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长期新冠症可能导致性功能障碍

长期新冠症可能导致性功能障碍

Carolyn Barber 2022-08-23
研究人员表示,从20多岁到70多岁,各个年龄段的男性均有可能因为感染新冠病毒而出现性功能障碍。

图片来源:GETTY IMAGES

新冠疫情爆发两年半后,人们仍然在计算新冠病毒及其引发的长期新冠(Long COVID)造成的损伤。美国疾病控制与预防中心(Center for Disease Control)表示,美国感染过新冠病毒的成年人当中有近20%,也就是美国的每13名成年人里就有一人正在忍受长期新冠的折磨。

从普通症状(咳嗽、发烧、头痛)到略显神秘的症状(大脑模糊、味觉或嗅觉丧失、针刺感),医生和研究人员对各种症状进行了详尽分类。但最新的证据让人们迫切想知道答案,而且可能促使很多犹豫不决的男性重新考虑接种疫苗。

新冠肺炎和阳痿有关吗?看起来关系越来越明显

“我认为二者确实存在关联。”迈阿密大学医疗卫生系统(University of Miami Health System)的男性生殖医学和外科主任兰吉特·拉马萨米说。“跟科学中的其他领域一样,有联系并不意味着存在因果关系。”

统计数字非常重要。拉马萨米和团队就该课题进行了迄今为止规模最大的研究,着重比较了超过23万有新冠感染史的男性与同等数量从未感染新冠病毒的男性的登记数据。结果是:“我们发现,平衡了几种合并症之后,新冠病毒感染者被诊断患有勃起障碍的风险比未感染者高约20%。”拉马萨米说。

中国和意大利的研究以及其他多项研究,均支持勃起障碍与新冠病毒之间存在联系的观点。虽然各项研究大多样本量较小,但在《自然》(Nature)杂志上发表的一项针对近50万成年人的研究发现,出现长期新冠症状的男性可能同时出现射精困难和性欲下降症状。

一项针对60项研究的大规模审议得出结论:“由于新冠病毒传染性很强,大部分男性可能面临勃起障碍,这一点令人担心。”这也说明应该进行长期研究以厘清问题的严重程度。

“已知的是,新冠病毒感染尤其是出现高烧症状的感染会显著降低精子数量和活力(活动精子的数量)。”克利夫兰医学中心(Cleveland Clinic)的男性生育和男科研究员拉维提·博莱说。“针对少数患者的多次研究表明,三到六个月后男性精子质量有所恢复,但确实需要对更多患者进行更长时间随访(以确认结果)。”

虽然各种问题的流行程度各不相同,但一些流行病学研究表明,受影响的人数可能惊人,达到数千万。在新冠疫情初期的一项小型研究中,意大利罗马第二大学(University of Rome Tor Vergata)的内分泌学和医学性学教授伊曼纽尔·扬尼尼发现,如果校正其他潜在因素,新冠病毒感染者报告阳痿的可能性几乎是未感染男性的六倍。佛罗里达大学(University of Florida)的一项健康研究发现,感染新冠病毒后报告阳痿的可能性为正常情况的三倍。

“男性通常不愿意报告性功能障碍,说明问题可能比表面更严重。”扬尼尼说。

到底是什么原因?

也许最重要的是背后的生物学机制。新数据表明,新冠病毒可以对内皮细胞功能造成不利影响,这是重要线索。内皮细胞释放能够调节血管松弛和收缩的物质,因此受损后可能影响很多功能,包括身体最需要时为阴茎供血的能力。

因此,感染新冠病毒后勃起障碍病例可能是更普遍健康问题的指标,说明人们罹患心血管疾病、心脏病或中风等其他严重疾病的风险同样增加。

拉马萨米和研究人员已经发现的证据表明,在感染后长达七个月里,病毒仍然可以存留在阴茎组织内皮细胞内,说明对海绵体内皮的直接损伤可能影响勃起功能。《西北医学》(Northwestern Medicine)的研究人员对感染新冠病毒的猴子进行了一项未经同行审议的预印本研究发现,男性生殖道内的多个部位,包括前列腺、阴茎和睾丸都会受到感染。

拉马萨米称之为“可能是病毒会留在相关器官内且能复制的最直接证据。”

“内皮功能障碍可能导致勃起功能障碍恶化。”亨利福特医院(Henry Ford Hospital)的男性健康主任阿马纳特·兰巴特拉说。不过兰巴特拉补充道:“我们不了解(勃起障碍)病例增多的整体机制。”

从某种程度上说,主要因为男性的性健康始终依赖多个变量,任何变量都可能在特定时间内造成相当大的影响,包括激素水平、血流或其他生理因素,其中任何因素出问题都可能影响性健康。

心理健康以及某些用于治疗心理或情绪疾病的药物可能发挥重要作用。简言之,良好的精神状态与男性性功能可能密切相关。与此同时,世界卫生组织(World Health Organization)报告称,在新冠疫情爆发的第一年里,全世界的焦虑和抑郁发病率增加了25%,因为新冠疫情中人们被迫隔离,加剧了情感和生理压力。

两种常见的长期新冠症状,即味觉或嗅觉丧失也可能是因素之一,因为研究人员称感官可能促进性欲。

换言之,当前情况可能是诸多因素共同作用的结果,其中包括简单的事实,即尽管(人们希望)只是暂时,但感染新冠会让人不健康。“感染了新冠就会影响健康,与阴茎勃起不利也直接相关。”约翰斯·霍普金斯大学医学院(Johns Hopkins Medical Institutions)的泌尿学教授阿瑟·伯内特说。

根据2021年拿索等人发布的一份报告,估计约有10%至20%感染新冠的男性会出现睾丸炎,即一个或两个睾丸出现炎症。

对男性性健康的影响会持续多久?

供职于克利夫兰医学中心的博莱医生说:“男性的性健康肯定会受到影响,只是目前尚不清楚其影响有多严重,会持续多久。”

中国一项针对新冠康复者的研究显示,勃起障碍或会持续至少6个月的时间,另一项前瞻性队列研究发现,新冠肺炎患者在感染病毒后的60天内,精子形态、精子浓度、精液量和精子数量均会大幅下降。

意大利的一项研究表明,在感染新冠病毒7个月后,超过50%的男性睾丸激素水平仍然较低,而该指标偏低会使男性的勃起功能受到影响。“我们认为,(感染新冠病毒)不会对(男性性能力)产生永久影响。”拉马萨米说,但该推论尚需后续数据支撑。

无需多言,上面提到的问题你肯定都不想碰到,那么如何才能避免呢?在撰写本文的过程中,笔者采访了许多医生和研究人员,在被问到该问题时,相关人员均给出了相同的答案:接种疫苗。

供职于迈阿密大学的拉马萨米说:“许多人觉得新冠疫苗和新冠病毒很像,所以对身体的影响也一样……但我们发现,二者之间几乎没有关联。”拉马萨米与其他人携手完成的一项研究发现,在接种两剂辉瑞(Pfizer)或Moderna的疫苗后,精液质量相关指标并未出现下降,其他几项相关研究得出的结论也是如此。

尽管人们担心新冠疫苗可能会对男性的性健康产生负面影响,但目前尚未发现相关证据。让身陷危险境地是感染病毒,而不是采取预防措施。

与此同时,目前尚不清楚接种疫苗是否能够防止患者因为感染新冠而出现勃起障碍。供职于亨利福特医院的兰巴特拉医生说:“大家都很想知道这个问题的答案。”像他说的那样,由于疫苗可以预防许多新冠危重症状,“从逻辑上讲,应该也会对性功能产生保护。不过目前还没有最终数据。”

在进行相关讨论时,常常绕不开这个主题。位于罗切斯特的妙佑医疗国际(Mayo Clinic)专门研究男性性功能障碍与不孕不育问题的泌尿科医生马修·齐格尔曼说:“需要强调的是,当前进行的所有研究都有很大的局限性,我们暂时还不能给出任何有力的结论。”

现在还不能确定感染新冠是否会导致勃起障碍。许多患者在感染新冠病毒后会出现多种症状,但性功能完全未受影响。

博莱说:“如果患者本身患有影响阴茎血管健康的疾病(如糖尿病或心脏病),而后又感染了新冠病毒,则可能会受到更大的伤害。与血管健康的人员相比,他们更容易受到(病毒)影响。”在预测新冠康复者是否会出现勃起障碍时,基线勃起状态、新冠症状轻重、是否吸烟等因素也具有显著的相关性。

所有观看体育节目的电视观众都可以告诉你,即便(性功能)受到影响,患者也能够找到对症药物。新冠疫情期间,放眼全美,勃起障碍相关治疗药物的销量均显著提升。不过最好还是从一开始就避免感染新冠病毒、预防出现并发症,对男青年而言也是如此。研究人员表示,从20多岁到70多岁,各个年龄段发男性均有可能因为感染新冠病毒而出现性功能障碍。

切记:不要以自己的性健康(以及其它东西)为赌注去挑衅新冠病毒。

拉马萨米说:“我认为,在面对新冠病毒时,我们依然应该慎之又慎,并且尽量避免感染这种病毒。在我看来,那种‘感染一下好了,这样以后就安全或者不会再得新冠了’的想法简直是痴人说梦,痴心妄想。新冠病毒依然十分危险,我认为,目前我们仍未了解其可能产生的全部后果。”(财富中文网)

卡罗琳·巴伯(Carolyn Barber),医学博士,拥有25年的急诊科医生从业经验。著有《失控的药物:致命的未知之物》(Runaway Medicine: What You Don’t Know May Kill You)一书,她为《财富》杂志等全美发行的出版物撰写了大量关于新冠肺炎的文章。巴伯是加州无家可归者工作计划“变革之轮”(Wheels of Change)的联合创始人。

Fortune.com上评论文章中表达的观点仅代表作者个人观点,并不代表《财富》杂志的观点和立场。

译者:梁宇

审校:夏林

新冠疫情爆发两年半后,人们仍然在计算新冠病毒及其引发的长期新冠(Long COVID)造成的损伤。美国疾病控制与预防中心(Center for Disease Control)表示,美国感染过新冠病毒的成年人当中有近20%,也就是美国的每13名成年人里就有一人正在忍受长期新冠的折磨。

从普通症状(咳嗽、发烧、头痛)到略显神秘的症状(大脑模糊、味觉或嗅觉丧失、针刺感),医生和研究人员对各种症状进行了详尽分类。但最新的证据让人们迫切想知道答案,而且可能促使很多犹豫不决的男性重新考虑接种疫苗。

新冠肺炎和阳痿有关吗?看起来关系越来越明显

“我认为二者确实存在关联。”迈阿密大学医疗卫生系统(University of Miami Health System)的男性生殖医学和外科主任兰吉特·拉马萨米说。“跟科学中的其他领域一样,有联系并不意味着存在因果关系。”

统计数字非常重要。拉马萨米和团队就该课题进行了迄今为止规模最大的研究,着重比较了超过23万有新冠感染史的男性与同等数量从未感染新冠病毒的男性的登记数据。结果是:“我们发现,平衡了几种合并症之后,新冠病毒感染者被诊断患有勃起障碍的风险比未感染者高约20%。”拉马萨米说。

中国和意大利的研究以及其他多项研究,均支持勃起障碍与新冠病毒之间存在联系的观点。虽然各项研究大多样本量较小,但在《自然》(Nature)杂志上发表的一项针对近50万成年人的研究发现,出现长期新冠症状的男性可能同时出现射精困难和性欲下降症状。

一项针对60项研究的大规模审议得出结论:“由于新冠病毒传染性很强,大部分男性可能面临勃起障碍,这一点令人担心。”这也说明应该进行长期研究以厘清问题的严重程度。

“已知的是,新冠病毒感染尤其是出现高烧症状的感染会显著降低精子数量和活力(活动精子的数量)。”克利夫兰医学中心(Cleveland Clinic)的男性生育和男科研究员拉维提·博莱说。“针对少数患者的多次研究表明,三到六个月后男性精子质量有所恢复,但确实需要对更多患者进行更长时间随访(以确认结果)。”

虽然各种问题的流行程度各不相同,但一些流行病学研究表明,受影响的人数可能惊人,达到数千万。在新冠疫情初期的一项小型研究中,意大利罗马第二大学(University of Rome Tor Vergata)的内分泌学和医学性学教授伊曼纽尔·扬尼尼发现,如果校正其他潜在因素,新冠病毒感染者报告阳痿的可能性几乎是未感染男性的六倍。佛罗里达大学(University of Florida)的一项健康研究发现,感染新冠病毒后报告阳痿的可能性为正常情况的三倍。

“男性通常不愿意报告性功能障碍,说明问题可能比表面更严重。”扬尼尼说。

到底是什么原因?

也许最重要的是背后的生物学机制。新数据表明,新冠病毒可以对内皮细胞功能造成不利影响,这是重要线索。内皮细胞释放能够调节血管松弛和收缩的物质,因此受损后可能影响很多功能,包括身体最需要时为阴茎供血的能力。

因此,感染新冠病毒后勃起障碍病例可能是更普遍健康问题的指标,说明人们罹患心血管疾病、心脏病或中风等其他严重疾病的风险同样增加。

拉马萨米和研究人员已经发现的证据表明,在感染后长达七个月里,病毒仍然可以存留在阴茎组织内皮细胞内,说明对海绵体内皮的直接损伤可能影响勃起功能。《西北医学》(Northwestern Medicine)的研究人员对感染新冠病毒的猴子进行了一项未经同行审议的预印本研究发现,男性生殖道内的多个部位,包括前列腺、阴茎和睾丸都会受到感染。

拉马萨米称之为“可能是病毒会留在相关器官内且能复制的最直接证据。”

“内皮功能障碍可能导致勃起功能障碍恶化。”亨利福特医院(Henry Ford Hospital)的男性健康主任阿马纳特·兰巴特拉说。不过兰巴特拉补充道:“我们不了解(勃起障碍)病例增多的整体机制。”

从某种程度上说,主要因为男性的性健康始终依赖多个变量,任何变量都可能在特定时间内造成相当大的影响,包括激素水平、血流或其他生理因素,其中任何因素出问题都可能影响性健康。

心理健康以及某些用于治疗心理或情绪疾病的药物可能发挥重要作用。简言之,良好的精神状态与男性性功能可能密切相关。与此同时,世界卫生组织(World Health Organization)报告称,在新冠疫情爆发的第一年里,全世界的焦虑和抑郁发病率增加了25%,因为新冠疫情中人们被迫隔离,加剧了情感和生理压力。

两种常见的长期新冠症状,即味觉或嗅觉丧失也可能是因素之一,因为研究人员称感官可能促进性欲。

换言之,当前情况可能是诸多因素共同作用的结果,其中包括简单的事实,即尽管(人们希望)只是暂时,但感染新冠会让人不健康。“感染了新冠就会影响健康,与阴茎勃起不利也直接相关。”约翰斯·霍普金斯大学医学院(Johns Hopkins Medical Institutions)的泌尿学教授阿瑟·伯内特说。

根据2021年拿索等人发布的一份报告,估计约有10%至20%感染新冠的男性会出现睾丸炎,即一个或两个睾丸出现炎症。

对男性性健康的影响会持续多久?

供职于克利夫兰医学中心的博莱医生说:“男性的性健康肯定会受到影响,只是目前尚不清楚其影响有多严重,会持续多久。”

中国一项针对新冠康复者的研究显示,勃起障碍或会持续至少6个月的时间,另一项前瞻性队列研究发现,新冠肺炎患者在感染病毒后的60天内,精子形态、精子浓度、精液量和精子数量均会大幅下降。

意大利的一项研究表明,在感染新冠病毒7个月后,超过50%的男性睾丸激素水平仍然较低,而该指标偏低会使男性的勃起功能受到影响。“我们认为,(感染新冠病毒)不会对(男性性能力)产生永久影响。”拉马萨米说,但该推论尚需后续数据支撑。

无需多言,上面提到的问题你肯定都不想碰到,那么如何才能避免呢?在撰写本文的过程中,笔者采访了许多医生和研究人员,在被问到该问题时,相关人员均给出了相同的答案:接种疫苗。

供职于迈阿密大学的拉马萨米说:“许多人觉得新冠疫苗和新冠病毒很像,所以对身体的影响也一样……但我们发现,二者之间几乎没有关联。”拉马萨米与其他人携手完成的一项研究发现,在接种两剂辉瑞(Pfizer)或Moderna的疫苗后,精液质量相关指标并未出现下降,其他几项相关研究得出的结论也是如此。

尽管人们担心新冠疫苗可能会对男性的性健康产生负面影响,但目前尚未发现相关证据。让身陷危险境地是感染病毒,而不是采取预防措施。

与此同时,目前尚不清楚接种疫苗是否能够防止患者因为感染新冠而出现勃起障碍。供职于亨利福特医院的兰巴特拉医生说:“大家都很想知道这个问题的答案。”像他说的那样,由于疫苗可以预防许多新冠危重症状,“从逻辑上讲,应该也会对性功能产生保护。不过目前还没有最终数据。”

在进行相关讨论时,常常绕不开这个主题。位于罗切斯特的妙佑医疗国际(Mayo Clinic)专门研究男性性功能障碍与不孕不育问题的泌尿科医生马修·齐格尔曼说:“需要强调的是,当前进行的所有研究都有很大的局限性,我们暂时还不能给出任何有力的结论。”

现在还不能确定感染新冠是否会导致勃起障碍。许多患者在感染新冠病毒后会出现多种症状,但性功能完全未受影响。

博莱说:“如果患者本身患有影响阴茎血管健康的疾病(如糖尿病或心脏病),而后又感染了新冠病毒,则可能会受到更大的伤害。与血管健康的人员相比,他们更容易受到(病毒)影响。”在预测新冠康复者是否会出现勃起障碍时,基线勃起状态、新冠症状轻重、是否吸烟等因素也具有显著的相关性。

所有观看体育节目的电视观众都可以告诉你,即便(性功能)受到影响,患者也能够找到对症药物。新冠疫情期间,放眼全美,勃起障碍相关治疗药物的销量均显著提升。不过最好还是从一开始就避免感染新冠病毒、预防出现并发症,对男青年而言也是如此。研究人员表示,从20多岁到70多岁,各个年龄段发男性均有可能因为感染新冠病毒而出现性功能障碍。

切记:不要以自己的性健康(以及其它东西)为赌注去挑衅新冠病毒。

拉马萨米说:“我认为,在面对新冠病毒时,我们依然应该慎之又慎,并且尽量避免感染这种病毒。在我看来,那种‘感染一下好了,这样以后就安全或者不会再得新冠了’的想法简直是痴人说梦,痴心妄想。新冠病毒依然十分危险,我认为,目前我们仍未了解其可能产生的全部后果。”(财富中文网)

卡罗琳·巴伯(Carolyn Barber),医学博士,拥有25年的急诊科医生从业经验。著有《失控的药物:致命的未知之物》(Runaway Medicine: What You Don’t Know May Kill You)一书,她为《财富》杂志等全美发行的出版物撰写了大量关于新冠肺炎的文章。巴伯是加州无家可归者工作计划“变革之轮”(Wheels of Change)的联合创始人。

Fortune.com上评论文章中表达的观点仅代表作者个人观点,并不代表《财富》杂志的观点和立场。

译者:梁宇

审校:夏林

Two and a half years after the onset of the pandemic, we’re still calculating the damage done by SARS-CoV-2 and its worrisome scion, Long COVID. The Center for Disease Control says that nearly 20% of U.S. adults who have been infected by the virus–or one in 13 adults in our country–are still experiencing Long COVID symptoms.

Doctors and researchers have exhaustively categorized those symptoms, which range from the mundane (cough, fever, headache) to the slightly mysterious (brain fog, loss of taste or smell, a pins-and-needles sensation). But it’s a more recent body of evidence that has them looking for answers–and it may push many vaccine-hesitant men to reconsider their stance.

Are COVID-19 and impotence linked? Increasingly, that appears to be the case

“I don’t have any doubt in my mind that there is an association,” says Dr. Ranjith Ramasamy, director of male reproductive medicine and surgery for the University of Miami Health System. “Like anything else in science, association does not imply causation.”

The statistics are significant. Ramasamy and his team conducted the largest study to date on this topic, in which they compared National Registry data from over 230,000 men with a history of COVID-19 infection to an equivalent number of men who have not had the virus. Result: “We found the risk of getting diagnosed with erectile dysfunction was about 20% higher in men who had COVID versus those who did not after we balanced out for several of the comorbidities,” says Ramasamy.

Survey studies in China and Italy, among multiple others, support the notion of a link between ED and the virus. While the majority of these studies have small sample sizes, a study of nearly half a million adults published in Nature identified ejaculation difficulty and reduced libido as Long COVID symptoms in men.

A large review of 60 studies concluded that “ED could be a concerning consequence for a large segment of the male population given the high transmissibility of COVID-19,” signaling a need for long-term studies to clarify the extent of the issue.

“We know that COVID infection, especially with high fever, can significantly drop sperm counts and motility (the number of sperm moving),” says Raevti Bole, a Cleveland Clinic fellow in male fertility and andrology. “There have been multiple studies done on small numbers of patients suggesting that guys can recover their sperm quality after three to six months, but we really need to follow more patients for a longer time (to know for sure).”

While the prevalence of these issues varies, some epidemiological studies suggest potentially dramatic numbers, with tens of millions of men affected. In a small study conducted early in the pandemic, Dr. Emmanuele Jannini, a professor of endocrinology and medical sexology at the University of Rome Tor Vergata, found that those who had been infected were nearly six times as likely to report impotence as men who’d dodged the virus, once the results were corrected for other potential factors. A University of Florida Health study found these reports were three times as likely after an infection.

“Men are generally reluctant” to report sexual dysfunction, suggesting that the problem may be greater than we know,” Jannini says.

What is going on here?

First and perhaps foremost, biology is at work. Emerging data shows that COVID-19 can adversely affect endothelial cell function, which is a significant clue. These cells release substances that modulate vascular relaxation and contraction, so damage to them is likely to impair a wide range of functions, including the body’s ability to get proper blood flow to the penis when it’s most urgently needed.

For that reason, a post-COVID case of ED may be an indicator of a more general health issue, placing one at increased risk of other serious conditions like cardiovascular disease, heart attacks or strokes.

Ramasamy and his researchers have found evidence of the virus remaining within the endothelial cells of penile tissue as much as seven months after infection, which suggests that direct damage to cavernosal endothelium may affect erectile function. A non-peer-reviewed, preprint study conducted on COVID-infected monkeys by researchers at Northwestern Medicine found that multiple sites within the male genital tract, including the prostate, penis, and testicles, were infected with SARS-CoV-2.

Ramasamy described it as “probably the best evidence we have that the virus can remain within these organs and can replicate.”

“The endothelial dysfunction could make the erectile dysfunction worse,” says Dr. Amarnath Rambhatla, director of men’s health at the Henry Ford Hospital. However, Rambhatla added, “We don’t understand the whole mechanism of why (increased ED) has been happening.”

In part, that’s because men’s sexual health has always been dependent on multiple variables, any of which might exert considerable influence in its own time, including hormone levels, blood flow, or other physiological factors, a deficiency in any one of which may inhibit sexual health.

It’s important to highlight the role that mental health–and certain medicines used to treat psychological or emotional conditions–may play. Put simply, a good state of mind is closely linked with good sexual performance for men. Meanwhile, the World Health Organization has reported a 25% increase in the prevalence of anxiety and depression worldwide during the first year of the pandemic, as COVID forced people into isolation and ratcheted up both emotional and physical stress.

Even the loss of taste or smell, two common Long COVID symptoms, could factor in, since researchers say these senses can contribute to a person’s ability to become aroused.

In other words, it may be a lot of things working together, including the simple fact that getting COVID plunges you into an unhealthy state, albeit (one hopes) a temporary one. “I think that if you get COVID it can affect your health, and that directly ties to adversity with regard to your mechanism of penile erection,” says Dr. Arthur Burnett, professor of urology at Johns Hopkins Medical Institutions.

Orchitis, an inflammation of one or both testicles, has been estimated to occur in about 10 to 20% of men infected by the virus, according to a 2021 report by Nassau et al.

How long does it last?

“Men’s sexual health is definitely being affected,” says the Cleveland Clinic’s Bole. “We just don’t know how severely and for how long.”

A Chinese study of COVID-19 recovered patients showed that erection problems could last at least six months, while a prospective cohort study found significant deterioration in sperm morphology, sperm concentration, semen volume, and the number of spermatozoa in COVID-19 patients up to 60 days after infection.

A study from Italy showed that seven months after COVID infection, more than 50% of men still had low testosterone levels (which can affect erectile function.) “We don’t think this is a permanent thing,” Ramasamy says, but follow-up data is needed.

Needless to say, you want to avoid all of this, and every physician and researcher asked about it for this article said the same thing: Get vaccinated.

“People thought that the COVID vaccine and the COVID virus were pretty similar, and could lead to the same impacts…But we showed that there is pretty much no association,” said the University of Miami’s Ramasamy. He has co-authored a study that found no decrease in any semen parameters after two doses of either the Pfizer or Moderna vaccines, and several other studies have reached the same conclusion.

For all the fear-mongering about the potentially harmful effects of the COVID vaccines on male sexual health, no evidence has been found. The danger lies in contracting the virus, not in taking steps to prevent it.

At the same time, it’s not clear that getting vaccinated is a shield against COVID-based ED. “That’s the million-dollar question,” says Dr. Rambhatla from the Henry Ford Hospital. As he put it, since vaccines protect against many of COVID’s most severe symptoms, “logically it makes sense” that sexual function might also be protected. “We don’t have final data yet.”

That is a common theme when it comes to this topic. “It is important to emphasize that all of the available studies have major limitations, and we can’t make any strong conclusions at this point,” says Matthew Ziegelmann, a urologist specializing in male sexual dysfunction and infertility at the Mayo Clinic in Rochester.

It’s not at all certain that a COVID infection will lead to ED. You could suffer from many effects of the virus without sexual dysfunction being among them.

“If you already have a condition that affects the blood vessels in your penis (like diabetes or heart disease), and then you get COVID, which could cause more injury, you’re more vulnerable than someone who had healthy blood vessels to start with,” Bole said. Baseline erectile status, COVID-19 severity, and smoking have also been found to be significantly predictive of ED in healthy individuals post-COVID.

Treatments for those affected are certainly available, as anyone who watches sports on T.V. can tell you. Nationwide sales of ED medications have increased markedly during the pandemic. However, the best option is not to suffer from COVID and its complications in the first place–and that goes for younger men, too. Researchers say they’ve seen COVID-related cases of sexual dysfunction in men ranging from their 20s to their 70s.

The bottom line: Don’t try to outguess this virus, not with your sexual health–among other things–potentially on the line.

“I think we should still be cautious about trying and trying not to get the virus,” Ramasamy says. “I think the whole concept of, ‘Let me get some COVID so I will be safe for the future or not get (it) again’–those are just bad hypotheses and theories. It’s still a bad virus, and I think we still don’t know its complete ramifications.”

Carolyn Barber, M.D. has been an emergency department physician for 25 years. Author of the book Runaway Medicine: What You Don’t Know May Kill You, she has written extensively about COVID-19 for national publications, including Fortune. Barber is co-founder of the California-based homeless work program Wheels of Change.

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not reflect the opinions and beliefs of Fortune.

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