Abstract
Abstract Introduction The SARS-CoV-2 virus and associated COVID-19 infection is known to cause endothelial cell dysfunction. This has led some to hypothesize that COVID-19 infection may increase the risk of erectile dysfunction. Initial studies evaluating this association have been limited to small, single institution studies or have utilized electronic medical record databases that lack universal follow-up given they only capture follow-up care at a small proportion of health care facilities. Objective To assess if COVID-19 infection recovery is associated with increased rates of newly diagnosed erectile dysfunction (ED) using an insurance claims database. Methods Using IBM MarketScan, a commercial claims database, men with prior COVID-19 infection between January 2020 and January 2021 were identified using ICD-10 diagnosis codes. Using this cohort along with an age-matched cohort of men without prior COVID-19 infection, we assessed the incidence of newly diagnosed erectile dysfunction (ED). Men with ED secondary to prostatectomy or radiation were excluded. Covariates were assessed using a multivariable model to determine association of prior COIVD-19 infection with newly diagnosed ED. Results 42,406 men experienced a COVID-19 infection between January 2020 and January 2021 of which 610 (1.44%) developed new onset ED within 6.5 months follow up. On multivariable analysis while controlling for diabetes, cardiovascular disease, smoking, obesity, hypogonadism, thromboembolism, and GU malignancy, prior COVID-19 infection was associated with increased risk of new onset ED (HR 1.27; 95% CI 1.1-1.5; P=0.001). COVID-19 infection carried a similar association with new onset ED as did diabetes and BMI 25-30, HR 1.3 and 1.29, respectively. Conclusions Prior to the widespread implementation of the COVID-19 vaccine, the incidence of newly diagnosed ED is higher in men with prior COVID-19 infection compared to age-matched controls. Prior COVID-19 infection was associated with a 27% increased likelihood of developing new-onset ED when compared to those without prior infection. Additional longitudinal studies are needed to evaluate the risk of erectile dysfunction after following asymptomatic infection and in the setting prior vaccination. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Cooper Medical, Boston Scientific, Acerus, Coloplast, Endo, Turtle Health, Maximus, FirmTech, StreamDx, Inherent Bioscience.
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