Semih TÜRK, Cihan DEMİREL, Emre SALABAŞ, ibrahim Halil BALOĞLU

COVID-19 enfeksiyonunun erkek cinsel fonksiyonları üzerindeki etkisi ve risk faktörleri

AMAÇ: Bu çalışmanın amacı COVID-19 hastalığı sonrasında oluşan erkek cinsel disfonksiyonunun incelenmesi ve risk faktörlerinin araştırılmasıdır. GEREÇ ve YÖNTEMLER: Bu çalışma PCR ile onaylanmış COVID-19 tanısı alan erkeklerin enfeksiyon öncesi ve sonrasını, International index of erectile function-15 (IIEF-15) formu ve alt başlıkları ile sorgulayan ve risk faktörlerini inceleyen ilk uzunlamasına çalışmadır. 2020-2021 yılları arasında 114 erkek hastaya IIEF-15 formu ilk tanı anında ve 3 ay sonra olmak üzere 2 defa uygulanmıştır. BULGULAR: Ortanca yaş 49 yıl (IQR: 29-58.5) olan hastalarda ortanca IIEF-EF skoru 24’den 20’ye (p=0,001) düşmüş, ayrıca orgazm (9’dan 8’e,p=0,01), cinsel istek (8’den 7’ye,p=0,001), cinsel tatmin (11’den 8’e,p=0,001) ve genel tatmin (8’den 7’ye,p=0,001) dahil tüm alt gruplarda da anlamlı düşüş saptanmıştır. Klinik anlamlı IIEF-EF düşüşü olan hastalarda, anlamlı oranda daha yüksek diyabet (%37 vs %13,8, p=0,01), hipertansiyon (%40,7 vs %20,7, p=0,04), sigara içiciliği (%40,7 vs %20,7, p=0,04), pnömoni (%44,4 vs %23,0,p=0,03) ve daha düşük oranda halsizlik (%66,7 vs %86,2, p=0,02) gözlemlenmiştir. Çoklu değişken risk analizinde pnömoni (OR: 3,55,p=0,02) ve halsizlik semptomu (OR: 0,22,p=0,01) klinik anlamlı IIEF-EF düşüşünün (IIEF > 4) anlamlı bağımsız risk faktörleri olarak saptanmıştır. SONUÇ: COVID-19 vakaları kliniğimize ürolojik semptomlar ile başvurabilirler. Bu enfeksiyon, erektil fonksiyonlar, orgazm, cinsel istek ve tatmin dahil olmak üzere cinsel fonksiyonların hepsinde bozulmaya sebep vermektedir. Hastaların üçte birinde erektil disfonksiyon şiddetinde bir seviye artma görülmüştür. Pnömoni ve halsizlik semptomları, enfeksiyon sonrası sertleşme sorunu için prediktif faktörlerdir. Pnömoni, üriner urge semptomu ve diyabet, erektil fonksiyon dışındaki IIEF alt gruplarında da bozulmaya sebep olabilir. Endotelyal disfonksiyonun, COVID-19 kaynaklı cinsel disfonksiyon ile ilişkili olması muhtemeldir.

The impact of COVID-19 infection on sexual functions of males and associated risk factors

OBJECTIVE: The objective of this study is to investigate the sexual dysfunction(SD) occurring after COVID-19 disease and possible risk factors. MATRERIAL and METHODS: This is the first longitudinal study comparing the sexual health of males, prior and latter to PCR confirmed COVID-19 diagnosis using the all domains of International index of erectile function-15 (IIEF-15) questionnaire and investigating the risk factors for SD. Between 2020-2021, 114 male patients were included and surveyed by IIEF-15 twice, at the time of diagnosis and after 3 months. RESULTS: Median age was 49 years (IQR: 29-58.5). Median IIEF-EF score decreased (24 to 20,p=0.001) and there was also a statistically significant decline in all domains of IIEF-15 including orgasm (9 to 8,p=0.01), sexual desire (8 to 7,p=0.001), sexual satisfaction (11 to 8,p=0.001) and over satisfaction (8 to 7,p=0.001). Patients with an IIEF-EF decrease > 4 (n=27, 23.7%) had significantly higher rates of diabetes (37% vs 13.8%, p=0.01), hypertension (40.7% vs 20.7%, p=0.04), smoking (40.7% vs 20.7%, p=0.04), COVID-19 pneumonia (44.4% vs 23.0%, p=0.03) and lower rates of fatigue (66.7% vs 86.2%, p=0.02) than the other group Pneumonia (OR: 3.55,p=0.02), and fatigue (OR: 0.22,p=0.01) were significant independent risk factors of minimally clinically significant IIEF-EF decrease (>4). CONCLUSION: COVID-19 cases may present with urologic symptoms to our outpatient clinics. The disease causes deterioration in all aspects of sexual function, including erectile function, orgasm, sexual desire and satisfaction of the patients. A third of patients face a decrease of one rank in erectile dysfunction severity. Pneumonia and fatigue symptoms are significant risk factors of post-COVID-19 erectile dysfunction. Pneumonia, urinary urgency symptom and diabetes mellitus increase the risk of deterioration in IIEF domains besides erectile function. Endothelial dysfunction may be one of the causes of post COVID-19 sexual function decline..

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