Is ED a long COVID symptom?

A secondary analysis of CORES II* has shown that nearly a fifth of Japanese men hospitalized for COVID-19 developed symptoms of erectile dysfunction (ED) up to 2 years following the infection.

As there are no clearcut protective measures against the development of ED, the research team conducted a retrospective analysis based on a self-reported questionnaire to assess ED prevalence in 609 male COVID-19 survivors (median age 56 years). [Sci Rep 2025;15:6279]

Nineteen percent of participants (n=116) developed ED at 1 year and 2 years after being infected. In the 1-year survey, 86 respondents reported symptoms of ED. At 2 years, 70 respondents reported symptoms of ED. Forty men had symptoms at both timepoints.

Sixty-eight percent (n=79) reported developing ED within 28 days of COVID-19 infection, while 4.3 percent (n=6) developed ED symptoms 2–5 months after COVID-19 infection.

By year 2, a quarter of those who developed ED symptoms showed improvement, but nearly half had no apparent improvement in symptoms.

Mental health impact, sleep disturbance

There was also a strong association between ED symptoms and mental distress, as men with ED had higher Hospital Anxiety and Depression Scale – Depression at 1 year (6 vs 4; p<0.001) and 2 years (7.5 vs 4; p<0.001) after being infected with COVID-19.

Similarly, EuroQol 5-dimensions 5-level scores for anxiety/depression were significantly worse among men with vs without ED at years 1 (0.209 vs 0.078; p=0.033) and 2 (0.271 vs 0.052; p=0.002), as were the scores for usual activities at 1 year (0.407 vs 0.212; p=0.015) and pain/discomfort at 2 years (0.500 vs 0.178; p=0.003).

In a meta-analysis, the presence of ED was strongly associated with the risk of developing depression (odds ratio [OR], 1.39), and depression was associated with a higher risk of developing ED (OR, 2.92).

Given the strong association between ED and depression and anxiety, the researchers suggested non-pharmacological interventions to improve symptoms. “It has been noted that a reduction in the serotonergic transmission system may occur in long COVID, and serotonin may be a therapeutic option for long COVID. However, serotonin itself inhibits dopamine secretion and causes drug-induced ED, so its use in the treatment of ED as a long COVID [symptom] may be controversial.”

Moreover, the American Urological Association recommends that all men presenting with ED undergo evaluation for potential psychosocial factors (including depression and anxiety). [J Sex Med 2018;15:1073-1082]

Apart from the mental distress, sleep disturbance was also deemed associated with ED in the exploratory clustering analysis evaluating the 1-year survey data. This aligns with evidence demonstrating the higher risk of developing ED in the presence of sleep disturbance. [Int J Clin Pract 2015;69:846-852]

Study limitations

However, the retrospective nature of the study may have introduced recall biases, while the study population comprising hospitalized patients may have introduced bias toward age groups at risk of hospitalization.

“Similarly, the nature of ED, such as severity, nocturnal or morning erection, sexual intercourse erection, or masturbation erection, and intercourse frequency … have not been investigated,” the researchers noted.

Nonetheless, psychological symptoms and sleep disturbance underline the need for supportive care and management among men who have developed ED symptoms following a COVID-19 infection, they said.