A recent study published in Andrologia reported that coronavirus disease 2019 (COVID-19) vaccination does not elevate the risk of erectile dysfunction (ED).
Although mRNA vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are safe and effective, vaccination rates have declined as some people suspect that vaccination causes impotence. For instance, Google searches regarding male reproductive issues increased by 34,900% following the emergency use authorization of Pfizer’s COVID-19 vaccine.
While SARS-CoV-2 vaccines have not been linked to ED, several reports have identified COVID-19 as a potential etiology of ED. SARS-CoV-2-infected males are 3.3 times more likely to experience ED than non-infected males. It has been hypothesized that penile endothelium could be damaged in COVID-19 due to the ubiquitous expression of the receptor, angiotensin-converting enzyme 2 (ACE2), in endothelial cells.
Viral replication damages the penile microvasculature leading to ED. Moreover, SARS-CoV-2 particles have been detected in corpus cavernosa even after COVID-19 resolution, supporting the hypothesis. Although none of the prior vaccination programs has been associated with ED, people cite sexual dysfunction for vaccine skepticism.
The study and findings
The present study assessed the risk of developing ED after COVID-19 vaccination. Adult males in the United States were surveyed anonymously using the Amazon Mechanical Turk (MTurk) platform. Participants aged 45 or older who identify as biological males without physician-diagnosed ED were included in the survey, and a 16-item questionnaire was administered.
The survey also included the International Index of Erectile Function (IIEF-5), a multidimensional scale to evaluate ED. Respondents provided information about past COVID-19 diagnoses, vaccination history, and current erectile function. A chi-squared test was performed to compare categorical variables. Mann-Whitney U tests were used to compute IIEF-5 scores. The association of COVID-19 vaccination with ED was estimated using multi-variable-adjusted logistic regression.
The overall response rate was 81.8%; an exploratory analysis of 138 respondents was performed. 121 (87%) individuals were vaccinated against SARS-CoV-2; most (101) were double-vaccinated, 18 were partially vaccinated, two were boosted, and 17 were non-vaccinated. Most (55.1%) males were aged 45 to 54 years. About 67% of respondents reported having tested positive for SARS-CoV-2. Of these, 45% had COVID-19 in the past six months, and the remaining respondents were diagnosed more than six months before the survey.
Around 47% of subjects were vaccinated with Pfizer’s COVID-19 vaccine, 38.3% with Moderna’s vaccine, and approximately 14% with Janssen’s vaccine. The median IIEF-5 score was 20 among vaccinated respondents, compared to 22 among non-vaccinated subjects. The adjusted logistic regression analysis showed that COVID-19 vaccination was not associated with an elevated risk of ED.
The study concluded that SARS-CoV-2 vaccination was not associated with a higher risk of ED in males 45 years or older. Erectile function was not statistically different between vaccinated and non-vaccinated participants. Although vaccinated males reported mild ED, this was not statistically different from non-vaccinated males.
Notably, the IIEF cannot assess males who use erectile aids (medications or vacuum devices). The use of the MTurk platform is subject to self-misrepresentation and social desirability bias. Altogether, these findings could have a far-reaching impact on decision-making and public health immunization amid the ongoing challenges of vaccine hesitancy and novel mutant variants of SARS-CoV-2.