Medical Examiner

What You Really Need to Know About Your Penis, COVID, and Vaccines

“It’s very hard to have good sex when you’re dead.”

LOS ANGELES, CALIFORNIA - DECEMBER 12: Nicki Minaj accepts the Gamechanger Award onstage during Billboard Women In Music 2019, presented by YouTube Music, on December 12, 2019 in Los Angeles, California. (Photo by Rich Fury/Getty Images for Billboard)
Nicki Minaj has questions, and this penis doctor has answers. Rich Fury/Getty Images

Nicki Minaj turned a lot of heads Monday when she told her 22 million followers on Twitter that she refused to take the COVID vaccine to attend the Met Gala, and that she planned to do more “research” before she got the shot. She added, “My cousin in Trinidad won’t get the vaccine cuz his friend got it & became impotent. His testicles became swollen. His friend was weeks away from getting married, now the girl called off the wedding.”

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A classic example of vaccine misinformation and how it spreads, Minaj’s post set off a nightlong round of ridicule. Many speculated her cousin’s friend in fact acquired a sexually transmitted infection that derailed his wedding. But rumors like the one Minaj heard, particularly around men’s sexual health, have made up a common thread of COVID vaccine conspiracies that really do affect vaccine decision-making. And they obscure an actually alarming fact: COVID-19 itself, not the vaccine, can “linger” in the penis and have serious effects on men’s sexual health. I called Dr. Aaron Spitz, a prominent urologist and the author of The Penis Book: A Doctor’s Complete Guide to the Penis, to explain what the current science tells us about what COVID really does to men’s bodies, the fears he’s heard from his patients, and why viruses like this only become real to some men when it concerns their dick. Our conversation has been condensed and edited for clarity.

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Aymann Ismail: What do we know right now about how COVID can affect men’s sexual health?

Aaron Spitz: To the extent that we know there’s a separate and distinct problem that COVID is causing in men’s sexual health—aside from a man’s lungs, his heart, and all of that—there have been studies looking at fertility. In about 5 percent of cases, they find that there is a negative effect on male fertility in terms of lowering sperm count and lowering the motility or movement of the sperm. So yes, it has been shown that when men get infected with COVID, and in particularly more severe cases in this small percent, there can be an impact on their fertility. Whether this is a long-lasting effect is not known.

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In a bigger percentage of men, maybe about 20 percent or so, there has been noted to be a decrease in testosterone and an increase in hormones that the pituitary gland, a little gland that’s in your brain behind your eyeballs, secretes to make your testicles produce testosterone and sperm. If there’s something wrong with the testicles—if the testicles are injured, and they can’t make as much testosterone and sperm as they normally do—pituitary glands send out even more of that signal. So the fact that there were these men whose signals were higher and their testosterone was lower indicates that the testicles were being injured.

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On the other hand, it could be that guys who inherently have poor function in their testicles, who already have lower testosterone, are the ones more prone to get sicker from COVID. It’s a chicken-egg question: Did they have bad COVID because they had low testosterone, or did the COVID give them low testosterone? We don’t know. But it’s entirely possible that the COVID made them have low testosterone, because in autopsy studies of men who died from COVID, a small percentage of them had inflammation and injury in the testicles themselves.

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Does COVID have any particular effect on penises and erections?

If the testosterone is lower, then there could be a difficulty with erections, because erections rely on testosterone to have the tissue of the penis to be healthy and to allow blood flow. So, low testosterone can decrease the health of the penis and its ability to get erections. But, again, there’s no clear data on that with COVID.

There are men who are seeking care for erectile dysfunction and low testosterone because they had COVID, and it’s verifiable that that’s why they have it. That’s because a more common relationship between erectile dysfunction and COVID is likely to be anxiety and stress. COVID freaks people out psychologically, and it’s extremely stressful physically, too, and financially. Stress causes humans to release adrenaline to cope with it. And adrenaline in humans causes blood to rush to the heart and lungs and brain and liver to be able to cope with a physical attack, a physical stress. If the stress is just psychological, like financial or situational, the body still responds with adrenaline. Stress makes it harder to get an erection. If a guy has stress from COVID, or if he’s got stress because he lost his job, or lost a loved one—whatever it is, the adrenaline released in the moment that he’s stressed can make it hard to get an erection. And if a person is just chronically stressed out, their adrenaline releases higher at a chronic level and that, too, is going to decrease blood flow to the penis. The stress component of COVID is a lot more likely to be the cause of erectile dysfunction than coronavirus itself.

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What about the COVID vaccine—is there any evidence any of the COVID-19 vaccines can affect the penis or testicles?

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There is not. In fact, one study showed that sperm count went up temporarily after the vaccine. It did not go down. And so at the very least, you can say that the COVID vaccine does not harm fertility in men, and it actually, in fact, boosted the sperm counts a little bit after the vaccine.

There is no evidence of the vaccine causing any impairment to testosterone production or causing any inflammation or pain in the testicles or causing erectile dysfunction. Now, a person could get a transient flulike syndrome after the vaccine or after the booster, and they can feel really lousy for a day or two. And during that time, they may not be able to perform sexually very well because they feel lousy. It’s just because they’re having a strong immune response, and it’s just a temporary phenomenon. Now for some guys, they can develop performance anxiety around that short-lived episode. It’s not uncommon for a guy who has a normal sexual function to be off one night. And it may be because he’s under the weather and he will panic and think, “Oh my God, this never happened to me before. This is terrible. Something is wrong with me.” And the next time he goes to have sex, he’ll get the idea in his head. “Oh my God, what if that happens again?” And that thought causes his body to release adrenaline, which then decreases the flow of blood to the penis and makes him have a bad erection. And it becomes a vicious circle. A guy may think he has erectile dysfunction because of the shot when it’s really performance anxiety.

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Is it possible for one’s testicles to become swollen as an effect of the COVID vaccine?

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No. The COVID vaccine is not causing an infection in your body. The COVID vaccine is stimulating your antibodies against the COVID virus shell, but it is not stimulating your antibodies against your testicle tissue. It’s not mounting an immune response that then wants to attack the cells of the testicle. Whereas the COVID infection, in fact, can attack the cells of the testicle because that virus binds to those cells and then it can drop its viral load into the cells and then it reproduces and then it explodes itself. So no, the vaccine will not cause inflammation and swelling and pain of the testicles.

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What would cause a man’s testicles to become swollen in that kind of way?

The most common cause of painful swelling of the testicles is an infection. And in younger men, the most common types of infections are sexually transmitted infections, like chlamydia, for example. And in older men, the most common cause of infection would be something like E. coli from their own intestinal tract. That would be the most common cause of a painful sudden swelling of the testicles that would come out in a day or two. And these are treated with antibiotics.

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You know, the reason why I’m asking. It might sound random, but—

Nicki Minaj. Yeah, I saw the tweet.

Tucker Carlson on Fox News just read the whole tweet on his television program and said it “seems sensible.” What do you think was really going on?

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Who knows? But it is not due to the COVID vaccine.

Do your patients often ask about COVID and sexual performance in men?

I’ve gotten more questions about fertility than sexual performance. I think that there may have been news reports about these studies that did show decrease in sperm count, but I think it’s also a human concern. There’s this thing that does terrible things to you: There’s long-haul syndromes, strokes, lungs, sense of smell loss, and then, “What’s it going to do to my dick?”

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Have you been seeing any misinformation that you want to take this moment to dispel when it comes to how the COVID vaccine affects a man’s health?

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The best thing I can say is when male health has been studied in the context of the COVID vaccine, what’s been demonstrated is that sperm counts temporarily improve. Wow. And nothing else. No other health effects have been demonstrated. No negative health effects have been demonstrated. So, I mean, that’s pretty good!

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And then the other thing I would say is, if you’re going to go online for your health information, then go to reputable sources like PubMed, which has journal articles that are peer reviewed and can provide the best information. It may be difficult to understand what these articles are saying, but at the very least, you could then take these questions to a physician or go to the CDC. But don’t go to social media, celebrity sites, or the dark web or wherever else people are getting this terrible information.

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What would you suggest if someone like me is worried about their own body in this way? What’s the best practice to address it?

The best practice is to try to get information from a medical expert and not from social media or from friends and family. So, if you have the ability to make an appointment with a physician, ask your physician these questions, you’re likely to get the best possible answer. If you have access to a specialist, make an appointment or have a conversation with an infectious disease specialist or urologist, even better. But at the very least, have this conversation, ask these questions of a physician.

Just to be very clear, what is the greater risk for a man’s sexual health: getting the COVID vaccine or not getting it?

The greater risk is not getting the vaccine because it’s very hard to have good sex when you’re dead.

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