COVID-19 Endothelial Dysfunction Can Cause Erectile Dysfunction: A Histopathological, Immunohistochemical, and Ultrastructural Study of the Human Penis
Our study is the first to show the presence of COVID-19 virus in the penis long after the initial infection in humans. Our results also suggest that widespread endothelial cell dysfunction due to COVID-19 infection may contribute to ED. Future studies will evaluate novel molecular mechanisms for how COVID-19 infection leads to ED.
Kresch E, Achua J, Saltzman R, Khodamoradi K, Arora H, Ibrahim E, Kryvenko ON, Almeida VW, Firdaus F, Hare JM, Ramasamy R. COVID-19 Endothelial Dysfunction Can Cause Erectile Dysfunction: Histopathological, Immunohistochemical, and Ultrastructural Study of the Human Penis. World J Mens Health. Health. 2021;39:e22. https://doi.org/10.5534/wjmh.210055
Commentary
Studies have observed that COVID-19 can invade cells and affect cells and tissues that co-express ACE-2 and TMPRSS-2. Affected tissues affect endothelial cells, which explains the widespread endothelial dysfunction and COVID-19 infection. This phenomenon has been confirmed by electron microscopy, raising the question of whether penile tissue, which is rich in endothelial cells, is affected by this disorder. In short, the study provided a description of the histopathological features of penile tissue in patients who recovered from COVID-19 infection and later developed severe erectile dysfunction (ED).
A further hypothesis of this study is that ED is a consequence of systemic infection with COVID-19 and may be the result of extensive endothelial dysfunction. The other two hypotheses were that the worsening of ED in the patients studied could be due to the presence of the virus in the endothelium of the sponge itself.
However, the limitations of this study's conclusions are the sample size of two and the lack of objective quantification of erectile function before and after infection in patients and controls, so it does not seem possible to determine whether COVID-19 infection has this effect on all men.
