The Effects of Long COVID on Sexual Health

Everyone awaits the day when the COVID-19 pandemic will end. Yet, backlash caused by the SARS-CoV variant is far from over for COVID long-haulers who continue to be ill long after they experience their first symptoms.

Despite the worldwide burnout known as "COVID fatigue," sexual long COVID may motivate the global community to continue its best efforts to prevent the spread of coronavirus variants.

Below are a few possible symptoms of long COVID leading to sexual long COVID:

• Erectile dysfunction in males; emotional distress and low libido in females
• Circulation disorders that block blood flow to the genitals 
• Brain fog, including confusion, forgetfulness, inability to concentrate or stay awake during sex
• Endocrine disorders involving a new onset of diabetes, thyroid disease, or low testosterone levels
• Anxiety and depression related to long-haul problems that suppress libido
• Sensory dysfunctions or nerve pathway disorders causing tingling or pain in hands and feet
• Musculoskeletal pain and joint tenderness that makes intimate activity uncomfortable
• Brain events (such as strokes) and cardiac dysfunctions ranging from extra beats to heart attacks
• Lung problems like shortness of breath, cough and chest discomfort that deter intercourse

Many physicians tell survivors they have no measurable COVID-19 after-effects and blame nuisance symptoms like poor sexual performance on "pandemic stress." Unfortunately, these misdiagnoses diminish the COVID survivor's plea for help.

Moreover, physicians don't discuss sexual health issues unless the patient mentions the problem first — many patients are too embarrassed to report sexual performance issues while struggling to recover, so sexual long COVID often goes untreated.

Sixty-four-year-old Anita (a pseudonym), who lives in The Villages in Florida, caught COVID-19 in December 2021. She tested positive after developing a fever, fatigue, and cough. She soon became short of breath and struggled to perform simple tasks.

Anita went to the Emergency Department and was in intensive care for five days because of low oxygen levels caused by COVID pneumonia. She reported feeling death anxiety as soon as her hospitalization began, and her thoughts about death persisted for months.

To this day, Anita has not fully recovered from COVID-19 because of her anxiety and shortness of breath. This fear affects her love life. She also claims that experiencing COVID-19 is still her most debilitating issue.

"Before I discovered that my illness caused me to develop asthma, I would wake up in the middle of the night and feel so confused. It took weeks to realize that I was awakening because I was short of breath."

Fortunately, after months of doctor's visits, testing, and medication trials, Anita reports her asthma to be in better control. "I now depend on two inhalers, especially when I exert myself. I cannot hike or exercise like I did before I got sick without having an asthma attack."

"However, I admit to having significant problems with my love life because I am afraid sexual activity will trigger an asthma attack. I'm hopeful I'll one day feel as well as I did pre-COVID. I don't have the same quality of life since long COVID impacted my world. I'm so glad my husband didn't catch my infection, but I think he knows my illness has damaged our love life."

Anita's experience of having to endure months of doctor visits and testing confirms how hard it was for her to get the health care she eventually received for her breathing issues.

Her primary care physician kept telling her that she was imagining her long COVID problems and suggested she needed a therapist. She admits that no one has asked her if COVID-19 has affected her sexual health.

Clyde Goodheart, of Fort Lauderdale, Florida, is a biomedical research scientist who studies viruses and other disease causes. Goodheart believes that long COVID complications are likely due to "micro clots" that block blood flow to multiple affected organs. 

According to Goodheart, "COVID long haulers who have problems with breathing most likely have tiny clots in the smallest blood vessels (capillaries) in their lungs." 

Goodheart explains how tiny blood clots cause endothelial dysfunction, which occurs when the linings of blood vessels become damaged, causing circulation to the affected organs to become blocked. Post-COVID endothelial dysfunction contributes to erectile dysfunction (ED) when micro clots impair the circulation inside the penis, which causes problems with getting or keeping an erection. 

Genital circulation is not the only organ system affected by impaired circulation; lungs, brain, heart, nerves,and muscles can all potentially be damaged by micro clots that impair circulation.

A study by the University of Florida Health (UFH) shows that men infected by a SARS-CoV-2 variant are three times more likely to develop erectile dysfunction than men unaffected by infection.

Here's what UFH researchers discovered:

• In men who suffered significant COVID-19 infections, those with increased risk factors for COVID-19 complications were most likely to develop long-term ED.
• Complication risk factors include prior history of diabetes, lung disease, obesity, circulation or heart disease and smoking.
• The virus binds to primary organ tissues, including the penis and testicles. This bond decreases the amount of testosterone produced and increases the risk of ED. The virus has been found in penis tissue biopsy long after the initial infection.
• Testosterone loss increases the risk of developing all other complications associated with long COVID.
• The study also confirmed that sexual long COVID causes both genders to experience brain fog, breathlessness, anxiety and fatigue.

It is fair to say that the next global public health crisis may be to care for patients afflicted with life-altering disabilities caused by long COVID.

The threat of sexual long COVID may be psychologically more intimidating to the COVID-weary community than are other long-haul complications. Sexual long COVID may spur more people to vaccinate or to improve their social distancing and other transmission precautions. 

Only time will tell how COVID-19 will affect those most affected by the long-term exponential complications. More research and a better understanding of all factors that make COVID-19 an enduring pandemic are needed to provide the best treatment practices for the millions infected worldwide.