In a recent study published in the IJIR: Your Sexual Medicine Journal, a group of researchers used a large United States (U.S.) claims database to assess the risk of developing erectile dysfunction (ED) following a diagnosis of long coronavirus disease (COVID) compared to acute COVID, considering hospitalization status and vasopressor administration.

Study: Comparing risk of post infection erectile dysfunction following SARS Coronavirus 2 stratified by acute and long COVID, hospitalization status, and vasopressor administration: a U.S. large claims database analysis. Image Credit: Prostock-studio/Shutterstock.com

Background 

Since the outbreak of COVID-19, over 750 million cases have been confirmed, and nearly 7 million deaths have occurred. Post-COVID-19 sequelae impact many organ systems, including cardiovascular, pulmonary, immunologic, endocrine, vascular, reproductive, and neurologic systems.

These effects raise concerns among professionals who now confront acute and chronic infections. From a urologic perspective, patients face a higher risk of ED following COVID-19. Up to 50.3% of men developed ED within three months post-infection.

Further research is needed to better understand the differential impact of long and acute COVID on ED and to guide more effective prevention and treatment strategies.

About the study 

The present study conducted a retrospective cohort analysis using electronic health records (EHRs) and insurance claims from the TriNetX COVID-19 Research Network, covering over 109 million patients from 81 healthcare organizations.

Data, collected up to June 2023, included demographics, diagnoses (International Classification of Disease (ICD-10) codes), and procedures (Current Procedural Terminology (CPT) codes), validated across specialties.

TriNetX adheres to Health Insurance Portability and Accountability Act (HIPAA), ensuring data de-identification. As only de-identified records were used, the study was exempted from Johns Hopkins Institutional Review Board oversight, providing aggregate patient counts and statistical summaries.

Included were men over 18 who tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) between December 1, 2020, and June 1, 2023, with at least one follow-up visit two weeks post-diagnosis.

Exclusions were men with previous ED diagnoses, Phosphodiesterase type 5 (PDE5) inhibitor prescriptions, intracavernosal injections, penile prosthesis, prostatectomy, pelvis radiation, or pulmonary hypertension.

Three analyses assessed risks associated with long COVID diagnosis, vasopressor use, and inpatient hospital services within one month of initial diagnosis. Outcomes were new ED diagnoses, new PDE5 inhibitor prescriptions, or both within 1 to 18 months post-infection.

Propensity score matching (1:1, greedy nearest neighbor, 0.1 SD width) balanced covariates such as age, race, comorbidities, and healthcare utilization. TriNetX calculated risk ratios and 95% CIs using R’s Survival package, with significance defined by a two-sided alpha of less than 0.05.

Study results 

A total of 184,253 men met this study’s inclusion and exclusion criteria. Before propensity score matching, 2,839 (1.5%) men were diagnosed with long COVID at least four weeks after their initial diagnosis, while 181,414 (98.5%) had only acute COVID.

Among these patients, 173,411 (94.1%) did not receive vasopressors within one month of their initial diagnosis, whereas 10,842 (5.9%) did. Additionally, 161,383 (87.6%) men were not treated with inpatient hospital services, while 24,726 (13.4%) were.

Following propensity score matching, equal-sized cohorts were established: 2,839 men with and without long-term COVID-19, 10,842 men with and without vasopressor administration, and 19,695 men with and without inpatient hospital services.

The average ages of men in the long and acute COVID cohorts were 54.5±16.7 and 55.1±17.1 years, respectively (p = 0.21). The vasopressor administration cohorts’ average ages were 57.4±17.8 and 56.6±17.6 years, respectively (p < 0.001).

The inpatient hospital services cohorts had average ages of 59.0±17.4 and 58.7±17.4 years, respectively (p = 0.10). 

The study found a statistically significant increased risk of ED in men diagnosed with long COVID. Specifically, 3.63% of patients with long COVID were diagnosed with ED or prescribed PDE5 inhibitors, compared to 2.61% of those with acute COVID (RR 1.39, 95% CI 1.04, 1.87).

There was no statistically significant difference in ED risk for those who received vasopressors; 2.06% of patients who received vasopressors were diagnosed with ED or prescribed PDE5 inhibitors compared to 2.23% of those who did not (RR 0.92, 95% CI 0.77, 1.10).

Similarly, no significant difference was found for patients who received inpatient hospital services, with 2.40% of these patients diagnosed with ED or prescribed PDE5 inhibitors compared to 2.57% of those who did not receive inpatient services (RR 0.93, 95% CI 0.82, 1.06).

Conclusions 

To summarize, researchers found a significantly increased risk of ED following long COVID infections, but no significant change in ED risk for individuals who received vasopressors or required hospitalization.

This demonstrates the unique impact of long COVID on sexual health. Moreover, the rates of ED diagnosis following long COVID were lower than previously reported in smaller cohorts, with some studies showing rates as high as 50%.