RESUMEN
OBJECTIVE: The main objective of this revision is to summarize the current existing evidence of the potential adverse effects of SARS-CoV-2 on the male reproductive system and provide the recommendations of the Asociación Española de Andrología, Medicina Sexual y Reproductiva (ASESA) concerning the implications of COVID-19 infection in the management of male infertilty patients and testicular endocrine dysfunction. METHODS: A comprehensive systematic literature search of the databases of PubMed, Web of Science, Embase, Medline, Cochrane and MedRxiv, was carried out. RESULTS: The presence of orchitis as a potential complication of the infection by SARS-CoV-2 has not yet been confirmed. One study reported that 19% of males with COVID-19 infection had scrotal symptoms suggestive of viral orchitis which could not be confirmed. It is possible that the virus, rather than infecting the testes directly, may induce a secondary autoimmune response leading to autoimmune orchitis. COVID-19 has been associated with coagulation disorders and thus the orchitis could be the result of segmental vasculitis. Existing data concerning the presence of the virus in semen are contradictory. Only one study reported the presence of RNA in 15.8% of patients with COVID-19. However, the presence of nucleic acid or antigen in semen is not synonyms of viral replication capacity and infectivity. It has been reported an increase in serum levels of LH in males with COVID-19 and a significant reduction in the T/LH and FSH/LH ratios, consistent with subclinical hypogonadism. CONCLUSIONS: The findings of recent reports related to the potential effects of COVID-19 infection on the male reproductive system are based on poorly designed, small sample size studies that provide inconclusive, contradictory results. Since there still exists a theoretical possibility of testicular damage and male infertilty as a result of the infection by COVID-19, males of reproductive age should be evaluated for gonadal function and semen analysis. With regard to the sexual transmission of the virus, there is not sufficient evidence to recommend asymptomatic couples to abstein from having sex in order to protect themselves from being infected by the virus. Additional studies are needed to understand the long-term effects of SARS-CoV-2 on male reproductive function, including male fertility potential and endocrine testicular function.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pandemias , Neumonía Viral/complicaciones , Salud Reproductiva , Salud Sexual , Adulto , Betacoronavirus/aislamiento & purificación , Betacoronavirus/patogenicidad , Betacoronavirus/fisiología , COVID-19 , Hormona Folículo Estimulante/sangre , Humanos , Hipogonadismo/sangre , Hipogonadismo/etiología , Inmunoglobulina G/análisis , Leucocitos , Hormona Luteinizante/sangre , Masculino , Orquitis/etiología , Orquitis/virología , Próstata/virología , ARN Viral/análisis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2 , Semen/virología , Preservación de Semen , España , Testículo/inmunología , Testículo/patología , Testículo/virología , Testosterona/sangre , Vasculitis/etiología , Adulto JovenRESUMEN
In 1993 the NIH (National Institute of Health) Consensus Conference on Impotence defined erectile dysfunction as the permanent incompetence to start or maintain an erection enough to enable satisfactory sexual intercourse. Erectile dysfunction (ED) is a frequent disorder that affects negatively quality of life of males suffering it. Its prevalence varies between different countries, cultures and races. The first population studies published date from early 90's and still keep their validity. All of them show the influence of age on prevalence of ED, as well as its close relationship with cardiovascular diseases. Depending on the definition used and study design prevalence varies from 10 to 52%, mainly in men between 40-70 years, with an incidence in western countries between 25-30 new cases per 1000 inhabitants year.