Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

J Endocrinol Invest. 2021 Feb;44(2):223-231. doi: 10.1007/s40618-020-01350-1. Epub 2020 Jul 13.


Purpose: The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a "cytokine storm", which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients.

Methods: A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed.

Results: Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED.

Conclusion: COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.

Keywords: COVID-19; Cardiovascular health; Erectile dysfunction; Male hypogonadism; SARS-CoV-2; Sexual dysfunction.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2 / physiology
  • COVID-19* / complications
  • COVID-19* / physiopathology
  • COVID-19* / psychology
  • Cardiovascular Diseases / virology
  • Cytokine Release Syndrome / virology
  • Erectile Dysfunction / blood
  • Erectile Dysfunction / psychology
  • Erectile Dysfunction / virology
  • Humans
  • Hypogonadism / virology
  • Luteinizing Hormone / blood
  • Male
  • Reproductive Health*
  • SARS-CoV-2* / physiology
  • Sexual Health*
  • Testis / enzymology
  • Testis / physiopathology
  • Testis / virology
  • Testosterone / blood


  • Testosterone
  • Luteinizing Hormone
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2