DOI: 10.1093/jsxmed/qdae001.069 ISSN: 1743-6095

(073) Post-Infection Erectile Dysfunction Risk - Comparing COVID-19 with Other Common Acute Viral Infections: A Large National Claims Database Analysis

U Choi, C Able, A Grutman, A Maremanda, R Nicholson, A Gabrielson, A Cohen, T Kohn
  • Urology
  • Reproductive Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Psychiatry and Mental health



It is unknown if erectile dysfunction (ED) risk following Coronavirus-19 (COVID-19) infection is virus-specific.


To assess the risk of ED in COVID-19 patients as compared to patients with other common viral infections.


A US claims database (TriNetX Diamond Network) was queried from January 2020 to April 2023. Cohorts included men aged ≥18 with ≥1 outpatient visit (CPT 1013627, 1013638) within 1-18 months of infection (Figure 1). Cohorts were generated for men positive for (1) SARS Coronavirus 2 (TNX Curated 9088), (2) influenza (ICD-10 J9-11), (3) RSV (CPT 87280, 87634; ICD-10 J12.1, 21.0, B97.4; LOINC 31950-9, 33390-6, 33045-6, 5876-8, 5877-6, 68966), (4) enterovirus (ICD-10 A08.39, B34.1; LOINC 5843-8, 82194-2, 29558-4, 29591-5, 97151-5, 49847-7, 93856-3), (5) acute viral hepatitis (ICD-10 B15-16, 17.0-2, 17.9), (6) mononucleosis (ICD-10 B27), (7) herpes zoster (CPT B02), and (8) no acute viral illness. Men with multiple viral infection types were excluded. Men with ED diagnosis (ICD10 N52), phosphodiesterase-5 inhibitors (PDE5i) (RxNorm 1231301, 598, 358263, 306674, 136411), intracavernosal injections (CPT 54235, J0270, J2760, J2440), and penile prosthesis (CPT 54405-11, 54415-7; ICD-10 N48.6) prior to infection were excluded. Those with prostatectomy (SNOMED 9047006), pelvis radiation (ICD-10 DWY6-7, DW06-7), pulmonary hypertension (ICD-10 I27.0, I27.2, I27.20), or chronic viral hepatitis (ICD-10 B18) before or after infection were excluded. All sildenafil, vardenafil, and avanafil doses and 10 or 20 mg tadalafil were included. Outcomes were rates of new ED diagnosis (ICD-10 N52), PDE5i prescription (RxNorm 1231301, 598, 358263, 306674, 136411), and new ED diagnosis or PDE5i prescription 1-18 months following infection diagnosis. ED diagnosis and/or PDE5i prescription rates were compared between men with COVID-19 to all other cohorts. Propensity score matching was performed with age at index, race, ethnicity, type 2 diabetes mellitus (ICD-10 E11), overweight and obesity (E66), hypertension (I10), ischemic heart disease (I20-I25), pure hypercholesterolemia (E78.0), alcohol dependence (F10), nicotine dependence (F17), mood disorders (F34), atherosclerosis (I70), obstructive sleep apnea (G47.33), testicular hypofunction (E29.1), inpatient hospital services (CPT 1013659), and outpatient services (CPT 1013626).


The COVID-19 cohort was matched to: 35,226 in the influenza cohort, 1,565 in the RSV cohort, 16,317 in the enterovirus cohort, 2,461 in the viral hepatitis cohort, 2,797 in the mononucleosis cohort, 2,171 in the herpes zoster cohort, and 87,064 in the no acute viral illness cohort. After matching, men with COVID-19 were not more or less likely to receive an ED diagnosis or PDE5i prescription when compared to influenza (risk ratio (RR) [95% Confidence Interval] RR 1.098 [0.999-1.206]), RSV (RR 1.318 [0.761-2.284]) or enterovirus (RR 1.039 [0.909-1.187]) (Table 1). Men with COVID-19 were less likely to develop ED diagnosis or PDE5i prescription than men with viral hepatitis (RR 0.711 [0.512-0.988]) and herpes zoster (RR 0.37 [0.72-0.490]) and more likely to receive an ED diagnosis or PDE5i prescription than men without any viral illness diagnosis (RR 1.329 [1.247-1.416]) (Figure 2).


COVID-19 infection was associated with lower risk for ED diagnoses or PDE5i prescriptions than infection with herpes zoster. This may indicate post-viral ED may be more related to the general febrile response than the virus itself.



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