Erectile function at three months after COVID-19 recovery

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In a recent study published in PLoS ONE, researchers explored the manifestation of erectile dysfunction (ED) after coronavirus disease 2019 (COVID-19) recovery.

Study: Erectile dysfunction after COVID-19 recovery: A follow-up study. Image Credit: BlurryMe/Shutterstock
Study: Erectile dysfunction after COVID-19 recovery: A follow-up study. Image Credit: BlurryMe/Shutterstock


Persistent sexual dysfunction following COVID-19 infection, also known as sexual long COVID syndrome, is a serious issue that could impair the quality of life. Research on this syndrome is still insufficient. One study showed that ED remained prevalent six to nine months after COVID-19 recovery. However, additional post-COVID-ED research is also required to address variations in sociocultural situations or post-recovery times.

About the study

In the present study, researchers examined the erectile function and its antecedents three months following COVID-19 recovery.

The King Chulalongkorn Memorial Hospital conducted an observational cohort study of hospitalized male COVID-19 patients. The team enrolled all male patients between 18 and 70 years who tested positive for COVID-19 with nasopharyngeal swab specimens and who reported having engaged in sexual activity in the previous two weeks between May and July 2021.

To stop the spread of the virus, the examination was done over the phone or online with patients who could not read or write. The same questionnaires were used to appraise each individual three months after their recovery. Age, education, body mass index (BMI), underlying diseases, marital status, and history of nicotine and alcohol usage were recorded at baseline. The COVID-19 vaccine and hospitalization treatment details were retrieved.

The International Index of Erectile Function 5 (IIEF-5) was used to evaluate each participant's erectile function during and three months after being diagnosed with COVID-19. The Thai Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety, respectively. Additionally, reports of penile morning erections from people were compiled.

Thai IIEF-5 is a self-rated test with five questions focusing on sexual intercourse satisfaction and erectile function in the Thai population. It is a common evaluation tool for diagnosing and evaluating EDs. Its scores could be divided into five categories: severe, moderate, mild to moderate, mild, and no ED. The Thai PHQ-9 was used to assess depressive symptoms such as sad mood, loss of energy and interest, problems sleeping and eating, feelings of worthlessness, difficulty focusing, psychomotor irregularities, and thoughts of self-harm or death. The severity of generalized anxiety disorder is measured using the GAD-7 scale. The measured symptoms included anxiety, unrestrained and excessive worrying, difficulty falling asleep, irritability, restlessness, and fear that something terrible might occur.


Between May and June 2021, a total of 153 of 654 hospitalized male COVID-19 patients reported being sexually active and qualified for the research. The initial assessment included the collection of the history of COVID-19 treatment up until discharge. A second evaluation fully completed by 141 participants was obtained three months following the COVID-19 infection. Between the first and second evaluations, there were no appreciable differences in mean age, BMI, or other variables. Most study participants had education levels below a bachelor's degree, were married or in relationships, and were employed.

At baseline, mental health status concerning depression and anxiety, erectile function, and self-reported normal morning erection was assessed. After examination of symptoms three months after COVID-19 recovery, the team observed remarkable differences in all aspects except the incidence of anxiety and self-reported normal morning erection. All participants whose IIEF-5 findings were ED-positive underwent a logistic regression to identify ED-related factors at three months.

Age and comorbidities were significant ED risk factors and were assessed. The team noted that males aged 40 years and older and having major depression at the time of infection had a significant association with ED after three months after COVID-19 infection. On the other hand, being overweight and suffering from hypertension, hypercholesterolemia, and diabetes mellitus were almost significant. Since ED is a dynamic disorder that changes over time, there are currently no gold standards for classifying ED associated with COVID-19.

Hence, the team divided all participants into four groups: those with no ED, transient ED, persistent ED, and later onset ED. The most typical ED was persistent ED, which was associated with severe depression during infection. Following recovery, a statistically considerable difference was observed in self-reported normal morning erection.


The study findings revealed that the prevalence of ED was still quite high even though it dramatically improved three months after COVID-19 recovery. Additionally, male patients older than 40 or experiencing major depressive disorder during COVID-19 were more likely to test positive for ED three months later. In the years following the end of the pandemic, doctors and patients would benefit from future studies concentrating on ED management, particularly in persistent ED.

Journal reference:
Bhavana Kunkalikar

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.


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