The Neural correlates of COVID-19-induced erectile dysfunction in males

Emerging evidence suggests that there are long-term complications after recovery from COVID-19, which involve
multiple systems and lead to deterioration of the quality of life. Among these different complications, male sexual
dysfunction, in particular erectile dysfunction, is one of the complications being identified recently. It was initially
hypothesized that due to the presence of Angiotensin-converting enzyme II (ACE2) and transmembrane protease
serine 2 (TMPRSS 2) in testes and Leydig cells, the male reproductive system is vulnerable to the infection of
COVID-19, which may lead to a decrease in testosterone production and sexual dysfunction. However, evidence
from a recent neurological study suggests that COVID-19 may be directly associated with dysregulation of the
nervous systems at the central level in regions including the limbic system (e.g., hippocampus and amygdala),
hypothalamus, brainstem, and the peripheral system (e.g., sympathetic nerves, olfactory bulb). As these affected
regions are crucial for sexual behaviors, these observations may provide an alternate explanation for sexual
dysfunction in COVID-19 survivors. To explore the potential involvement of the nervous system in sexual
dysfunction induced by COVID-19, this review discusses the recent findings from the neurological perspective and
states the possible research work that may be needed to delineate the underlying pathology