURPOSE: Erectile dysfunction and COVID-19 share similar risk factors, including vascular disruption of integrity, cytokine release, cardiovascular disease, diabetes and obesity. The aim of this study was to investigate the association between erectile dysfunction and COVID-19 patients. METHODS: Odds ratio for erectile dysfunction in patients with a history of COVID-19 with and without comorbidities were calculated using a patients' registry platform i2b2. ICD-10 diagnoses codes were accessed for queries and data were analyzed using logistic regression. RESULTS: Patients with COVID-19 were 3.3 times more likely to have erectile dysfunction with 95% CI (2.8, 3.8). The association became stronger with odds ratio 4.8 (95% CI (4.1, 5.7)) after adjusting for age groups. The odds ratio remained the same after adjusting for smoking status with 3.5 (95% CI (3.0, 4.1)). After adjusting for race, COVID-19 patients were 2.6 (95% CI (2.2, 3.1)) times more likely to have erectile dysfunction. The odds ratio were 1.6, 1.8, 1.9 and 2.3 after adjusting for respiratory disease, obesity, circulatory disease and diabetes, respectively. CONCLUSION: COVID-19 and erectile dysfunction are strongly associated even after adjustment for known risk factors and demographics.

The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers.

INTRODUCTION: Long term complications of COVID-19, the disease caused by the SARS-CoV-2, involve many organ systems, dramatically worsening the quality of life, and finally contributing to impaired physical functioning. Despite the presence of well-identified pathogenetic mechanisms, the effect of "Long COVID" on sexual health has been only marginally addressed. OBJECTIVES: To provide coverage of the current literature on long COVID, its epidemiology, pathophysiology, and relevance for erectile function. METHODS: Comprehensive review of literature pertaining to the epidemiology and pathophysiology of long COVID, and its relevance for erectile function. RESULTS: Symptoms of long COVID are highly prevalent and involve almost all systems of the human body, with a plethora of clinical manifestations which range from minor nuisances to life-threatening conditions. "Brain fog" and fatigue are the most common complaints, although other neuropsychiatric complications, including sensory dysfunctions, anxiety, depression, and cerebrovascular events have also been reported. The respiratory and cardiovascular systems are also affected, with dyspnea, pulmonary fibrosis, endothelial dysfunction, and myocarditis occurring in some COVID long haulers. A subset of patients might develop endocrine manifestations, including onset of diabetes, thyroid dysfunction, and hypogonadism. Overall, long COVID features many complications which can impair erectile function by multiple pathogenetic mechanisms, and which could require tailored treatment: (i) careful investigation and management from the sexual medicine expert are therefore much needed, (ii) and future research on this topic is warranted. CONCLUSION: in COVID-19 long haulers, several complications can adversely affect erectile function which, upon future tailored studies, could be used as biomarker for the severity of the long COVID disease and for its follow-up. Sansone A, Mollaioli D, Limoncin E et al. The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers. Sex Med Rev 2022;10:271-285.

Predictive factors of erectile dysfunction in Egyptian individuals after contracting COVID-19: A prospective case-control study.

This study aimed to screen healthy individuals who contracted COVID-19 for erectile dysfunction (ED) and to determine the potential risk factors that can predict ED in these individuals. One hundred and seven cases versus 90 controls agreed to participate in the study. Two structured interviews with 1 month interval were conducted. All participants were evaluated by the validated Arabic version of the international index of erectile function (IIEF-5) and assessment of the psychological state by Hamilton depression rating scale (HDRS). Interestingly, the study had demonstrated a significant difference in mean testosterone level between cases and controls (3.91 ± 2.31, 5.04 ± 2.22, p < 0.001 respectively). Additionally, the study had demonstrated a significant difference in mean IIEF-5 score between cases and controls (22.63 ± 2.79, 23.54 ± 1.26, p < 0.041 respectively). Moreover, there were significant differences in mean anxiety and stress scores of the cases before and after COVID-19 (4.95 ± 4.03, 6.19 ± 3.55, p = 0.022, 12.75 ± 9.98, 15.30 ± 7.42, p = 0.024 respectively). A multiple logistic regression model for predicting ED occurrence post-COVID-19 had revealed that smoking, baseline IIEF-5 score and COVID-19 severity (p = 0.022, p = 0.017, p = 0.021, p = 0.009, p = 0.008 respectively) were the only significant independent variables.