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

Abstract

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.

Post-COVID-19 pneumonia lung fibrosis: a worrisome sequelae in surviving patients

“…This is matching to study by Wong et al [ 15 ], who stated that older people are more likely to develop pulmonary fibrosis following MERS. Low incidence was noted in 45–60-year age group (7 patients out of 25; 28%), and 25–45-year age group showed least incidence (5 out of 25 patients; 20 %); this was also noticed by Das K.M, et al [ 16 ] that correlated age with MERS and SARS-CoV 2 pulmonary fibrosis development.…”

Testicular Atrophy and Hypothalamic Pathology in COVID-19: Possibility of the Incidence of Male Infertility and HPG Axis Abnormalities

“…Although the presence of SARS-CoV-2 in the testes remains controversial, hypogonadism resulting from the inflammation in the testes is increasingly evident [105,106]. Thus, a defect in the steroidogenesis in the testes reflected by the reduced level of testosterone may be the underlying basis for the abnormal levels of FSH and LH in patients with COVID-19.…”

Pelvic Floor Considerations in COVID-19

“…There has been some interesting research on erectile dysfunction after COVID-19 that shows that the virus invades the Leydig cells of the testicle, causing widespread inflammation leading to erectile dysfunction. 42 Sexual dysfunction in post–critical illness does seem to impact men more than women but should be screened in all patients to help with quality-of-life measures. 43 …”